Excited for your diary... You have given us hope that Dr Parihar is still an option... Do you know the new price list for surgery with Parihar, if so please could you send me the link on mention it here. If possible In $ or £. I believe it’ll be around 50k for one surgery 
Also I am from India too but live in Uk so it’ll be a better option for me. Please reply, thank you !
Thanks Gman!
"How Much Lengthening is possible:
5 cms can be safely done in most situations
Usually not more than 5 or 6 cms in the tibia, depending on function (see other comments at bottom of page)
internal lengthening nails may allow 7.5 cm of length in the FEMUR (again depending on clinical progress)
We don't do external lengthening of the femur in cosmetic cases, only for unilateral LLD due to unequal growth in the femur.
There are three methods that can be used:
"lengthening over nail" (LON) method.
External fixator only - if patient does not want to undergo the LON or if the anatomy does not allow the use of the nail.
internal lengthening nail (precice 2).
Description of the technique:
1. LON:
at the initial surgery, a fixator is applied on both the legs and a rod is put inside the bone.
The bone is then cut and gradual lengthening begun after 7 days. This lengthening is done at 0.75 mm to 1 mm per day.
at the end of lengthening, (usually 50 to 60 days if distracting at 1 mm per day, more if 0.75 per day), the rod which was place inside earlier is locked, so that the fixator can be removed. the rod then holds the bone in its lengthened position till such time as the bone matures. this process normally takes a minimum of additional 120 days.
The overall period before a patient gets back to normal for a lengthening of 6 cms is a minimum of around 6 months.
However, oftentimes, depending on the patient it may take anything from 8 – 12 months.
2. External Fixator only:
Similar to the above, except that an internal rod is not implanted. Therefore the fixator has to remain on the legs till the bone is fully healed.
3. Internal Lengthening Nail:
No external fixator is used. A special, imported nail is implanted in the bone to be lengthened, and a magnetically actuated mechanism in the nail lengthens the nail (and thus the bone) by 1 mm per day.
Once desired length is achieved, the distraction is stopped and bone heals.
Advantages / Disadvantages of each:
LON:
Advantage: The “external fixator time” is much less than the “healing time” and patient is free of the inconvenience of the fixator. (fixator is removed after the lengthening – about 2.5 to 3 months)
Disadvantage: small risk of infection in the bone due to the nail inside. Small risk of pain in the knee from the insertion site of the nail.
External fixator:
Advantage: least risk of intramedullary infection. No risk of knee pain
Disadvantage: The ‘external fixator time” is the same as the “healing time”. i.e. fixator has to be on the leg till the bone is healed.
Internal lengthening nail:
Advantage: no external device, therefore no problems with scars, least amount of pain of the three methods.
Disadvantage: cost. Small risk of complications related to the nail – embolism, infection etc.
Time periods involved:
hospitalisation is usually for 7 days, but the patient has to stay in mumbai till the distraction is complete as this is the time till which problems if any can occur. once the rod is locked, patients can go back home and just send xrays to monitor the healing.
overall return to normal activity would take a minimum of 6-8 months.
in the initial period while the distraction is going on, the patient is relatively
incapacitated, and is only able to do bed to wheelchair transfers. after the locking is done, patients can begin putting weight on their legs and walking with the aid of a walker (zimmer frame) depending on pain and the xray apperance. usually i would expect most patients to be taking almost full weight about 4 months after surgery (with crutches)
The time taken to heal depends on multiple factors, which are primarily related to the patient – i.e. LON or external fixation or internal nails, will all heal at the same rate for a given patient .
Stay in Mumbai:
Since the patient needs to stay in Mumbai for the duration of lengthening, a stay of 90 - 100 days is envisaged
Short term rentals are not easy to find, and patients most likely would need to stay in a hotel in the vicinity. Hotels would give you cheaper rates for a long stay. This is not included in the costs of treatment.
Other comments:
normally we do not do lengthening more than 5 or 6 cms for cosmetic reasons, as the rate of complications rises exponentially after that length.
in any case, we are very clear that function is more important than length, and in case any problems with function (such as stiffness in the ankles) arises during the treatment, we stop at whatever length has been achieved, and concentrate on the physiotherapy to regain function.
the process is fairly taxing for the patient, and needs good emotional support from a partner or other member of family.
For Surgery, we need an accompanying Relative to be present in the hospital. Only in very rare situations we do we undertake surgery without a relative present.
Costs:
The overall costs for the procedure come to around Indian Rupees 9,00,000/- (Rupees nine lac only).
This includes, stay in hospital for the surgery, doctors fees, physiotherapy, OT charges materials used in hospital / surgery.
in case of internal lengthening there is an additional cost for the nails which is ordered directly by the patient from the company –see below for costs.
This does not include stay in Mumbai after discharge from hospital, physio after discharge from hospital etc.
Future Function after lengthening:
Once the bones have healed, there should be no problem with exercise and full activity.
When the LON Cannot be done:
If the bone to be lengthened is too thin, or too narrow, or too short, to accept a nail, LON cannot be done.
In that case, only External fixator lengthening can be done. In that event, the fixator remains on the leg till the bone is completely healed, (a process which may take 10 – 12 months for a 6 cm lengthening).
The patient is able to move around and perform most activities, but the fixators on the leg may be a bit of an impediment, depending on the patients personal and job profile.
More about Internal Lengthening: (Precice 2 nails):
Precice 2 nails are available in India.
The cost for the nails (in addition to hospital charges) is 10.55 lakhs per nail (total 21.10 lakhs). This includes the costs to do the paperwork for the import of the nails (by the local distributor). (This is a new, reduced price)
This cost is ONLY the nails, and costs for hospital and professional fees are additional.
Patient needs to stay in India during the lengthening phase.
Using this nail, the femur, or the tibia can be lengthened. The femur is preferred.
Once a patient decides for the surgery, the entire payment for the nail is to be made to the local distributors, who in turn will start the paperwork to import the nail to India, specifically for that patient.
It takes 6 weeks, after payment for the nails to be available for implantation.
After the paperwork is completed, a clinical support person from Nuvasive USA will double check the sizes etc and discuss with us, prior to despatching the nails.
A clinical support person from Nuvasive USA, will be present during the surgery, for support.
in case of malfunction, a replacement would be provided without charge. there would be some OT charges etc involved, which would be charged by the hospital, but no surgeon charges
More Information (Skype Consultation):
we apologise that we do not do email consultation (replying to and fro to various questions on email)
If you have a lot of questions that need answering, we would be happy to do a 20 minute Consult on Skype, @ at cost of US$ 200, at a time that is mutually convenient to you and us.
Please write down a list of questions that you may have, so that you can make the most of the time available.
email us at info@bonedocs.in with 'skype consult' in the subject line, and your convenient times to speak (with your time zone) and we will get back to you with possible times and details of how the payment is to be made, before the consult.
Alternatively, if you live in India, we are happy to see you in Mumbai for a consultation in person.
"
Just quoted from the link sent here. Also in the original post for Stryde.
Author
Topic: Thoughts on going with Dr. Parihar? (Read 4464 times)