One of the problems I think that we encounter with leg lengthening is that orthopedic surgery in general is a very crude practice. I have never been in a leg lengthening procedure, but I have assisted in hip and knee replacements and similar principles and techniques apply.
Reaming out bone cavities and screwing bone fragments into rods feels far more like rough carpentry in the operating room than it does a precise science. And when we're talking about alignments of joints which can lead to early arthritis with only a mm or two off, there is a lot of room for very easy to make, very significant error.
Take the fixation of the distal femur/tibia relative to the proximal. Even a slight misalignment in any one axis (which can be induced even by the process of drilling in the screws) could cause chronic joint problems down the road. Bones are rigid, and once they heal in place, they will just grind on any points of unequal stress until arthritis develops.
It seems apparent based on the case reports of guys like Guichet/Paley that some doctors are very good at maintaining sufficient alignments that such issues do not become chronic problems at least for 10+ years post-op. Beyond then? Who knows.
But if you have seen a hip replacement or knee replacement by a good academic surgeon, you will understand that even the best orthopedic surgeons are not that "precise", and why there is such a variance in outcomes. It is just intrinsic to the nature of the crude "hack, slash, break, saw, and drill" kind of surgery that we are dealing with.
This is one of the reasons I have always been such a big fan of the external hexapods like Taylor Spatial or what KiloKAHN went with. They are the only way to go back AFTER the initial surgical cuts are made and progressively throughout the recovery period maintain and control axis in all three dimensions of space.
The Reverse Planning Method championed by Dr. Baumgart should in theory offer the same degree of control, but that degree of control is limited by the human element of trying to get all the screws and rods in exactly the right position during the first operation, which is really, really hard to do down to the mm. Any slight error may be potentially amplified by lengthening.
If I was an orthopedic surgeon, it is not a surgery I would be eager to provide cosmetically given the enormous range of possible outcomes even with best efforts and experience, and the unknown consequences of a slight misalignment 20 years from now. I think I would only want to do it with a TSF/hexapod, because that's the only way you truly have mm-level control over fixing the almost inevitable small misalignments that may occur during the first part of the procedure.
That said, as someone who wants to get LL, if I go ahead with it I will still probably go with an internal femur approach, because the benefits of speed are worth it. I would be sure I go with someone who has a good reputation and many years of experience. I would also want to make sure I select a doctor who has a measured and even, calm demeanor, rather than one that is prone to excessive emotionality or too eager to downplay risks.
It's too bad you've had a bad outcome Cooper. I'm glad you're getting it sorted out. It sounds like from what the other patient said here Dr. Monegal wanted to fix it but not until you were finished extending. This is as I said the reality of going with a non-hexapod device - if errors take place, it limits the ability to fix them straight off.
You probably made the right decision getting it fixed sooner than later. I don't know what happened to bluebarbie in the end, but I practically begged her to go get a TSF correction of her horrible monorail misalignment rather than just wait like her surgeon was telling her to. The longer you wait with misalignments, the more consolidation you get. It's true the callus is soft and can be "bent" manually during a refixation process, but this will to my understanding just be done roughly by hand. It won't have the precision of a true hexapod/TSF correction.
Good luck on getting better. I'm sure you'll bounce back.
How are you managing financially with this level of extended and unexpected disability? If you don't want to answer here, you can PM me. I'm mostly curious because my biggest impediment to LL outside of the alignment error fears is difficulty getting sufficient time off work and from having steady income.
Thanks for sharing your experiences with all of this. It's unfortunate you went through it, but it's valuable to everyone that you have shared it.
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Topic: Fitbone Stage Right Tibia Lenghtening (Dr. Monegal), Barcelona, Spain (Read 73114 times)