Ladies and Gents,
This first post of mine is a segue into a proper diary of my limb lengthening experience with Dr. Monegal in Barcelona, Spain. I was operated on exactly 11 days ago and will touch upon my post-op life (which has been absolutely 1st class) soon enough but wanted to share some of the pre-op interaction that I feel potential LL’ers may find equally valuable. The email chain that I have going with Dr. Monegal is more than 60 individual threads deep, but I’ve distilled that chain into a top 20 of sorts and formatted it Q&A style.
Also, just as a heads up, the posts for my diary will be weekly summaries covering highlights, so please do not expect daily updates. In this way, my diary should be more This Week Tonight w/ John Oliver than The Situation Room w/ Wolf Blitzer… and hopefully the readability of my diary will parallel the watchability of the aforementioned analogy. Nevertheless, I just wanted to say THANK YOU!!! to the value added contributors of this forum. Your experiences, questions, posts, etc. have given me a wealth of knowledge/information which I’ve leveraged to launch my own journey.
With that said, here is my TOP 20 Q&A with Barcelona’s Dr. Alex Monegal…
DR. MONEGAL: First of All thank you for Considering me as an option to perform Limb lengthening. Regarding your questions Please find my answers as follows:
QUESTIONS:
1) In the LL forums, you have made your preference for treating each individual limb or “segment” during separate surgeries very clear. I respect your motives for this and do appreciate your desire to minimize fat-embolism risks and maximize patient mobility during recovery. Unfortunately, I do not believe that I will have sufficient time to follow that protocol. I have approximately 5 months that I can dedicate to surgery, distraction and initial consolidation in Barcelona. With that said, would you be willing to perform a bilateral femur lengthening in a “1 stage” procedure?
DR. MONEGAL: I have done that in very selected cades and I try to be very cautious when Doing that. I do ferform the drilling of the osteotomy line prior to the canal reaming in order to reduce canal preasure. I Also Try to perform a very non-agressive reaming. This Is a key Point to prevent such unlikely event.
Another important Point Is surgical time. I am Currently performing Femur procedures and my timing Is 1h35-1h50 minutes per segment which Is Great.
You must be aware that full weight load Is Not allowed when performing bilateral Procedures. So wheelchair Is needed for Long distance transfers.
2) You have stated that the fitbone nail can be inserted into the femur using either an antegrade or retrograde approach. Given my stated objectives, do you have a preference for either one? What factors do you use to determine whether antegrade or retrograde is most suitable?
DR. MONEGAL: Technically there Is no difference But I trully prefer retrograde. Reason Is because retrograde can allow Is to correct axial deviations and predict a normal mechanical axis of the lengthenned limb. When performing antegrade nail Just follows the anatomical axis of the Femur and patients may end-up with X shape legs. I have seen that with other implants such as Precice or Albizzia. I am aware that one of the bigest concerns among the patients Is anterior knee Pain. For they reason I try to avoid trans patellar tendon approach. I do perform Suprapatellar approach for tibiae and parapatellar when doing retrograde femur. Both approaches were presented at Fitbone user Meeting Last year and even prof Baumgart Is doing them on a regular basis.
3) Much has been opined about what the ideal rate of distraction is for minimizing soft tissue stress while maximizing lengthening potential. Understanding that every patient and situation is different, do you have a generic preference as to the ideal daily distraction rate that you recommend for your Patients?
DR. MONEGAL: I do lenghten 4-5 mm intraoperatively. After 7-8 days patients start lenghtening at 0,81 mm/day. Depending on their tolerante to distraction they can increase the pace up to 1,08 mm/Day.
4) I have a predisposition to keloid formation and hyperpigmentation when scarring. Have you dealt with patients having similar skin sensitivities and/or is there a dermatologist at the Clinica Diagonal that can help minimize the potential of the aforementioned conditions?
DR. MONEGAL: Yes I have. Scars are very nitchy when performing Fitbone procedures but we can advice you some silicone pads or products to prevent that.yes we do have dermatologists at the Clinic.
5) Many LL doctors have a preoperative guideline that they require their patients to follow. Do you have any pre-op requirements/recommendations in terms of stretching ability, muscle strength, dietary nutrition, vitamin supplementation, etc.?
DR. MONEGAL: From the anatomical Point stretching muscles Is the key Point rather than muscle work out. I do recommend stretching:
1- Harmstrings
2- aductor muscles
3- quadriceps
4- gemelli/Psoleous
There Are vitamínic complexes that can help. Most important are B,D,C vitamin for the calcium absortion, Fe absortion and periphereal nerve care.
6) Assuming we were to move forward with surgery, how much local lead time do you require of your patients? In other words, how much time must I spend in Barcelona prior to surgery in order to complete all of the necessary pre-op checks and exams?
DR. MONEGAL: To order implants and to do the Planning 3-4 weeks in advance are Required. I migth need x rays to make the preop planning, you can send to me If you decide to go for it. i need:
1- standing telemetric x rays of both limbs
2- full lateral view of both femurs
Medical and anaesthetic assessment can be done the day before surgery, my advice would be to come 2-3 days so you can rest and see the clinic and the city.
7) What are your thoughts/recommendations about both physical therapy and weight-bearing during the recovery process?
DR. MONEGAL: Patients do start recovery at the clinic. It Is very important to work on muscle stretching, knee ROM and walk on Crutches. Isometric muscular excercises of quadriceps and gemelli are Also very important.
Patients Will have the support of a personal trainner if they wish when they are discharged from the clinic.
At week 4 they normally can walk and swim in the pool and practice static cycling at the gym.
8 ) Do you recommend or discourage patients from upper body exercise during the recovery period?
DR. MONEGAL: I do RECOMMEND this kind of excercises but NOT gain muscle weight
Author
Topic: Bilateral Femur Lengthening with Dr. Monegal (Incomplete) (Read 4047 times)