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[onemorefoot]

I wonder which is the actual cost for each item Precice, LON?

[Stadiometer]

Email: franz.birkholtz@walkamile.co.za

[Stadiometer]

[Stadiometer]

[Stadiometer]

[YourSpaceBoyfriend]

Good to hear about dr. Franz again.

Doe i'm bit worried about current situation in SA.

[Out of Touch]

Right now I'm deciding between Birkholtz and Parihar for internals.

Wasn't his precise more expensive before? $41K isn't too bad 

Thanks for the info.

[ll3ll]

Yeah this is really great to hear thank you for the update! Seems like Parihar/Birkholtz are a pretty great option for internals with very well-trained physicians but a much more feasible price.

[onemorefoot]

Out of touch, his internals are still in the same range of price, but if you read carefully will realize that the package doesnt include pshysio, accomodation and everyday food,  that is the reason because the price was quoted as 52k USD.

[Out of Touch]

^

Ah, I forgot that his old package had physio included along with accommodation.

[mediocre]

Just want to chime in. I had a clinic consult with Dr Franz about 3 years ago in SA. Here are my impressions:

• He doesn't do touting (does not advertise boastfully)
• His practice is busy with non CLL cases so I guess that's why he's not desperate advertising for CLL; and that's the main disadvantage I guess, he doesn't have a lot of CLL cases/experiences than other doctors here and so some patients may still be reluctant to choose him
• He is very realistic, and won't give you unrealistic centimetre goals; after x-ray measurements he tells me realistic goals with priority on my safety but still open to adjustments if my body would allow
• If I have funds and time, would still do CLL with him.  I just hope he still accepts CLL when I get the funds
• I'm not saying SA is completely safe (and for sure SA is one of the most violent countries in recent years) but I'd be more scared walking around USA (than in SA) knowing guns are freely available (in fact in 2012 figure, USA and SA are #1 and #2 in highest gun-related deaths) LINK
• Another thing to consider is how much patients are protected in SA when there's a dispute; in USA and most Western countries, patients are more reassured.

[Col92]

Reply| DeleteJunk| 
Re: COST OF BILATERAL FEMUR LENGHTHENING SURGERY?
FB
Franz Birkholtz <franz.birkholtz@walkamile.co.za>






  Reply|
Yesterday, 05:54
Some additional info I receive from Dr Birkholz. I think he would be a good choice, just a shame that he has taken out accommodation and PT from quote. I think he is trying to give his patients more flexibility, better hotel and more PT if you can afford it.


Thank you for quote. May I ask some additional questions.



1.Can I have an approximate price for all other aspects not covered in quote. Accommodation, further x-rays, physical therapy. Basically anything else that you can

* Accommodation ranges widely depending on level but starts at around 800$ a month. Xrays are included for three months. As in the document physio after hospital is around $55 per hour. Recommended three times a week.

think of based on your experience of patients completing this process. 

2. Do you test the functionality of the nail during initial surgery?

*yes and we replace a nonfunctional nail straightaway at no extra cost.

3. What would be my position if nail failed. Would I be responsible for the cost of a further surgery to replace the nail and the cost of the nail?

*if a nail breaks (highly unlikely) replacement with a trauma nail will be done. Cost will be shared. Hospital and nail costs for patients account. Around 8000$


4. What are the scars like with this surgery?

*2cm incision where nail is inserted on side of hip. 4 stab incisions for locking screws. 2cm incicision lateral above knee for ITB release.

5. Do you advise weight bearing during lengthening or would i be in a wheelchair for all of that time?

*check document. Upon discharge you will aready be weight bearing on a walking frame. Double leg stance.

[Franz]

Hi everyone,

Since I am being swamped by emails, I thought it may be a good idea to open this thread again for questions and answers. In this way I can answer once for everyone's benefit. Please keep it civil and to the point.
Ground rules: no trolling, no badmouthing of eachother or other doctors. My intention here is to provide information. For real medical advice you need to see your local CLL doctor. There are fantastic docs out there who can look after you well.

I will endeavour to answer speedily and accurately, but bear in mind this happens inbetween normal patient care, so answers may take a while.

Fire away!

[onemorefoot]

Sorry to hear that, Dr. Franz. I have just one little doubt, before a tibial lengthening is not recommended to use heels more than 2 cm, right? In the unfortunated case that some people have used high heels( up to 4 cm) for a long time, would you recommend a percutaneous achilles tendon lengthening prior to the tibia surgery??

[Franz]

Interesting question. :-)
I personally don't think that having worn heels is necessarily a contra-indication. It really depends more on your current flexibility and stretching routine during and after lengthening. I almost never perform the achilles lengthening at the beginning, but tend to add it to the exfix removal procedure at the end if it is deemed necessary.
Hope this helps?

[onemorefoot]

Thank you very much for your time, Dr.

[jbc]

Dr. Birkholtz, thank you for returning to the forum! I would certainly appreciate your take on the following questions:

1) Do you believe that a biceps femoris release is required for femoral lengthening? Some Drs perform it as a precautionary measure, some do not - I would love your opinion on this, and specifically, what the tradeoffs are in performing/not performing the release?

2) What do you consider a "safe" lengthening amount for close to full return to athletic activity? Reading through literature, you and other Drs have stated 5 cms, possibly 6 cms. Are there specific medical/physiological reasons as to why this is considered a "safe" length, and/or is there more leeway between a person of, say, 168 cms in stature vs one of 178 cms in stature (leaving aside the why the taller person would seek the procedure)?

The latter seems to be a pretty common question on the board, I'm not sure I've seen it answered in great detail.

Your time here is very much appreciated. I am actually glad you are being bombarded by inquiries , based on your reputation, you seem to be a terrific surgeon and clinician, and I hope your CLL practice continues to blossom. TIA.

[MyronReducto]

Dr.Birkholtz

Thank you very much for your contribution to this forum.

Would the benefits outweigh the risks of nail removal, femur PRECICE2 in particular?

[yyes]

Dr Birkholtz

I am looking my femurs internally . I am looking to lengthen 2 inches.

How long would it take to recover from the day of surgery all the way to doing sports again specifically soccer and basketball. And would I be able to go back to 100 percent athletic abilities?

[Franz]

Thank you very much for your time, Dr.

No worries

[Franz]

Dr. Birkholtz, thank you for returning to the forum! I would certainly appreciate your take on the following questions:

1) Do you believe that a biceps femoris release is required for femoral lengthening? Some Drs perform it as a precautionary measure, some do not - I would love your opinion on this, and specifically, what the tradeoffs are in performing/not performing the release?

2) What do you consider a "safe" lengthening amount for close to full return to athletic activity? Reading through literature, you and other Drs have stated 5 cms, possibly 6 cms. Are there specific medical/physiological reasons as to why this is considered a "safe" length, and/or is there more leeway between a person of, say, 168 cms in stature vs one of 178 cms in stature (leaving aside the why the taller person would seek the procedure)?

The latter seems to be a pretty common question on the board, I'm not sure I've seen it answered in great detail.

Your time here is very much appreciated. I am actually glad you are being bombarded by inquiries , based on your reputation, you seem to be a terrific surgeon and clinician, and I hope your CLL practice continues to blossom. TIA.

Hi, thanks for the kind words.

Biceps femoris lengthening is not something I do often and my suspicion is that with my conservative lengthening goals, we probably need it less often than with surgeons who routinely push to 8cm. ITB release, on the other hand, is something I think is essential in nail based femoral lengthening. This helps nail elongation and does not seem to cause any long-term effects.

The issue with a discussion around safe lengthening amounts is that the complications as well as athletic ability are so variable per patient and that many individual factors contribute. As a rule, we start seeing more complications of regenerate delayed unions, deformities, muscle contractures etc after around 5 cm. That is where that comes from. Of course the athletic recovery is dependent on a number of factors like: -pre-surgery athletic ability ; -lengthening amount (this affects the lever arms and mechanics, as well as muscle tightness) ; -muscle tightness and contracture which is also is indirectly related to lengthening amount ; -alignment after lengthening ; and postoperative rehabilitation.
In general, we can probably ironically get a bit more length safely in a patient with a longer starting height than in someone who starts out shorter. It is a precentage equation. So, again, the guys who need the most length are ironically again the guys in whom we can probably safely add less. Just life, I guess?

[Franz]

Dr.Birkholtz

Thank you very much for your contribution to this forum.

Would the benefits outweigh the risks of nail removal, femur PRECICE2 in particular?

Good question. We simply do not know what the long-term effects of those magnets are. Furthermore MRI is impossible with those nails in.

For these reasons it is advisable to have them removed. The issue is that it is surgery again and that it may well end up with slightly larger scars as well. Ironically the wounds used to remove the nails are typically larger than to insert them.

[Franz]

Dr Birkholtz

I am looking my femurs internally . I am looking to lengthen 2 inches.

How long would it take to recover from the day of surgery all the way to doing sports again specifically soccer and basketball. And would I be able to go back to 100 percent athletic abilities?

50mm lengthening:
10 days lag period, 50 days distraction period. Ie 2 months till length is achieved. Bone consolidation typically takes another 4 months. Ie by six months full unaided weight bearing should be OK. Return to sport the six-nine months after that, depending on the type of sport.

Ballpark is around 18 months.

[TIBIKE200]

Hello doctor Franz.

 I wanted to ask, is there a reason that both you and dr.Rozbruch now more "easily" accept people taller than below the 3%? Before, only a handful of docs accepted people of certain heights (my 5'7 included) but now it seems doctors are more open to do the operation on taller folks (I presume based on the risk/reward ratio).
 
 Basically, what I am asking is if the new methods really did "revolutionized" LL in terms of safety? Did the precise nail really made the procedure much more safer, thus making more doctors feel more comfortable doing this procedure on even taller (sane minded) folks?

[applesandoranges]

Hi Dr. Franz, thanks so much for answering our questions. I'm interested in your quote about the ITB release. What exactly is an ITB release? What happens to the band after? Does it go back to normal?

ITB release, on the other hand, is something I think is essential in nail based femoral lengthening. This helps nail elongation and does not seem to cause any long-term effects.

[Franz]

Hello doctor Franz.

 I wanted to ask, is there a reason that both you and dr.Rozbruch now more "easily" accept people taller than below the 3%? Before, only a handful of docs accepted people of certain heights (my 5'7 included) but now it seems doctors are more open to do the operation on taller folks (I presume based on the risk/reward ratio).
 
 Basically, what I am asking is if the new methods really did "revolutionized" LL in terms of safety? Did the precise nail really made the procedure much more safer, thus making more doctors feel more comfortable doing this procedure on even taller (sane minded) folks?

Good observation. I think you are hitting the nail on the head (excuse the pun). As techniques and technologies evolve, surgical indications also evolve.

[TIBIKE200]

Good observation. I think you are hitting the nail on the head (excuse the pun). As techniques and technologies evolve, surgical indications also evolve.

 So indeed we can safely say that LL is much more safer today than even 5 years ago?

[KiloKAHN]

Hi Dr Birkholtz,

When you first obtained access to the Precice nail, was a representative from Ellipse sent by the company to be present during the surgeries? If so, how long does that continue until Ellipse decides that a representative doesn't need to be there for the surgery every time you use it on a patient?

[Franz]

Hi Dr. Franz, thanks so much for answering our questions. I'm interested in your quote about the ITB release. What exactly is an ITB release? What happens to the band after? Does it go back to normal?

The iliotibial band (itb) is a connective tissue band on the outside of the thigh. It crosses over the knee as well. As opposed to tendons, the itb cannot really be stretched too much. Because of that, it is often a major resistive force to distraction and can cause nails to malfunction and also can cause a flexion contracture of the knee. This is the reason we advocate releasing it routinely. It is not really a very complicated procedure. A small slit is made in the itb. That allows it to stretch. It then heals up with a form of scar tissue. Interestingly scar tissue is made up mostly of collagen, a protein that also makes up most of the itb. Recovery is essentially complete.

[Franz]

So indeed we can safely say that LL is much more safer today than even 5 years ago?

Absolutely

[NeedForSpeed]

Hello Dr. Franz,

I really appreciate that you have offered to help us understand the limb lengthening process through your experience

I would like to ask about the prospects of a patient who chooses to undergone a 8.0 cm lengthening on both tibias using external fixators, followed by intramedullary nailing; LATN. For a person who does such an amount of lengthening:
1) How long would a he be needing to use a wheelchair after the surgery?
2) Is weight bearing possible right after the surgery?
3) How long would one have to use crutches after 'graduating' from the wheelchair