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[Drago]

Which one would be preferable in terms of retaining functionality and less problems to run into - full 8 cm on femurs or 6 cm on femurs + 4 cm on tibias?

[6CMFemurs]

Full 8 CM femur. One surgery is safer than two. You can finish the one operation and start on your recovery. I only did femurs, but I hear that tibias take forever too and there are a lot more complications.

[Drago]

Full 8 CM femur. One surgery is safer than two. You can finish the one operation and start on your recovery. I only did femurs, but I hear that tibias take forever too and there are a lot more complications.

I see. I keep getting mixed opinions on this one though given you don't approach the maximum limit in either of those in contast.

[ghkid2019]

short term like 2 years probably 8cm femurs is better but you have to account for the fact that doing  femurs will inevitably misalign the axis of the femurs and effectively make you walk differently biomechanically and may result in arthritis. ideally 6cm femurs and 4 tibias for long term in terms of like recovery in 5-10 years+ is better for long term recovery and lifestyle. do not misunderstand doing femurs at all will mess up the axis even 1cm but less reduces that misalignment and 6 + 4 is huge amount of lenghtening no matter how one tries to twist it and you will not be the same ever. athleticism idk i feel like in the long run doing 6 + 4 is still better athletically but its just a guess.

my understanding is that in the long long term, 10 years + it is better to do quadrilaterals just because of biomechanics. short term definitely single segment.

[Drago]

short term like 2 years probably 8cm femurs is better but you have to account for the fact that doing  femurs will inevitably misalign the axis of the femurs and effectively make you walk differently biomechanically and may result in arthritis. ideally 6cm femurs and 4 tibias for long term in terms of like recovery in 5-10 years+ is better for long term recovery and lifestyle. do not misunderstand doing femurs at all will mess up the axis even 1cm but less reduces that misalignment and 6 + 4 is huge amount of lenghtening no matter how one tries to twist it and you will not be the same ever. athleticism idk i feel like in the long run doing 6 + 4 is still better athletically but its just a guess.

my understanding is that in the long long term, 10 years + it is better to do quadrilaterals just because of biomechanics. short term definitely single segment.

Yeah I suppose, that makes sense overall. I'd like to hear Dr. Assayag's input on this.

[Tokito_Ohma]

short term like 2 years probably 8cm femurs is better but you have to account for the fact that doing  femurs will inevitably misalign the axis of the femurs and effectively make you walk differently biomechanically and may result in arthritis.

Arthritis? I haven't read of a single case of arthritis from patients who did femur LL, and there is plenty who did it. Of course you will walk differently, I walked differently from when I was 10 years to now but I am bigger so my walk adjust accordingly.

Plenty of guys have done 8cm femur Stryde in this forum, all recovered to good levels. I'm guessing anyone here doing LL probably isn't trying to be a professional athlete, but above average is enough.

[Tartar]

short term like 2 years probably 8cm femurs is better but you have to account for the fact that doing  femurs will inevitably misalign the axis of the femurs and effectively make you walk differently biomechanically and may result in arthritis. ideally 6cm femurs and 4 tibias for long term in terms of like recovery in 5-10 years+ is better for long term recovery and lifestyle. do not misunderstand doing femurs at all will mess up the axis even 1cm but less reduces that misalignment and 6 + 4 is huge amount of lenghtening no matter how one tries to twist it and you will not be the same ever. athleticism idk i feel like in the long run doing 6 + 4 is still better athletically but its just a guess.

my understanding is that in the long long term, 10 years + it is better to do quadrilaterals just because of biomechanics. short term definitely single segment.

Arthritis in LL can be promoted ("due" is a too strong word) by: -joint pressure, which however decreases gradually anyway; -after a tibial lenghtening (probably beacuse an increased mechanical lever, but this is my thought based on statistics); -due to deformity of the knee. Lengthening over the anatomical axis with a nail leads to a valgus deviation BUT:
-The deviation got is very light
-You have to consider that everyone has a different "starting point"; someone has a slightly valgus knee at the beginning, others can have a slightly varus knee at the beginning.


Anyway, femur lenghtening has be proven to be better for athleticism recover, but tibia is a good option if your tibia is pretty short at the beginning or if you don't have much money, because external tibia is a safe procedure unlike external femur.

[Vibes]

I have read a lot of topics on this specific question...aka is it safer to do more in one segment or less in both etc.

Ultimately, based on my reading it seems that patients have it much easier recovery-wise when it comes to femurs. AKA even doing tibs at all introduces a much longer recovery timeline so ultimately when trying to preserve absolute athletic ability the only true choice is femurs. And then probably just doing 5-6.5 cm and not the full 8cm of STRYDE.

[Drago]

I have read a lot of topics on this specific question...aka is it safer to do more in one segment or less in both etc.

Ultimately, based on my reading it seems that patients have it much easier recovery-wise when it comes to femurs. AKA even doing tibs at all introduces a much longer recovery timeline so ultimately when trying to preserve absolute athletic ability the only true choice is femurs. And then probably just doing 5-6.5 cm and not the full 8cm of STRYDE.

Ideally one would not be doing it at all, but I wouldn't be satisfied with anything less than 8 cm honestly. So what about in that case? Most opinions point to 8 cm femurs but I'm worried I won't be able to get it because I'm inflexible and some unexpected problems could occur which make me stop at 6 cm or so, then I will have to touch tibias.

[Vibes]

Ideally one would not be doing it at all, but I wouldn't be satisfied with anything less than 8 cm honestly. So what about in that case? Most opinions point to 8 cm femurs but I'm worried I won't be able to get it because I'm inflexible and some unexpected problems could occur which make me stop at 6 cm or so, then I will have to touch tibias.

I understand and to be honest I agree with you and it is hard to be satisfied with only the safest option of 5-6.5cm femur.

Based on many diaries it seems that the best athletic recoveries have always been femurs--even those who went to 8cm. Most tibia diaries it seems patients have lingering tightness/difficulties in their soleus and Achilles for quite some time.

I think the answer is still probably 8cm femurs for you. But unfortunately you have the same problem as all of us...that we truly won't know until we have the surgery as everyone seems to have such radically-different results.

[Vibes]

short term like 2 years probably 8cm femurs is better but you have to account for the fact that doing  femurs will inevitably misalign the axis of the femurs and effectively make you walk differently biomechanically and may result in arthritis. ideally 6cm femurs and 4 tibias for long term in terms of like recovery in 5-10 years+ is better for long term recovery and lifestyle. do not misunderstand doing femurs at all will mess up the axis even 1cm but less reduces that misalignment and 6 + 4 is huge amount of lenghtening no matter how one tries to twist it and you will not be the same ever. athleticism idk i feel like in the long run doing 6 + 4 is still better athletically but its just a guess.

my understanding is that in the long long term, 10 years + it is better to do quadrilaterals just because of biomechanics. short term definitely single segment.

I thought the axial deviation you are referring to has since been dismissed by Paley? I asked him during consult and he said that because of retrograde insertion techniques they are able to position nail not perfectly center in bone if you can understand what i mean--it is put in at slight angle within the intramedullary canal.

Using this technique, the otherwise previously-thought deviation of 1mm per cm lengthened (aka 8mm deviation total for full 8cm of STRYDE nail lengthening) does not occur.

BTW I'm not making any claims either way, only sharing what I was told.

[ghkid2019]

I thought the axial deviation you are referring to has since been dismissed by Paley? I asked him during consult and he said that because of retrograde insertion techniques they are able to position nail not perfectly center in bone if you can understand what i mean--it is put in at slight angle within the intramedullary canal.

Using this technique, the otherwise previously-thought deviation of 1mm per cm lengthened (aka 8mm deviation total for full 8cm of STRYDE nail lengthening) does not occur.

BTW I'm not making any claims either way, only sharing what I was told.

idk but i think its possible to minimize but eventually its still gonna deviate slightly just by virtue of not being straight no matter how the nail be shoved in. im sure paley can make it drastically reduced where it esentially doesnt affect much though but there is gonna be a little which is just not ideal. and based on bone remodeling looks straight on all his xrays so it really doesnt matter how he shoves it in, the bone heals straight it appears so it gonna be deviated.

[Vibes]

idk but i think its possible to minimize but eventually its still gonna deviate slightly just by virtue of not being straight no matter how the nail be shoved in. im sure paley can make it drastically reduced where it esentially doesnt affect much though but there is gonna be a little which is just not ideal. and based on bone remodeling looks straight on all his xrays so it really doesnt matter how he shoves it in, the bone heals straight it appears so it gonna be deviated.

I agree, it doesn't make sense that it could be reduced to zero. I just hope that we can trust the top experts because if we can't even trust what Dr. Paley or Dr. Roz/etc say then who can we trust at all...