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[Franz]

thanks for your repsonse dr. franz,

so your saying if anyone does 8cm on their femurs they WILL get knee pain and arthritis in the future?

No, they will get a change in alignment. This may lead to knee pain and arthritis. It is very individual, but we cannot really predict who will and who wont.

[Dingo]

No, they will get a change in alignment. This may lead to knee pain and arthritis. It is very individual, but we cannot really predict who will and who wont.

Could this misalignment be corrected through a subsequent tibial LL with axis correction, on a later date after the femur LL?

[shawty]

Hi Dr. B,

Does have muscular legs affect the lengthening process.  For example is having muscular calves bad for tibia lengthening and strong muscles in the upper leg bad for femur lengthening.  Not sure if others might know the answer to this.

[theuprising]

Hi Dr. B,

Does have muscular legs affect the lengthening process.  For example is having muscular calves bad for tibia lengthening and strong muscles in the upper leg bad for femur lengthening.  Not sure if others might know the answer to this.

Hey shawty this question was answered somewhere in the general limb lengthening section a while back I'm sure you'll be able to find it. The answer was along the lines of Pilates is an ideal exercise for those doing LL to give you an idea of the degree of muscularity and flexibility that is good for LL.

One thing I've noticed with people who want big distances like 9-10 cm is that their doctor doesn't seek to stop them going for it. Some even encourage them to go at least 7 cm.

Would you stop a patient from lengthening any further than 5-6 cm or let them continue at their own risk?

[shawty]

Hey shawty this question was answered somewhere in the general limb lengthening section a while back I'm sure you'll be able to find it. The answer was along the lines of Pilates is an ideal exercise for those doing LL to give you an idea of the degree of muscularity and flexibility that is good for LL.

One thing I've noticed with people who want big distances like 9-10 cm is that their doctor doesn't seek to stop them going for it. Some even encourage them to go at least 7 cm.

Would you stop a patient from lengthening any further than 5-6 cm or let them continue at their own risk?

Thank you brother.  I'll search there.

[TRS]

Hi Dr. B,

Does have muscular legs affect the lengthening process.  For example is having muscular calves bad for tibia lengthening and strong muscles in the upper leg bad for femur lengthening.  Not sure if others might know the answer to this.

Hey Shawty,

This was addressed here http://www.limblengtheningforum.com/index.php?topic=347.0

[alps]

Can someone please give me Dr. Franz's email id? The one in the first post doesn't work.

[mediocre]

This worked for me.

reception(at)walkamile.co.za

His secretary will reply back. If you want his personal email, maybe you can ask her.

Can someone please give me Dr. Franz's email id? The one in the first post doesn't work.

[shawty]

Dr. B,

Do you lengthen femurs by any external methods?

[shawty]

I was looking at short term rentals in the Pretoria area,  and they are pretty cheap. I saw many 3 bedroom townhmhomes for under 1000 USD. If 3 people split the unit..it shouldn't cost more than 800 a month living expenses during lengthening/consolidation.

[Franz]

Could this misalignment be corrected through a subsequent tibial LL with axis correction, on a later date after the femur LL?

We could readjust the mechanical axis by adjusting the tibia, but that will mean your joint is at a slight angle.

[Franz]

Can someone please give me Dr. Franz's email id? The one in the first post doesn't work.

You can try:
fbirkholtz@gmail.com

franz.birkholtz@walkamile.co.za

[Franz]

Dr. B,

Do you lengthen femurs by any external methods?

Not advised due to lengthy times in frame and also knee stiffness.

[amatan]

Such a pity this doctor doesn't do cosmetic lengthening for patients over 165cm.  He is responsive and conservative with regards to length.  If he didn't have that requirement I would book tibia surgery with the precice asap.

[Franz]

The cutoff of 165 is a general rule. There may be exceptional circumstances where this rule can be relaxed. This is best discussed on a one-to-one basis.

[amatan]

I was 171cm and am recovering from femur surgery and am now 176.5 cm.  I don't have any exceptional circumstances other than wanting all the benefits that come with being average height and up and am far over the cutoff, so I doubt I would be a candidate. 

What sort of circumstances would constitute being exceptional?

[Franz]

I was 171cm and am recovering from femur surgery and am now 176.5 cm.  I don't have any exceptional circumstances other than wanting all the benefits that come with being average height and up and am far over the cutoff, so I doubt I would be a candidate. 

What sort of circumstances would constitute being exceptional?

The most important thing is that the patient should understand what theyre letting themselves into. For this reason I think you may qualify.

[Cooper]

What is the minimum stay will you require to stay for femur. Most of us are working professional and will be impossible to take off 75-90 days. Is it possible to return home after 30 days and lengthen rest at home?

[Franz]

What is the minimum stay will you require to stay for femur. Most of us are working professional and will be impossible to take off 75-90 days. Is it possible to return home after 30 days and lengthen rest at home?

Good question. It would be cheaper and easier to spend only 4-6 weeks, BUT you would lose out on the meticulous monitoring and daily physio by an experienced team. The problem is if things start going pear shaped, you would want to be close to the doctor who performed the op.
The calculation is as follows: 2 days pre-op. 5 days in hospital. 5-7 days before distraction. Ie 14 days until distraction starts. Then at least another 3-4 weeks to establish a physio routine and also pass through the biggest risk phase for thrombosis. So reluctantly, a minimum of 6 weeks. Provided you can get Ellipse to lend you an ERC unit to perform adjustments. You will also need to send me pictures of your range of motion hip knee and ankle weekly. You will need to send me xrays every two weeks.
So in theory it is possible although not advised.

[thetallerman]

I was 171cm and am recovering from femur surgery and am now 176.5 cm.  I don't have any exceptional circumstances other than wanting all the benefits that come with being average height and up and am far over the cutoff, so I doubt I would be a candidate. 

What sort of circumstances would constitute being exceptional?

176.5cm / 5'9.5 is exactly average in the US for all males. Are you in a different country?

[KiloKAHN]

Man, I'm trying to get from just about 165 to 170. 176 would be my goal after a second if I get through my first successfully.

[theuprising]

Dr B would you stop a patient from lengthening any further than 5-6 cm or let them continue at their own risk?
Assuming they don't have any problems during the lengthening period.

[Cooper]

You will need to send me xrays every two weeks.
So in theory it is possible although not advised.

Dr. Franz,
You are awesome doctor. It will be my stupidity not to be your CLL patient. Can you please check on ERC device? I think it will be OK because patient in US are allowed to take it home.

It appears I might be your first patient unless someone beats me . I am looking forward to come in end of May.

Cheers!!!

[Franz]

Dr B would you stop a patient from lengthening any further than 5-6 cm or let them continue at their own risk?
Assuming they don't have any problems during the lengthening period.

In my mind there is no such thing as patients own risk. In terms of safety, it is my responsibility to make the decisions, as I am the professional in this case. Sorry if this sounds paternalistic, but I need to sleep at night!
Having said this, if we reach 5cm and everything seems good, we may together decide to continue. Do not bargain on this, though.

[Franz]

Dr. Franz,
You are awesome doctor. It will be my stupidity not to be your CLL patient. Can you please check on ERC device? I think it will be OK because patient in US are allowed to take it home.

It appears I might be your first patient unless someone beats me . I am looking forward to come in end of May.

Cheers!!!

I am teaching in Dallas end of may, but can slot you in as from first week june. Please confirm by email. I do not want to schedule official appointments via open forums.

[Cooper]

I am teaching in Dallas end of may, but can slot you in as from first week june. Please confirm by email. I do not want to schedule official appointments via open forums.

Yes Sir. Email already sent.

[shawty]

I am teaching in Dallas end of may, but can slot you in as from first week june. Please confirm by email. I do not want to schedule official appointments via open forums.

You're coming to Dallas?! That's awesome! I live there

[KiloKAHN]

So you guys know, Dr Birkholtz's contact e-mails and website have been updated on the first post of this thread.

[Dingo]

The ratio is normally 0.8, ie tibia 80% of the length of the femur give or take.

So ideally, if one is able to do 2 LLs, one should aim to lengthen tibiae around 80% of the amount lengthened previously in the femurs to maintain the bio-mechanical ratio.

For example:

Femur: original length 40cm + 6cm of lengthening = 46cm final femur length

Tibia: original length 32cm + 4.8cm of lengthening = 36.8cm final tibia length

Original ratio: 32 / 40 = 80%

Increase ratio: 4.8 / 6 = 80%

Final ratio: 36.8 / 46 = 80%

[Polycrates.]

So ideally, if one is able to do 2 LLs, one should aim to lengthen tibiae around 80% of the amount lengthened previously in the femurs to maintain the bio-mechanical ratio.

For example:

Femur: original length 40cm + 6cm of lengthening = 46cm final femur length

Tibia: original length 32cm + 4.8cm of lengthening = 36.8cm final tibia length

Original ratio: 32 / 40 = 80%

Increase ratio: 4.8 / 6 = 80%

Final ratio: 36.8 / 46 = 80%

No. That would increase the ratio further. You can lengthen both equally and the ratio will be maintained.

[Dingo]

No. That would increase the ratio further. You can lengthen both equally and the ratio will be maintained.

You're wrong.

If your original dimensions are: tibia = 32cm and femur = 40cm >>> Tibia to femur ratio = 32/40 = 80%

If you increase the same amount, say 6cm on both tibia and femur you get >>> Tibia to femur ratio = (32+6)/(40+6) = 38/46 = 82,6%

To maintain the original ratio you have to increase the segments in proportion to the original ratio. This is basic math...