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[DanishViking]

So guys. Someone messages me private and revealed to me that the new "precice max" weight bearing nail, will properly first release in Europe in 4-5 years down the line according to nuvasive. For me that's not something I can tolerate waiting for. Now I know that people will tell me to just to go the US to get the surgery done, however my budget doesn't allow that, and I'm not sure I can enter the US.

So like I have written here before I will go with dr Giotikas since he is (in my opinion) the best value doctor compared to the price he offers internal lengthening nails for and the decades of experience he has. I'm not sure whether going with Precice 2.2. or Gnail is the right choice, so I have these questions.

1. Why do you think that one nail is better than the other?

2. People who know someone or have done their lengthening trough betzbone or Gnail (they're very similiar), do you/they regret your/their decision and why?

3. Am I wrong for believing that Gnail would be the better choice since you recover about 1-2 months quicker, and it would be almost impossible to fly home with a non weight bearing nail?

4. is the lengthening mechanism for Gnail almost impossible to use?

5. How often does the biggest Precice 2.2. nail break, any studies done for femurs or personal experience?

[GrowGrow123]

1) Precice is more advanced than G-Nail or Betzbone. Paley favors Precice. That should say all that needs to be said here.
2) Don't know.
3) If you really, really need to be able to walk upright sooner than later (like because of work commitments), then, no, you are not wrong.
4) No idea.
5) No idea. The lighter you are, the less likely this is to happen.

How much are you looking to lengthen? Anecdotally, my impression is that people have a difficult time lengthening the max amount on Betzbone / G-Nail compared to Precice. People tend to stop lengthening early more often because of the pain and difficulty. On the other hand, everyone that wants to get the full amount on Precice (8cm on femurs or 6 cm on tibias) seems to always get it. I did Precice and can say that lengthening on it is pretty effortless / painless.

If full weight bearing is important to you and you're okay with the possibility of getting 6 instead of 8 cm in lengthening, then the G-Nail / Betzbone is probably the way to go.

[Kaladin]

can you tell me a little more about your experience with precise?
how long did you use crutches for? do you think I'll be able to stand behind a desk with crutches and work about 1 month after surgery (during lengthening)?

and how long did it take for you to walk without crutches

[Stretcher]

can you tell me a little more about your experience with precise?
how long did you use crutches for? do you think I'll be able to stand behind a desk with crutches and work about 1 month after surgery (during lengthening)?

and how long did it take for you to walk without crutches

I had my femurs done last year with Paley and the Precise nail.  I had no real issues throughout the lengthening process. I was told by the therapists that there were pros and cons to the weight bearing nail that they noticed. The biggest in favor for the Precise being that those with the Precise nail were able to “normalize” their walking (when cleared to weight bear fully) faster than those with the Stryde.

How long do you plan on standing with the crutches? If it’s for 15-20 min intervals then maybe do able.

Once I was cleared to weight bear I was walking without the crutches in about 1 week. I probably could have done it faster but I was nervous. Was it a perfect walk? No, but I didn’t need crutches.

[DanishViking]

The only benefit I see from doing Gnail is weightbearing. But my biggest concern with Precice 2.2. is that it's going to break inside of me. I have heard tho that it barely breaks unless you abuse the nail by walking around or only standing on one foot like 20 times. What is your experience with the precice, are you lightweight and did it break or did you see many patients having replacements?

[GrowGrow123]

can you tell me a little more about your experience with precise?
how long did you use crutches for? do you think I'll be able to stand behind a desk with crutches and work about 1 month after surgery (during lengthening)?

and how long did it take for you to walk without crutches

I never used crutches. I went from wheelchair to walking in 4 months. I tried to use the walker for short distances every day just as exercise and to promote blood circulation to the legs. I don’t think it would have been easy to stand behind a desk after just one month.

[GrowGrow123]

What is your experience with the precice, are you lightweight and did it break or did you see many patients having replacements?

I was 180 pounds on the day of surgery. I am 173 pounds now a little over 4 months later. Mine didn’t break or have issues but I mostly used a wheelchair. I only used the walker as exercise and help consolidate throughout the day. Made sure to use my arms to support most of the weight since I’m over the limit the nails can bear.

I just got cleared to be fully weight bearing last week. Was able to immediately start walking like a penguin and skipped the crutches entirely

[DanishViking]

How much did you lengthen?

[GrowGrow123]

8cm on femurs. My recovery was very fast though. Doctor said 6 months is typically when people go full weight bearing on Precice when doing that much lengthening.

[DanishViking]

Do you believe I with a starting height of about 166 cm would be able to walk decently at 5 months in, doing like 7 cm femurs precice and travelling home without assistance or crutches throughout the airport going home to main country without issues?

Also did you do anthing to speed up the recovery process?

[GrowGrow123]

Do you believe I with a starting height of about 166 cm would be able to walk decently at 5 months in, doing like 7 cm femurs precice and travelling home without assistance or crutches throughout the airport going home to main country without issues?

Also did you do anthing to speed up the recovery process?

It's possible, but I wouldn't plan on it just to be on the safe side. The worst case scenario here is you have to go through the airport in a wheelchair. You get to skip the line and are first to board the aircraft.

I didn't do anything to speed up the process. I actually had to do things to slow down the process lol. I had early consolidation problems throughout the lengthening process because the bone was regenerating too quickly, but was able to get to 8cm before it did. Was doing like 2mm a day on the right leg by the end of it in order to beat it.

[Tehn84]

I did gnail, with Giotikas too as it happens. Don't regret it, glad I chose it over precise.

You'll find in Athens the majority (around an 80/20 split) are using gnail. The precise users tend to be Americans who are extremely concerned about muh FDA approval.

1+2) I wouldn't however really say one was better than the other and the majority of people got the results they wanted no matter the nail they were using. Precise makes going to physio harder work as you will need to use your wheelchair and walker to get in the taxi, whereas gnail patients can ditch the wheelchair very early on and eventually just use crutches. You won't be having a massive social life whatever the nail used, I didn't really see many gnail patients going sightseeeing or socialising and neither did I - in theory in might be possible but in reality I (and seemingly everyone else) was just too tired to do it, and 'full weight bearing' doesn't mean you won't get drained of your energy quickly when out walking. All I saw anyone manage was going to a restaurant for lunch, and even that was rare, most people were strictly staying home and ordering food in and only really went out when it was time to go to physio.

3) Yes flying home would certainly be easier with the weight bearing nail, although it's not like Precise patients couldn't fly home either. You just have to arrange an airport transfer with a taxi who will carry your bags for you, get a trolley at the airport etc - it's doable. Gnail patients were up and walking quicker and back to 'normal life' faster, that's true.

4) It can be difficult and painful at the start, almost everyone finds it gets easier with time. For some people it's easy right from day 1. I never met any patient in Athens who had to stop lengthening early because of this, although for sure at the start it's challenging and time consuming whereas Precise is easy.

5) Nail bending (not breaking) was a significant issue, but it wasn't limited to Precise or Gnail alone. There was a not insignificant minority of people who bent their nails, so you have to be careful no matter what you choose (and even then it's possible just to be unlucky).

[GrowGrow123]

I did gnail, with Giotikas too as it happens. Don't regret it, glad I chose it over precise.

You'll find in Athens the majority (around an 80/20 split) are using gnail. The precise users tend to be Americans who are extremely concerned about muh FDA approval.

From the Godfather of limb lengthening surgery himself:

“He sought a fully implantable lengthening solution. When the Albizzia femoral nail, developed by Guichet and Grammont, became available, he worked with the French company that made that nail to develop a tibial lengthening Albizzia for stature lengthening. He started using the femoral and tibial Albizzia in 1996.
The severe pain experienced by patients from the 15° rotation of the thigh through the break in the bone, as well as several implant failures, lead him to stop using this non-FDA approved device. This device is still being used in Europe under the name Guichet nail and Betz-Bone. While they have modified this nail to a small extent, it is still the original Albizzia nail that Dr. Paley abandoned in the 1990's. There are much better devices now and the use of this older nail should be abandoned.”

G-Nail isn't terrible and it's safe enough, imo, but it's not the latest or greatest piece of technology for limb lengthening out there.

[GrowGrow123]

Here's also Dr. Birkholtz view on G-Nail on the latest episode of the Cyborg4Life videos:

[Tehn84]

From the Godfather of limb lengthening surgery himself:

“He sought a fully implantable lengthening solution. When the Albizzia femoral nail, developed by Guichet and Grammont, became available, he worked with the French company that made that nail to develop a tibial lengthening Albizzia for stature lengthening. He started using the femoral and tibial Albizzia in 1996.
The severe pain experienced by patients from the 15° rotation of the thigh through the break in the bone, as well as several implant failures, lead him to stop using this non-FDA approved device. This device is still being used in Europe under the name Guichet nail and Betz-Bone. While they have modified this nail to a small extent, it is still the original Albizzia nail that Dr. Paley abandoned in the 1990's. There are much better devices now and the use of this older nail should be abandoned.”

G-Nail isn't terrible and it's safe enough, imo, but it's not the latest or greatest piece of technology for limb lengthening out there.

The thing is Paley is speaking from a doctors perspective not a patients. Maybe precise is "safer", that doesn't neccesrily mean better. You have to balance safety against convenience and obviously its a lot more convenient to have weightbearing. Paley doesn't give a damn if your life sucks while you're lengthening, or if you don't hit your goal because of this, if you got 3cm lengthened and then had a full recovery he'd consider that a good outcome.

"Severe" pain is pushing it a bit and I never saw anyone who had to quit early because of pain. Its true Precise has an easier lengthening method but its harder to do basic things like go to the bathroom, get in a taxi, go to a restaurant and of course it's a longer recovery period. Pick your poison, both have pluses and minuses and only the most blinkered can't accept that.

If it matters, gnail can also lengthen up to 10cm, whereas Precise is maxed at 8cm. Yeah yeah, Paley says 8cm maximum but its not like no one ever recovered who went above 8cm, he only says 8 because its a lower risk option and so better from the doctors perspective.

[otaviognu]

How many cm you did? what were your previous height?

[Tehn84]

How many cm you did? what were your previous height?

I did 8.5cm, started at 170cm.