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[Muse]

Note: please refer to our disclaimer about The Doctors Directory http://www.limblengtheningforum.com/index.php?topic=55.0

Updated Response from Dr Franz Birkholtz

:  We do perform cosmetic lengthenings in highly selective cases and LON is one of the techniques we employ. 5cm can be achieved in the tibias in a single procedure, but it is important to note that this is risky surgery and that one can end up with bilateral amputations as a result.

Our rough selection criteria of 165 cm in males as the upper limit. There are cases where, after thorough evaluation, it may be appropriate to perform CLL. This should not be seen as the norm and is definitely not a topic for open discussion.

Methods and Cost of Treatment

Externals (new frames): $30,000 USD approx.
LON/LATN:                   $35,000 USD approx.
Internals (PRECICE):      $52,000 USD approx.

*Dr Birkholtz's lengthening limit is 5 cm for tibias and 6 cm for femurs.

Cost Includes

- All professional fees for surgeon, anesthetist, physio, psychologist, occupational therapist.
- High care unit for 1 day.
- Normal hospital ward for 5 days.
- All followup visits, erc sessions and woundcare visits.
- Daily physio for 75 days.
- Doctor contact at least twice a week.
- Support by a multi disciplinary team experienced in limb reconstruction.
- Accommodation in a four star rated guesthouse close to hospital on a dinner bed and breakfast basis.
- Includes wifi and satellite tv. Also includes daily transfer to clinic for adjustments.
- The accommodation is for two people. This is a self catering unit.

Our lists are generally booked a couple of weeks in advance, but provided I am not on congress or holiday, we can accommodate most of the year.

Cost Excludes

- Cost excludes potential complications.

Consultation Process

Reference: http://www.limblengtheningforum.com/index.php?topic=137.msg5302#msg5302

Background

From his website: Dr Franz Birkholtz studied at the University of Pretoria and currently teaches courses in South Africa and abroad. He is practicing in Centurion with rooms in Lifestyle Management Park next to Unitas Hospital.

As of June, 2012 now does limb reconstruction operations bi-monthly at Vincent Pallotti Hospital in Cape Town. Contact the Cape Orthopaedic Trauma Group (Dr Bernstein) on 021 506 5555 to schedule an appointment.

Practice Number: 0280000226599

Contact Details

Dr Franz F Birkholtz
Orthopaedic Surgeon (MBChB(Pret) MMed(Orth)(Pret) FCOrth(SA))

Telephone: +27(0)12 644 2641
Fax: +27(0)12 644 2642
Website Url: www.walkamile.co.za
Email: reception@walkamile.co.za
Personal email: franz.birkholtz@walkamile.co.za


Postal address:
PO Box 11328
Centurion,
0046
Republic of South Africa

Practice address:
Suite 8C
Lifestyle Management Building
Unit 4
223 Clifton Ave
Lyttelton
Pretoria
South Africa

[An_Apple_A_Day]

Africa?!

I am simply not that brave.

[army85]

Why this doctor mentioned the risk of losing the limb? i've never read something like this related with LL... it sounds a bit disquieting!

[Sweden]

Why this doctor mentioned the risk of losing the limb? i've never read something like this related with LL... it sounds a bit disquieting!

Bc it's Africa. Nobody has any idea of what they're doing.

What sane person goes to Africa?

[An_Apple_A_Day]

Bc it's Africa. Nobody has any idea of what they're doing.

What sane person goes to Africa?

Haha, Jesus Christ.  I'd rather do LL myself than go Africa, maybe that's prejudice, I dunno.  But my balls are not that big no matter how cheap, when you also factor in the fact that it is more expensive than lots more options I literally could see no reason to go there, ever.

It is a scary, scary country.

That said I bet there are people in Somalia who would do the surgery for <$100.  Good luck surviving a week post op though.

[KiloKAHN]

Why this doctor mentioned the risk of losing the limb? i've never read something like this related with LL... it sounds a bit disquieting!

Some doctors like to give you the worst case scenario just to see if you're really sure you want to go through with the procedure, and are more conservative than other docs (as you see Dr. Birkholtz doesn't perform cosmetic lengthening on males over a certain height).

Also South Africa isn't even close to Somalia in terms of danger levels. It's one of the safer regions of Africa, but of course people there for tourism would want to take precautions that you wouldn't have to in other countries.  Still, not really fair to knock a doctor purely based on practice location, considering there are doctors in more developed countries that have shady business practices and manage to cripple people.

[LLL]

Yeah, South Africa is one of the more developed countries in Africa if I'm not mistaken, and it's a HUGE continent. Of course, I would never go there myself for something like this. But judging it straight away simply because of the continent it's on is a bit like saying you shouldn't do LL in China or South Korea because it's on the same continent as and right next to North Korea

[An_Apple_A_Day]

I dunno guys Africa is pretty lethal in all areas.

It took me a while to come around tot he idea of China and India, but Africa is whole next level.

[Sweden]

All of the countries in Africa are a total mess, even South Africa.

[FrankGarrett]

My local G.P. hires white doctors from South Africa. I've met 3 of them so far and I always confuse them for being German or Dutch because they have these Australianised Dutch or German accents. Seem like nice people, though, whether the doctor was white or black, I still wouldn't travel to South Africa for surgery.

South Africa is rife with crime, I remember looking at a video of a black guy doing a carjacking and it was like a scene Grand Theft Auto because it happened in the middle of traffic. Apparently, carjackings are very common down there.

[Franz]

Dear Friends,
As I am the doctor in question, I feel compelled to reply. Yes, Africa. South Africa is very different from your perceptions and I would challenge you to explore the country as a tourist before making general assumptions. The health system I work in and the unit I run is world renowned and I regularly (8 times per year) host surgeons from across the globe. During these weeks I teach the surgeons limb lengthening and reconstruction techniques. This includes surgeons from the US, UK, Sweden, UAE etc etc. Not really darkest Africa at all.
With regards to the lengthening itself, I stand by my comment that as a worst case scenario you could end up with an amputation and I would challenge you to discuss this with your chosen surgeon. This is how serious a decision cosmetic lengthening can be. Reasons for serious complications can vary, but may include injuring blood vessels, nonunions, infection etc. These complications happen anywhere, not only in Africa!
Although we perform lengthenings for malunions, congenital conditions and bone defects on almost every theatre list we do, and have vast experience in these techniques, we really do not perform cosmetic lengthenings anymore, and I would advise you to look elsewhere, but CHOOSE YOUR SURGEON CAREFULLY. Price should be the least of your concerns. Look for a doctor who communicates well and is happy to discuss potential complications with you...this is not a walk in the park.
Anyway, good luck in your search. Make sure that the extra inches will make you happy before you embark on your journey.
Best regards,
Franz Birkholtz

[BilateralDamage]

Dear Friends,
As I am the doctor in question, I feel compelled to reply. Yes, Africa. South Africa is very different from your perceptions and I would challenge you to explore the country as a tourist before making general assumptions. The health system I work in and the unit I run is world renowned and I regularly (8 times per year) host surgeons from across the globe. During these weeks I teach the surgeons limb lengthening and reconstruction techniques. This includes surgeons from the US, UK, Sweden, UAE etc etc. Not really darkest Africa at all.
With regards to the lengthening itself, I stand by my comment that as a worst case scenario you could end up with an amputation and I would challenge you to discuss this with your chosen surgeon. This is how serious a decision cosmetic lengthening can be. Reasons for serious complications can vary, but may include injuring blood vessels, nonunions, infection etc. These complications happen anywhere, not only in Africa!
Although we perform lengthenings for malunions, congenital conditions and bone defects on almost every theatre list we do, and have vast experience in these techniques, we really do not perform cosmetic lengthenings anymore, and I would advise you to look elsewhere, but CHOOSE YOUR SURGEON CAREFULLY. Price should be the least of your concerns. Look for a doctor who communicates well and is happy to discuss potential complications with you...this is not a walk in the park.
Anyway, good luck in your search. Make sure that the extra inches will make you happy before you embark on your journey.
Best regards,
Franz Birkholtz

Doctor Franz,

Your reply is extremely appreciated!  Please continue to post on this forums as I would love to hear more about your experiences, successes and failures as a surgeon in CLL.

Also, allow me to apologize on the behalf of the other posters in this thread.  They are incredibly uncultured and know nothing about Africa besides what the media in their home countries tell them.  I would be honored to get surgery done with you since you sound very knowledgeable and wise in this craft (it is an extremely dangerous procedure to do, which no doctor should sugarcoat).

Are you still doing CLL?  Do you have any interest in using PRECICE?  What about accommodations in your hospital?

Thank you!!

[ChrisIsaak]

I don't agree with most of you guys. South Africa is a developed country. I do think it would be a better option than India.

[KiloKAHN]

Dear Friends,
As I am the doctor in question, I feel compelled to reply. Yes, Africa. South Africa is very different from your perceptions and I would challenge you to explore the country as a tourist before making general assumptions. The health system I work in and the unit I run is world renowned and I regularly (8 times per year) host surgeons from across the globe. During these weeks I teach the surgeons limb lengthening and reconstruction techniques. This includes surgeons from the US, UK, Sweden, UAE etc etc. Not really darkest Africa at all.
With regards to the lengthening itself, I stand by my comment that as a worst case scenario you could end up with an amputation and I would challenge you to discuss this with your chosen surgeon. This is how serious a decision cosmetic lengthening can be. Reasons for serious complications can vary, but may include injuring blood vessels, nonunions, infection etc. These complications happen anywhere, not only in Africa!
Although we perform lengthenings for malunions, congenital conditions and bone defects on almost every theatre list we do, and have vast experience in these techniques, we really do not perform cosmetic lengthenings anymore, and I would advise you to look elsewhere, but CHOOSE YOUR SURGEON CAREFULLY. Price should be the least of your concerns. Look for a doctor who communicates well and is happy to discuss potential complications with you...this is not a walk in the park.
Anyway, good luck in your search. Make sure that the extra inches will make you happy before you embark on your journey.
Best regards,
Franz Birkholtz

Hello Dr. Birkholtz,

Thank you for your reply. It would certainly be to everyone's benefit if more doctors really emphasized what to expect in a worst-case scenario with limb lengthening. I've spoken to a number of orthopedic surgeons in my various inquires and whenever one tells me that complications are minimal or that the worst to expect is a pin-site infection here and there, I automatically scratch the doctor off my list. I guess I just think that if they give you sunny expectations, then they might not address a potentially serious problem that could happen later down the line. I've never heard any accounts of people getting their legs amputated, but then again my only other resource for years had been that site old forum  and it's known to sugarcoat and even hide serious complications that patients may receive. Now that that's a real possibility, it gives people a lot more to think about.

May I ask why cosmetic lengthening is something that you aren't fond of doing? Is it that you think it's too much risk for someone with perfectly healthy legs?

[Metanoia]

Dr. Birkholtz is an honest man and a good doctor as can be seen from his posting. Yes indeed, cosmetic LL is too dangerous to be recommended. It should be only done as a last resort when you are totally unhappy with your life, not just as a luxury.

[Franz]

Dear Kilokahn,

I think the debate around CLL goes wider. I suppose it has to do with cosmetic surgery in general. The reality is surgery is invasive and never perfectly safe. Up till recently we have not really had devices that were reliable, reproducible and predictable for femoral lengthening. Now with Precice we have that. In addition, the desired length is important. Anything beyond 4-5cm per segment becomes really problematic in terms of complication rates. Realistically the cost is almost prohibitive to go through a 4 segment lengthening, which means most patients end up with 5 cm either femoral or tibial. With this in mind, we have to ask whether the patient will really be happy with gaining 5 cm.
Having said all this, I realise very well that there are individuals who benefit greatly (physically and psychologically) from CLL, and it is this select group that I believe are the ideal patients.
As you can see this leaves us with a small group of patients who can a) afford it and b) be happy with it c) are healthy enough and d) are appropriate candidates (2 standard deviations shorter than the population average).
Once we've met all these criteria, there are few patients left.
From a doctor's perspective there are really 3 issues: patient safety, medicolegal risk and lastly a potential increased arthritis risk after CLL.

Hope this all makes sense?

Btw, Ballpark figure for CLL using bilateral Precice in our unit would be around 40 000 Euro. Tibial lengthening can be done with frames and would be a little less.

Rgds,

F

[BilateralDamage]

Thank you Doctor.  Could you let me know the best way to reach your office? I have many more questions and am very interested in having CLL done with you.

[Franz]

You are welcome to phone the office at +27(0)126442641 and speak to Madelein. They will probably tell you we do not perform CLL's though. :-).

If you wish you can mail me your questions, then I'll endeavour to answer them as quickly as possible.

You can reach me at franz.birkholtz@walkamile.co.za

[Adriano]

I thnk the pricing is a bit too much for LL in south Africa.

At these prices i would rather go to china where they have done a thousand times more LL surgeries and benefit from all that experience that they have over there.

I thought South african prices would be slightly higher than those in India but not what i see quoted here.

[Dingo]

Dear Dr Franz, thanks for joining our forum and answering our questions.

After reading many of the posts here, I can see that people don't really know a lot about South Africa and it's nice to have someone enlightening us.

When you gave us the round figure of 40k euros for femoral lengthening with the Precice, what would that include exactly? Just the surgery and a few days at the hospital? Or would it include everything (accomodation at a safe location, food, medications, physio, etc)?

If it includes all that I've mentioned above, then the 40k euros are not really that steep. If not, then it's very expensive. (one can get internal femurs in South Korea with ISKD for 35k euros with everything included)

I'd also like to emphasive the need to guarantee patients' safety, since from what I've been told by an Afrikaner who emigrated to my country and from what one can read about in praag.org, Pretoria isn't exactly the same as a small town in Switzerland.

[KiloKAHN]

Dear Kilokahn,

I think the debate around CLL goes wider. I suppose it has to do with cosmetic surgery in general. The reality is surgery is invasive and never perfectly safe. Up till recently we have not really had devices that were reliable, reproducible and predictable for femoral lengthening. Now with Precice we have that. In addition, the desired length is important. Anything beyond 4-5cm per segment becomes really problematic in terms of complication rates. Realistically the cost is almost prohibitive to go through a 4 segment lengthening, which means most patients end up with 5 cm either femoral or tibial. With this in mind, we have to ask whether the patient will really be happy with gaining 5 cm.
Having said all this, I realise very well that there are individuals who benefit greatly (physically and psychologically) from CLL, and it is this select group that I believe are the ideal patients.
As you can see this leaves us with a small group of patients who can a) afford it and b) be happy with it c) are healthy enough and d) are appropriate candidates (2 standard deviations shorter than the population average).
Once we've met all these criteria, there are few patients left.
From a doctor's perspective there are really 3 issues: patient safety, medicolegal risk and lastly a potential increased arthritis risk after CLL.

Hope this all makes sense?

Btw, Ballpark figure for CLL using bilateral Precice in our unit would be around 40 000 Euro. Tibial lengthening can be done with frames and would be a little less.

Rgds,

F

I understand where you're coming from and that does make a lot of sense. Thanks a lot for your response Dr. Birkholtz.

If it includes all that I've mentioned above, then the 40k euros are not really that steep. If not, then it's very expensive. (one can get internal femurs in South Korea with ISKD for 35k euros with everything included)

Can't really compare ISKD with PRECICE. Sure you can get ISKD cheaper for the initial price, but the ISKD is known throughout to have a very high rate of mechanical failure compared to other internal methods. Not only that, but it's hard to control the distraction rate and that can lead to difficulty in trying to prevent premature consolidation or when trying to slow lengthening in the possibility of non-union. If that happens, you can only guarantee that the ISKD stops lengthening by getting an additional surgery that puts an external fixator around the nail. When thinking of all those potential complications, you'd likely end up paying a whole lot more for ISKD than you would for PRECICE - not only in terms of money, but also in terms of recovery time.

[Franz]

Hi,

South Africa is not as safe as Switzerland. Very few places are.
Remember that emigrants often paint a more negative picture of a country.
Nobody can guarantee anyone's safety anymore (Twin Towers, North Korea, Syria, Boston Marathon, Phillipine Hurricane). However, our patients are safe. Remember I raise my kids here!
The quoted BALLPARK figure includes:
Bilateral femoral lengthenings with Precice by experienced surgeons
Access to and use of our multi disciplinary team comprising psychology, physiotherapry, occupational therapy,orthotics, specialized nursing etc.
Hospitalization in a private room. 1 day high care and 5 days general ward.
All professional fees.
Guesthouse accommodation with three meals per day. (Safe)
Daily visits with nursing team to perform adjustments.
Xrays throughout.
A top notch mutlidisciplinary team.

Should tibial LONs be performed, the price will drop to approximately 25K euro.

As you can see, the single largest element in the cost (approx 25K) is the price of Precice nails.

Hope this helps?

[Medium Drink Of Water]

That sounds like a really good deal.  If I hadn't already done LL I'd certainly consider going to you.  South Africa isn't US/Canada/Japan/Western Europe, but it's certainly cleaner and nicer than the 3rd world countries that charge only slightly less for LL.

Is the air there breathable? Because if it is, it sure beats New Delhi or Beijing.  I was lucky enough to have gone in 2007 when they were restricting factories and cars to clean up the air for the Olympics, but when I went back afterward for IM nail removal in late 2008 the air made me sick.

[Dingo]

Can't really compare ISKD with PRECICE.

Yes, the ISKD sucks compared with the Precice. I've written about all those things you mentioned in another thread.

Sure you can get ISKD cheaper for the initial price, ...

This is incorrect. A friend of mine from southern Brazil (actually a distant relative) has lengthened 1 tibia with an ISKD nail, because of an accident. The costs were covered by her health insurance and she saw the break up of all the costs given by the hospital to the insurance company. The ISKD nail was marked as having a price of 34,000 BRL which is around 15k USD.

Dr Paley has confirmed that the price of 1 Precice nail is 13k USD, so basically around the same as the ISKD.

There's no reason for the costs for Precice to be higher than those for ISKD. Actually, because of the potential complications with the ISKD we all know about, the costs for Precice should actually be lower!

[BilateralDamage]

Doctor Birkholtz,

Thanks for all your answers here; I sent you a lengthy email, please let me know if you received it. I'm very serious about doing LL with you.

[An_Apple_A_Day]

Something I want to know as well!  I know Dr. Donghoon Lee prefers LATN according to this post by Walk6 in his diary: "it offers a much quicker recovery time post-frame removal. He informed me that while the frames would stay on for a bit longer during LATN than LON, because there is no nail implanted during the actual lengthening and fixation process, the bone would be much stronger after the fixators are removed and hence recovery would be noticeably smoother for LATN.

So why not just go straight for External only and be done with the nail all together.

Sure you're in frames for longer, but once you're done, you're done.

[Medium Drink Of Water]

So why not just go straight for External only and be done with the nail all together.

Sure you're in frames for longer, but once you're done, you're done.

My thoughts exactly when I went to Dr. Mitkovic.  I was going to do all-external and live in Serbia for 9 months, then I'd be done with the whole thing forever.

[Franz]

Look, it is certainly the safest. It does mean long frame times though.

[An_Apple_A_Day]

Look, it is certainly the safest. It does mean long frame times though.

I have read that long time in frames = permanent muscle damage, is this rubbish?

[alps]

Hello Dr. Franz,

I've noticed that the new bone that is formed is not of a normal shape. It bulges out quite a bit. It is of a diameter greater than usual. Is this all right?

[Franz]

Long frame times do not necessarily equate to permanent muscle damage. We encourage early functional rehab including full weight bearing which promotes muscle function.
New bone (regenerates) are often wider than the original bone. This is a good thing. It means your surgeon knows what he's doing and you're creating good quality bone. Will have no effect on function.