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[Bjoern77]

Wow, .... 52000 euros !!!!!!!!!
My height is 186 cm But my wife's height is 157,
I liked his LL surgery but 52000 euros I do not have 52000 euros.

Why do you need LL surgery? You are 186cm! Are you crazy in the head? 

[tall enough]

He's properly looking to increase his height in order to get more distance to his wife 

[Bjoern77]

He's properly looking to increase his height in order to get more distance to his wife 

[growthPlz]

Is he terrible? I’ve heard his nail issues with bending and breaking are fixed, and have seen good diaries on him. Plus fully weight bearing. By the way I want 6cm femur and 4 on tibias. Let me know if I should consult with him. Thanks

[RealLostSoul]

Do and consult with him and see for yourself. Modern cases have all been good and I was told, from someone who does it rn with him, a lot of people are happy with betz. But of course you can never rule out the risk of being a bad case with complications.

[DonBones]

Is he terrible? I’ve heard his nail issues with bending and breaking are fixed, and have seen good diaries on him. Plus fully weight bearing. By the way I want 6cm femur and 4 on tibias. Let me know if I should consult with him. Thanks

I spent 1.5 hours talking to him on the phone yesterday and he seemed anything but terrible. He spent all that time explaining in a rather enthusiastic manner what can be done, what cases he had, why he is using Betzbone and of course also what can go wrong. My first impression was rather good. I suggest that you should consult with him

[Meh]

Betzbone is weight bearing as was stryde. What differentiates the two? Does betzbone rust also?

[RealLostSoul]

Betzbone is weight bearing as was stryde. What differentiates the two? Does betzbone rust also?

The difference is it's a mechanical nail, you extend it by ratcheting/clicking, usually this is more painfull.
It doesn't rust though.

[DonBones]

Betzbone is weight bearing as was stryde. What differentiates the two? Does betzbone rust also?

1. Betzbone is mechanical, you extend it by rotating your leg. For some people this is very painful, others do it effortlessly, see video at 8:30:



Stryde is extended via a magnet, which many people will find less daunting.
 
2. Stryde rusts and it can cause lesions (irregularities / cavities in your bone), which is claimed to result in pain many months post surgery. Betzbone has no such problems.

3. Stryde can be retracted, which it claims can help with non-union. Betzbone extends in only one direction.

[Bagga]

You commented the consultation was terrible yet you said you were impressed??
Sorry I was confused

[curlyfella]

how much was the consult

[DonBones]

how much was the consult

€350 - That's because it was over the phone. The other €150 you pay when you're there before the surgery.

[SirStretchAlot]

Hey nice to see you here DonBones

1) I had the opporunity to talk to 4 other patients during my 2 week hospital stay. Only 1 had no problems clicking. 2 had severe pain clicking (had to come back for anesthasia). 2 (including myself had moderate pain clicking). Out of a sample size of 5, I would say 80% of patients have had some problems clicking in at least one leg. Luckily for me, the pain becomes more manageable after 2.2cm.

2) Dr Betz loves to advertise the point that his nail has no iron in it, thus can't rust. It seems the rust causes pain for 5% of patients according to Dr Giotikas. Failures for Betzbone is at least double that. Still, it is severe enough of a % for Nuasive to voluntarily recall Stryde. That's usually what you get with American medical device suppliers. Extremely expensive, but reliable.

3) I posed that to Dr Betz too, and he claimed that non-union is extremely rare. I have received PMs from former patients who got non-union from Dr Betz. It seems this happens much more frequently in tibias and there is always some level of patient non-cooporation. For femurs, the retraction mechanism isn't a deal breaker, though for tibias, I would not consider Betzbone.

[DonBones]

Hey nice to see you here DonBones

1) I had the opporunity to talk to 4 other patients during my 2 week hospital stay. Only 1 had no problems clicking. 2 had severe pain clicking (had to come back for anesthasia). 2 (including myself had moderate pain clicking). Out of a sample size of 5, I would say 80% of patients have had some problems clicking in at least one leg. Luckily for me, the pain becomes more manageable after 2.2cm.

2) Dr Betz loves to advertise the point that his nail has no iron in it, thus can't rust. It seems the rust causes pain for 5% of patients according to Dr Giotikas. Failures for Betzbone is at least double that. Still, it is severe enough of a % for Nuasive to voluntarily recall Stryde. That's usually what you get with American medical device suppliers. Extremely expensive, but reliable.

3) I posed that to Dr Betz too, and he claimed that non-union is extremely rare. I have received PMs from former patients who got non-union from Dr Betz. It seems this happens much more frequently in tibias and there is always some level of patient non-cooporation. For femurs, the retraction mechanism isn't a deal breaker, though for tibias, I would not consider Betzbone.

Oh cheers for that, some interesting insights.

Do you have any sources for "Failures for Betzbone is at least double that."? I would like to read more about it.

[SirStretchAlot]

If you read earlier posts on this thread, they've compiled a list of complications and came to rates of near 30%. Giotikas told me he has seen estimates of 10%, which I think is likely closer to the truth. If it means anything, one of the patients I met who had his nail removed, had a broken screw. Luckily for him it happened during consolidation so it didn't lead to complications. But had it happened a few weeks earlier, things would be very different. I personally don't doubt Betz' surgical skills given that he has over 2000 surgeries under his belt. You will find that few if any complications are surgically related. He's a career surgeon and medical professor. However his nails don't have nearly the same reputation. No other doctors use his nails, even though they are cheaper than Stryde, for a reason. When asked about nail or screw breakages, Betz' doesn't even deny it. He just says it's the patients fault for weight bearing too early or not using crutches.

[Limblengtheningwarrior]

Thank for letting us know about it. So regarding the nail breakages, Betz just blames all on the patients' faults, but why did he advertise the nail to be "full weight bearing" in the first place? I am carefully considering Betzbone nail since it is the only option for loading full weight at the moment

[SirStretchAlot]

So the thing is both Stryde and Betzbone are full weight bearing in lab testing. I've seen xrays of both nails or their screws bending resulting in losing height gains or other complications. They are both a huge step up from Precise 2, but not perfect. Stryde has much more objective data from third party surgeons but only Betz' uses Betzbone, so we have to be skeptical about his claims. Stryde surgeons will ask that you walk with crutches during lengthening also. At the end of the day, it's just safer to use crutches and not test the limit of "full weight bearing" feature of any nail.

[Limbfan2020]

So the thing is both Stryde and Betzbone are full weight bearing in lab testing. I've seen xrays of both nails or their screws bending resulting in losing height gains or other complications. They are both a huge step up from Precise 2, but not perfect. Stryde has much more objective data from third party surgeons but only Betz' uses Betzbone, so we have to be skeptical about his claims. Stryde surgeons will ask that you walk with crutches during lengthening also. At the end of the day, it's just safer to use crutches and not test the limit of "full weight bearing" feature of any nail.

The main problem is that Betzbone doesn't have any regulatory approval from the FDA or EMA and Dr Betz is the only doctor who uses it. He doesn't have to report any complications (non-union, loose screws, corrosion etc.) to a regulatory authority. That means, he can say anything he wants and there will be no serious consequences when it's a lie.

Stryde is very different. It's an FDA approved device. Any complication has to be reported to the FDA! And if there is a slightest doubt about safety the device will be banned until further notice.

[DonBones]

The main problem is that Betzbone doesn't have any regulatory approval from the FDA or EMA and Dr Betz is the only doctor who uses it. He doesn't have to report any complications (non-union, loose screws, corrosion etc.) to a regulatory authority. That means, he can say anything he wants and there will be no serious consequences when it's a lie.

Stryde is very different. It's an FDA approved device. Any complication has to be reported to the FDA! And if there is a slightest doubt about safety the device will be banned until further notice.

It has the CE mark and is reviewed every year.

[Want-3-inches]

It has the CE mark and is reviewed every year.

They have withdrawn precice's CE mark but Betzbone still has it?

[DonBones]

They have withdrawn precice's CE mark but Betzbone still has it?

Of course. He wouldn't be operating without it. This is Germany we are talking about. The bar to bring anything to the market is fairly high. If anyone thinks Betz has been able to operate on thousands of people with a rogue nail for over 20 years then that is borderline ridiculous.

[SirStretchAlot]

Of course. He wouldn't be operating without it. This is Germany we are talking about. The bar to bring anything to the market is fairly high. If anyone thinks Betz has been able to operate on thousands of people with a rogue nail for over 20 years then that is borderline ridiculous.

It has to be noted that CE Marks only tell you that something is built to a certain "standard" and is often self-declared. It does not go through nearly the same thorough third-party audits that FDA does when it approves a medical device. In fact CE themselves say "...is not a quality indicator or a certification mark."

For example, I can say that my phone charger is built to provide 5000 mAh of battery life. The product then only has to be able to perform this out of the factory (standard), not after a year of rigorous use at home (quality). So we can be relatively certain that Betzbone does what it says it does in factory testing (CE Mark), but that has no bearing on whether this thing will live on in our bodies for months without any complication (FDA Approval).

[DonBones]

Without going into depth on any particular comment here, here is an excerpt from the EMA:

"Medical devices are products or equipment intended generally for a medical use and are regulated at Member State level. The Regulations on Medical Devices (Regulation (EU) 2017/745) and on In-Vitro Diagnostic Devices (Regulation (EU) 2017/746) changed the European legal framework for medical devices, introducing new responsibilities for the European Medicines Agency (EMA) and national competent authorities in the assessment of certain categories of medical device.

Medical devices in the EU have to undergo a conformity assessment to demonstrate that they meet legal requirements to ensure they are safe and perform as intended. EU Member States can designate accredited notified bodies to conduct conformity assessments.

The conformity assessment usually involves an audit of the manufacturer’s quality system and, depending on the type of device, a review of technical documentation from the manufacturer on the safety and performance of the device.

Manufacturers can place a CE (Conformité Européenne) mark on a medical device once it has passed a conformity assessment."

Source: https://www.ema.europa.eu/en/human-regulatory/overview/medical-devices

Whether this is as rigorous as the FDA I do not know, but having lived in Germany for 20 years I have no doubts that German standards of quality assurance are as good as anyones, in particular in medicine where entry requirements are extremely high. By that I mean top 1% of your graduation (Numerus Clausus) class and 13 years of studies before you can even call yourself a specialised doctor (i.e. Facharzt).

It would be inconceivable to me that someone makes it through this system, earns a professor title and works as one of the most senior surgeons in Munich to then produce a nail that is of low quality and sort of goes under the radar of the German or European quality assurance agencies.

I am of course not an expert in legal matters, but if safety and regulatory conformity are a concern, then I feel confident that Germany is one of the best, if not the best, place to go to.

[hanshi]

Without going into depth on any particular comment here, here is an excerpt from the EMA:

"Medical devices are products or equipment intended generally for a medical use and are regulated at Member State level. The Regulations on Medical Devices (Regulation (EU) 2017/745) and on In-Vitro Diagnostic Devices (Regulation (EU) 2017/746) changed the European legal framework for medical devices, introducing new responsibilities for the European Medicines Agency (EMA) and national competent authorities in the assessment of certain categories of medical device.

Medical devices in the EU have to undergo a conformity assessment to demonstrate that they meet legal requirements to ensure they are safe and perform as intended. EU Member States can designate accredited notified bodies to conduct conformity assessments.

The conformity assessment usually involves an audit of the manufacturer’s quality system and, depending on the type of device, a review of technical documentation from the manufacturer on the safety and performance of the device.

Manufacturers can place a CE (Conformité Européenne) mark on a medical device once it has passed a conformity assessment."

Source: https://www.ema.europa.eu/en/human-regulatory/overview/medical-devices

Whether this is as rigorous as the FDA I do not know, but having lived in Germany for 20 years I have no doubts that German standards of quality assurance are as good as anyones, in particular in medicine where entry requirements are extremely high. By that I mean top 1% of your graduation (Numerus Clausus) class and 13 years of studies before you can even call yourself a specialised doctor (i.e. Facharzt).

It would be inconceivable to me that someone makes it through this system, earns a professor title and works as one of the most senior surgeons in Munich to then produce a nail that is of low quality and sort of goes under the radar of the German or European quality assurance agencies.

I am of course not an expert in legal matters, but if safety and regulatory conformity are a concern, then I feel confident that Germany is one of the best, if not the best, place to go to.

You don't know what you're talking about. Since in the case of Betz the surgeon is identical with the manufacturer there is no effective control process whatsoever. The declaration of conformity simply means that the manufacturer promises that his product is conform the the EU regulation. But this is not verified. The regulation in question here is called 93/42/EWG and can be found online.

[DonBones]

Again, to reiterate:

1. Betzbone is definitely audited and approved by an independent body. Those bodies are commonly referred to as the "Bennante Stelle". This happens yearly and is mandatory to be able to keep the CE mark. Betz actually has to pay a fair amount of money for it. The audit will be by one of those: https://ec.europa.eu/growth/tools-databases/nando/index.cfm?fuseaction=country.notifiedbody&cou_id=276

2. Betz definitely does have to report complications to the so-called BfArM (Bundesinstitut für Arzneimittel und Medizinprodukte / Federal Institute for Drugs and Medical devices). This is the english version of their website for more info: https://www.bfarm.de/EN/Home/home_node.html

3. In general, surgeons in Germany hold a license which can be revoked should there be actual evidence of malpractice.

This is Germany and this is the EU we are talking about, and I am not sure how someone might think that a surgeon there can self-approve themselves. Having said that, I don't mean to get into meaningless merry-go-round discussions on those topics. My advice to anyone reading is:

a) Always have an actual consultation with a doctor such as Betz himself and never draw premature conclusions. If after the consultation you have major doubts it's likely best to look elsewhere or to avoid the surgery altogether.

b) Be vigilant when you read defamatory comments about doctors online. I think sometimes sentiments against particular doctors may be personal or competitive in nature.

[SirStretchAlot]

Again, to reiterate:

1. Betzbone is definitely audited and approved by an independent body. Those bodies are commonly referred to as the "Bennante Stelle". This happens yearly and is mandatory to be able to keep the CE mark. Betz actually has to pay a fair amount of money for it. The audit will be by one of those: https://ec.europa.eu/growth/tools-databases/nando/index.cfm?fuseaction=country.notifiedbody&cou_id=276

2. Betz definitely does have to report complications to the so-called BfArM (Bundesinstitut für Arzneimittel und Medizinprodukte / Federal Institute for Drugs and Medical devices). This is the english version of their website for more info: https://www.bfarm.de/EN/Home/home_node.html

3. In general, surgeons in Germany hold a license which can be revoked should there be actual evidence of malpractice.

This is Germany and this is the EU we are talking about, and I am not sure how someone might think that a surgeon there can self-approve themselves. Having said that, I don't mean to get into meaningless merry-go-round discussions on those topics. My advice to anyone reading is:

a) Always have an actual consultation with a doctor such as Betz himself and never draw premature conclusions. If after the consultation you have major doubts it's likely best to look elsewhere or to avoid the surgery altogether.

b) Be vigilant when you read defamatory comments about doctors online. I think sometimes sentiments against particular doctors may be personal or competitive in nature.

The problem with CE is that, it is in fact largely self-declared. "Notified Bodies" do not independently test the devices themselves. They audit your company's compliance to regulations. The manufacturer would issue a Declaration of Conformity and the independent "Notified Bodies" would review the documentation provided to justify the declaration (quality management system, technical files, etc...). I understand that you have faith in Germany, but in the area of medical devices, the EU audits its manufacturers much less rigorously than the US, where Nuasive, perhaps Betzbone's largest competitor is based.

Hanshi may have come down a bit hard, but I think his main point was that since Betz is the only user of Betzbone, there cannot exist an independent audit. Normally, it is in the customer's interest to report on defective products to benefit from refunds and other remuneration. However, since Betz is the customer and manufacturer, he has a financial incentive to under report complications so he can keep Betzbone on the market, hence a clear conflict of interest. He controls the data and what complications to report. Stryde on the other hand has independent data reported from different doctors globally. Nuasive cannot control what complications are reported.

I really don't think anyone is trying to defame Dr Betz. As a patient, I think he's a legit and experienced surgeon. Betzbone on the hand, may not be a reliable device and because he's the only user, we can never know.

[Want-3-inches]

The problem with CE is that, it is in fact largely self-declared. "Notified Bodies" do not independently test the devices themselves. They audit your company's compliance to regulations. The manufacturer would issue a Declaration of Conformity and the independent "Notified Bodies" would review the documentation provided to justify the declaration (quality management system, technical files, etc...). I understand that you have faith in Germany, but in the area of medical devices, the EU audits its manufacturers much less rigorously than the US, where Nuasive, perhaps Betzbone's largest competitor is based.

Hanshi may have come down a bit hard, but I think his main point was that since Betz is the only user of Betzbone, there cannot exist an independent audit. Normally, it is in the customer's interest to report on defective products to benefit from refunds and other remuneration. However, since Betz is the customer and manufacturer, he has a financial incentive to under report complications so he can keep Betzbone on the market, hence a clear conflict of interest. He controls the data and what complications to report. Stryde on the other hand has independent data reported from different doctors globally. Nuasive cannot control what complications are reported.

I really don't think anyone is trying to defame Dr Betz. As a patient, I think he's a legit and experienced surgeon. Betzbone on the hand, may not be a reliable device and because he's the only user, we can never know.

Great points. In fact, the problems with Stryde were first reported by a UK surgeon.

The only way the authorities can audit Betz's data is by forcing him to submit all his patient medical information so that they can verify that there are no gaps. But that would be a massive privacy violation and I doubt Betz would be allowed to give away any patient medical information except if there is a lawsuit.

[hanshi]

Again, to reiterate:

1. Betzbone is definitely audited and approved by an independent body. Those bodies are commonly referred to as the "Bennante Stelle". This happens yearly and is mandatory to be able to keep the CE mark. Betz actually has to pay a fair amount of money for it. The audit will be by one of those: https://ec.europa.eu/growth/tools-databases/nando/index.cfm?fuseaction=country.notifiedbody&cou_id=276

2. Betz definitely does have to report complications to the so-called BfArM (Bundesinstitut für Arzneimittel und Medizinprodukte / Federal Institute for Drugs and Medical devices). This is the english version of their website for more info: https://www.bfarm.de/EN/Home/home_node.html

3. In general, surgeons in Germany hold a license which can be revoked should there be actual evidence of malpractice.

This is Germany and this is the EU we are talking about, and I am not sure how someone might think that a surgeon there can self-approve themselves. Having said that, I don't mean to get into meaningless merry-go-round discussions on those topics. My advice to anyone reading is:

a) Always have an actual consultation with a doctor such as Betz himself and never draw premature conclusions. If after the consultation you have major doubts it's likely best to look elsewhere or to avoid the surgery altogether.

b) Be vigilant when you read defamatory comments about doctors online. I think sometimes sentiments against particular doctors may be personal or competitive in nature.

You are spreading misinformation. The notified body (in this case a small company from Aachen which already stopped doing certifications) did only certify the quality system of Betz's company, on paper only. And the certification is valid for 5 years. Not just 1 as you wrote.
It is true that doctors and manufacturers have the obligation to report "dangerous events" in connection with medical devices. However, Betz and his company have never done this(the problem is that there are no consequences if they don't report). This is a fact which has been brought up in a current lawsuit.
A doctor's license could be revoked however this normally only occurs after he has been sentenced for criminal charges.
Betz resides in the 2nd smallest federal state of Germany and the institutions there are very reluctant to go after him. He seems to be well connected locally.
I know many more details about this "Betzbone business" , but I'll leave it at that here.
If you choose Dr. Betz you will be at his mercy.

[growthPlz]

I’ve seen plenty of the recent diaries for betz, and it seems like he’s pretty good. From what you all have gathered, does he seem like a very good choice? I see the benefits being the weight-bearing nail, however the downside is that clicking can be painful for some. Thoughts on choosing him?
Thanks

[inchesmatter]

The downsides are that clicking is a nightmare and follow-up care is minimal. But he is a good surgeon and do your own research and become VERY well-informed about anatomy and PT, it can be good. I am a former Betz patient.

[growthPlz]

Could you further describe how clicking was a nightmare? It seems that for many the only downside to betz is the clicking.