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[exceeding2meters]

I discovered this surgery only 2 months ago so, for the people who have been following the scene for some years now, has the price reduced at all?

In 5 years from now, can we hope for the price of stryde to reduce a bit?

[RB]

Since stryde came out, prices have not decreased and have even increased in some cases. In theory the more doctors we have offering stryde, the price should fall due to basic economics but the issue is largely the price of the stryde nails. The doctors don’t profit as much as you would think from each surgery as the majority of the cost goes to the nails and the hospital, PT costs etc (unless your Paley who was involved in founding Nuvasive I believe).

[Medium Drink Of Water]

Lengthening prices continue to increase at a rate higher than inflation, just like all medical treatments.

Basic economics doesn't apply when there's no competition and no incentive to lower prices.  Device/supply companies, hospitals, and doctors will be able to charge whatever they want for medical care and get it unless the system fundamentally changes.

[Michael J. Assayag, MD]

So, allow me to fact check here

Ellipse technologies developed and designed the Initial Precice nail with 3 surgeons; John Herzenberg and Shawn Standard, two pediatric limb lengthening specialists, and Stewart Green.

It was then subsequently bought (along with Magec growing rods) by Nuvasive who was really a spine company.

That being said, The price is neither going up, and most surgeons are actively trying to decrease the cost of CLL. As of now, Stryde nails represent half the cost of the procedure, in certain cases more.

As more lengthening nails are designed and released, as long as they are as accurate and effective as the PRECICE technology, the overall cost will decrease . You will see that happening within a decade or 2.

Hope this helps!

Dr. Michael J. Assayag, MD. FRCSC
Limb Lengthening and Reconstruction Surgeon
International Center for Limb Lengthening of Baltimore
http://www.heightrx.com
https://www.limblength.org/conditions/short-stature/
massayag@lifebridgehealth.org
@bonelengthening on Instagram

[exceeding2meters]

Dr. Assayag thank you so much for your time!

I still have to wait about 7 years until I have the money for this. I really hope Stryde price falls so I can avoid doing tibias with TSF.

[Body Builder]

Dr. Assayag thank you so much for your time!

I still have to wait about 7 years until I have the money for this. I really hope Stryde price falls so I can avoid doing tibias with TSF.

Still external tibias with tsf is and will be the best way for LL and one of the cheapest.

[exceeding2meters]

Still external tibias with tsf is and will be the best way for LL and one of the cheapest.

Please correct me if I am wrong, but from what I have been reading externals take a significantly longer time to recover. If I can save a few months with the Stryde I d certainly go for it.

Other than that afaik TSF is weight bearing so not terrible either but I d rather go for the comfort of internal if possible.

[Body Builder]

With externals you need about 40 cm for every cm you gain and you are finished.
With internals you need an extra big surgery fir the removal of the nail till you are comoletely finished.

Also, with externals the surgery is much less invasive and you can correct easily any malunion with tsf.

Finally, tibias LL look better than femurs. On femurs though internal is the only way.

I strongly believe that external tibias is the most safe way to do LL and the less painful one, if you are willing to have frames for about 10 months.

[exceeding2meters]

if you are willing to have frames for about 10 months.

That's exactly what I am worried about. I want to do both tibia and femurs but ideally (assuming the perfect scenario of no complications) I would not want to spend more than 1.5 years max.

Now I don't know if it is possible to finish tibia with TSF, and then insert femur Stryde while TSF is still on.

The advantage of easily fixing malunions is amazing, but there is also the disadvantage of bad scarring for which I don't know what kind of excuse I could give

[Michael J. Assayag, MD]

That's exactly what I am worried about. I want to do both tibia and femurs but ideally (assuming the perfect scenario of no complications) I would not want to spend more than 1.5 years max.

Now I don't know if it is possible to finish tibia with TSF, and then insert femur Stryde while TSF is still on.

The advantage of easily fixing malunions is amazing, but there is also the disadvantage of bad scarring for which I don't know what kind of excuse I could give

The lengthening and then nailing technique (LATN) allows for decreases external fixation time and involves insertion of a trauma nail after the lengthening with ex fix is done. very good technique. accelerated regenerate healing, but does not allow for weight bearing until the bone hs solidified enough.

[exceeding2meters]

The lengthening and then nailing technique (LATN) allows for decreases external fixation time and involves insertion of a trauma nail after the lengthening with ex fix is done. very good technique. accelerated regenerate healing, but does not allow for weight bearing until the bone hs solidified enough.

Thanks doc, will keep that in mind!

[Michael J. Assayag, MD]

oh! sorry I actually misinterpreted what you wrote.

If one were to do stryde femur while fixators are on, one would have to make sure the fixator is fully isolated from the sterile field as not to contaminate the femoral surgical site.

[exceeding2meters]

oh! sorry I actually misinterpreted what you wrote.

If one were to do stryde femur while fixators are on, one would have to make sure the fixator is fully isolated from the sterile field as not to contaminate the femoral surgical site.

Got you, thanks! I presume a reputable surgeon would know how to do this.

[ZUCC420]

Got you, thanks! I presume a reputable surgeon would know how to do this.

I doubt most would be able to handle the comorbid pain of doing both femur and tibia.

[exceeding2meters]

I doubt most would be able to handle the comorbid pain of doing both femur and tibia.

You mean lengthening simultaneously? Because what I meant is finish lengthening tibia, do a few months break and then while frames are still on insert stryde in femurs.

I thought this would be more tolerable? But maybe I am talking bs. Still so much to learn about this surgery...

[Gman23]

If I’m right the prices are increasing and will increase even more ... and the new up coming surgeons are fairly cheap/ with decent prices but they’ll increase prices too prob ...

[Titan]

What if we change precice or stryde nails? What if one person does femur the other one tibia lengthening using precice and then change their nails? I have talked some doctor they said its possible theorically if nails not used badly.

[Body Builder]

What if we change precice or stryde nails? What if one person does femur the other one tibia lengthening using precice and then change their nails? I have talked some doctor they said its possible theorically if nails not used badly.

It is not possible to reuse an internal nail due to major risks of infection which is the worst it could happen with LL.
No sane person or doctor would risk an amputation for 20-30k euros.
Only external fixators can be used again with changing the screws to new ones, not internal nails.

[Titan]

The autoclave machine sterilize surgical tools which can be used in this situation. Every infection does not mean inevitable amputation. If you read Myevolution’s diary he said after he stopped tibia lengthening he had pain. When doctors in canada removed stryde they cultured the nail and found staphylococcus. Basically he had osteomyletis. So even what we call “best doctor” “Paley” can make mistake. But i am guessing myevolutions wellbeing is good now. Infection due to reusage of nail can be prevented easly in my opinion.

[Bane]

I posted something similar in a previous discussion, but here it is updated.

I wouldn't realistically expect a major price drop. In the US,  it’s about $80k to $100k for Stryde CLL. There may be a price drop of several thousand dollars, but not a major price drop of something like having the price go under $40k where the most of the clients wanting CLL can afford it or be able to take out a loan to pay it off in less than 10 years.

It's basic economics with the supply and demand curve. There is a very small supply of qualified orthopedic surgeons who can do leg lengthening surgery, and a very high demand for CLL. So that's why the price is so high. In the US, we only have less than a dozen qualified CLL surgeons. If the price for a qualified surgeon was greatly reduced to under $40k as mentioned above, demand would be so high (I’m guessing easily over 100,000 in the US, even over a million) the surgeon can only accept a small percentage of clients, and thus be able to raise prices again.

[Medium Drink Of Water]

Most people think this surgery is crazy.  Demand wouldn't go very high no matter how cheap it got.

But the problem on the supply side is that qualified CLL doctors can do other things too.  There's no reason for them to lower prices much.

[Bane]

Most people think this surgery is crazy.  Demand wouldn't go very high no matter how cheap it got.

But the problem on the supply side is that qualified CLL doctors can do other things too.  There's no reason for them to lower prices much.

A correction. "Most people think the external fixator surgery is crazy." Then in 2011 the first Precice internal nail was introduced. Precice 2 came out in 2014 which is reversible and increases maximum length from 6.5cm to 8cm. Stryde came out in 2018 and became mostly full weight bearing. All of these internal nail devices became game changers to make leg lengthening and recovery more safer, reliable, and produced less pain. As a result, demand went higher because of these internal nails.

[Medium Drink Of Water]

I always thought ramming a nail inside the bone cavity was the scariest part by far.

[Bane]

But if you look at animated videos of how surgeons fix a femur or tibia fracture, they ram inside a static rod inside the bone cavity, then insert 2 locking screws at each end, to stabilize it. It's just that the rod is a static piece of metal that doesn't lengthen.

[Medium Drink Of Water]

But if you look at animated videos of how surgeons fix a femur or tibia fracture, they ram inside a static rod inside the bone cavity, then insert 2 locking screws at each end, to stabilize it. It's just that the rod is a static piece of metal that doesn't lengthen.

Scary stuff most people only get done because it's medically necessary, though.

[Growing]

With externals you need about 40 cm for every cm you gain and you are finished.
With internals you need an extra big surgery fir the removal of the nail till you are comoletely finished.

Also, with externals the surgery is much less invasive and you can correct easily any malunion with tsf.

Finally, tibias LL look better than femurs. On femurs though internal is the only way.

I strongly believe that external tibias is the most safe way to do LL and the less painful one, if you are willing to have frames for about 10 months.

Hi, You seem very knowledgeable. I was actually considering stryde for the femur until I say your post. What about the longer tibia that you like over the femur? For me this is a hard choice because I do like to wear distressed jeans and I fear my knees won't be in the correct spot so the distressed knee part of my pants would be in a weird spot vs over the knee after lengthening. Also I fear my knees looking unusually low my lengthening the femur.

[Body Builder]

Hi, You seem very knowledgeable. I was actually considering stryde for the femur until I say your post. What about the longer tibia that you like over the femur? For me this is a hard choice because I do like to wear distressed jeans and I fear my knees won't be in the correct spot so the distressed knee part of my pants would be in a weird spot vs over the knee after lengthening. Also I fear my knees looking unusually low my lengthening the femur.

I am a veteran. Jeans look great with longer tibias compared ti longer femurs.
Also, with longer tibias your foot seems longer than with bigger femurs which.look bulkier but not that tall.
Also, your knee will remain at the same distance from your hips so distressed jeans will look the same. If you do femurs your knee cap will be go more downwards and jeans will look more weird.

Aesthetically tibias look better for me and for most LLers.
Also, as I mentioned, external tibias with tsf is by far the safest way to do LL.
But if you want internal nails, then femurs are easier.
Also, if you want more than 6-6.5cm height femurs are a safer choice too.