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[fivetenneeded2016]

Hi all, had been lurking around for a while, glancing a few diaries now and then .

So initially my plan was to go with Guichet but i dont want to get too old saving for my LL(I am 24 and i feel this is the phase of life i need height the most ) , and i am considering of having it done early next year. So I am looking forward for a lower budget but SAFE doc from India/Russia.

Some Docs I have in my mind are Dr. Parihar, Dr Solomin and Dr. Barinov. Although I feel Parihar would be the safest to go with for external tibia but barinov seems equally safe, if done in the 6cm limit for tibs.

The only reason for re-considering Parihar would be lack of enough diaries may be (have only seen penguinns and Kilos). At the same time, it is their regards for him and their experience made me consider him too as a potential doc that i could go with.

So my questions are :

1. Who would be the safest doc for a lower budget LL, considering i dont mind travelling abroad(I am an Indian) as long as the doc is safe and there are LLers who vouch for them.

2. And also the if i may consider a femur after an year or two, is it okay? I mean people generally do femurs before tibias. But given the time gap of 2 years post lengthening and touchwood everything is fine after, would it still have been better to have femurs done prior to tibias?

Please voice out your opinions which would help me decide better.

I would start posting more often as i want to begin my research on it :p so please bear with me 

[onemorefoot]

Consider only Solomin or Parihar, , both are safe. Solomin had a case here with an user called badwolf; many people including me considered him unsafe because of that. However, that guy had delayed consolidation or non-union, that is not doctor fault, is more  genetics. Dr Mangal is very good too, both of them have extensive Ilizarov training and  are ASAMI memebers.

[fivetenneeded2016]

Thanks onemorefoot

Also given that i would do external tibias, I read between LON and External Fixators, LON is bad in the long run in terms of knee pain but would get you rid of frames in like 4 months.

But how often do see veterans under good/safe surgeons complain of knee pain after LON?

I mean the knee pain cases are the ones you get to hear from docs like sarin (not to disrespect him, just that there are a lot of complains againt him)

Given a choice between the two which one would you go with?

[onemorefoot]

I would go to Parihar, very careful surgeon. You have to keep in mind that he is very conservative, if you develop severe equinus, maybe he wil tell you to stop lengthening and fix the problem( I dont think he would like to perform achilles tendon lengthening or gastrocnemius release), that is my only worry with him. Also he wont let you go over 6 cm. Think VERY well about pure Ilizarov, is very though; going to a good surgeon the chances of knee pain can be lowered a lot. Solomin is very good; however about badwolf I have some doubts, non-unions or delayed consolidations can be caused by poor osteotomies(not only genetics), that is concerning and the user didnt explain us well what doctor told him.

[fivetenneeded2016]

So if you went with parihar, would you do a LON or ilizarov?

Does LON really have that significant knee pain in long term if done under a careful surgeon or is it just a possibility that is overhyped? I mean if it were that serious people would prefer external fix. over LON otherwise.

P.S. I am going to Parihar next week for an initial appointment discussing the right choice

[fivetenneeded2016]

But i feel i should do a bit of research as my homework :p

[onemorefoot]

Parihar told that nobody of his patients has experimented that knee pain. Being a professional like him, he will tell you the advantages and disadvantages of each method, If I were you I would go for LON, even Kilo wrote in his diary that if he could come back in time he would go for LON, being in frames for over a year is HELL!!!
When you go for your consultation with Dr. Parihar, can you ask him one thing for your friend, onemorefoot

If severe equinus happens, can we consider the option of percutaneous techniques? Does it leave the Achilles tendon weak?

[fivetenneeded2016]

Sure man Although i do not understand most of the terms you used yet, I would read up about these as well

[notimportant]

I would say Dr Mitkovic should be also included in this thread.

[fivetenneeded2016]

Yes, forgot about him and kulesh, but here are very few diaries.

Besides Mitkovics device is only ideal for 4-5 cms...I dint come across a diary with more than 5.5 cms lengthened. And also no consolidation/ post consolidationop status of the OP.

Parihar could give you a centimeter extra :p

[Bander72]

Without question India, if I trusted Mongeal I'd go to Spain since I would be able to communicate with him in Spanish. Not feel totally weird being in another country. Not worrying about communicating with the locals.

[fivetenneeded2016]

After the suggestion for Dr. Mitkovic from 'notimportant' I started reading his patients diary from the old forum.

Has great success rates and also very economical. Apart from the price the fact that i like is the special monorail of his. Since i had an ACL reconstruction surgery couple of years ago i am quite hesitant of getting a nail through my knee.

So I dont know if parihar would provide that :/ . I would probably be more clear after my consultation with him this wee

After reading on Mitkovic, now i have only two docs for consideration - Parihar and Mitkovic.

As much as I would to goto Parihar, I also would want a monorail done for tibias. And have not read of parihar perform any monorails.

[onemorefoot]

Friend, monorials without a nail are a bad idea for LL( If you are slim they can be a good option), if not, please dont use them. You can get a misalignment and that will have to be corrected with another surgery.

[fivetenneeded2016]

Actually I am slim and i weigh aroun 54 kgs. As i said i would consider monorail only if i am told by Parihar that LON could damage my knee in the future given my knee history.

But is

[onemorefoot]

XD, I didnt read everything.

[fivetenneeded2016]

*But would you say monorail is safer than an intermedullary nail if the person is thin?
Or would LON still be a better choice?

sorry some of it was sent partially 

[onemorefoot]

With your knee problem, you can consider monorials.

[Whereintheworld?]

I honestly have not researched the method too intently, but my understanding is that the monorail is prone to misalignments that, unlike the ilizarov, cannot be fixed without additional surgery.

Look into this more though, I might be wrong.

[fivetenneeded2016]

definitely, would continue my research for some more time

[Bander72]

If Mitchov can safely get people to get 5 cm at least with his internal device then I would definitely choose him.

[fivetenneeded2016]

there are mitkovics diaries on the old forum with successes above 5 cms as well..there are people who did 7cms on his monorail successfully, as well.

[fivetenneeded2016]

also is there a reason why we dont see much beijing diaries offlate, here? knowing that they allowed a greater length om the tibias

[Bander72]

Yes but a issue  he is working on his internal is thay they stop lengthening prematurely.

[fivetenneeded2016]

i was talking of monorails without the IM nail. that looks fine and people have lengthened 7cm using it

[Bander72]

Yes but internal is always the better option and all would pretty much do it if it was as cheap as external.

[fivetenneeded2016]

for tibias i guess external is good without IM nails, to avoid knee problem in the long run

[fivetenneeded2016]

correct me if i am wrong

[682]

Yes but internal is always the better option and all would pretty much do it if it was as cheap as external.

Internal while more comfortable is poor compared to external to correct misalignment should it occur.

[fivetenneeded2016]

682, which doc would be the best, mitkovic with monorails or parihar with LON ?

[KiloKAHN]

Monorails aren't done by Dr Parihar for CLL because unlike with standard frames you have nothing to hold the foot in a neutral position while resting and that makes it easier to develop equinus contracture. There's apparently other complications such as x-legs that can be caused by them if the doctor doesn't install them perfectly.

[fivetenneeded2016]

Parihar told that nobody of his patients has experimented that knee pain. Being a professional like him, he will tell you the advantages and disadvantages of each method, If I were you I would go for LON, even Kilo wrote in his diary that if he could come back in time he would go for LON, being in frames for over a year is HELL!!!
When you go for your consultation with Dr. Parihar, can you ask him one thing for your friend, onemorefoot

If severe equinus happens, can we consider the option of percutaneous techniques? Does it leave the Achilles tendon weak?

had a meeting with parihar, it was a 3 step meeting, first was with someone else who jotted down my story, why i want LL, my stats etc. next was dr ahuja, who cleared my questions...yet to have my meeting with dr. Parihar.
So I did ask your question. The answer was yes, it could be done safely(without weakening) if done carefully.

Yet to meet Parihar.
 Dr. Ahuja also said that the 5-6cm max is based on an observation and they say it so that the patient is happy to accept that as a worst case. So anything over that would be a bonus. He said a lot depends on your muscles.