Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[medcare]

Think twice about this for cosmetic purposes. I've been witness of disastrous outcomes in otherwise perfectly healthy patients. This is not correct.

[ReadRothbard]

Such as what?

[KrP1]

Think twice about this for cosmetic purposes. I've been witness of disastrous outcomes in otherwise perfectly healthy patients. This is not correct.

i didnt read what you said yet, please repeat

[ReadRothbard]

Medcare, you’re usually very rude, but in this thread you’re telling the truth. Sometimes LL leads to disastrous outcomes, and sometimes these disasters are unavoidable, even if you’re operated by the best surgeons in the world. Fat embolism, for example, isn’t a theoretical complication, but a very real risk which is usually silenced in the forum and however happens. And there are patients from the best surgeons in the world who die from it. I’ve been told this by a very reliable source from a medical point of view. 
Can we do anything to avoid these risks? Sometimes it's imposible to avoid these disastrous outcomes, but you can minimize complications by choosing a good doctor, who stays in the safe zone and respects the protocols. It’s better not doing more than one segment at once and even avoiding CLL if possible. Risks are high and real out there.

Do you happen to have any data on how often fat embolism happens?

[KiloKAHN]

Only things about embolism death I found so far:

[Fat embolism during limb lengthening with a centromedullary nail: three cases].
Blondel B1, Violas P, Launay F, Sales de Gauzy J, Kohler R, Jouve JL, Bollini G.

Several methods are available for progressive limb lengthening, including centromedullary nailing, external fixation, or a combination. Each technique has its own advantages and drawbacks. In trauma victims, use of centromedullary nailing is associated with potentially fatal fat embolism. This fatal outcome might also occur during limb lengthening, particularly in bilateral procedures. To our knowledge, fat embolism has not been reported with the use of centromedullary nail for limb lengthening. This was a multicentric study of three cases of fat embolism, including one fatal outcome. In all, 36 centromedullary lengthening nails were inserted in the three centers before these acute episodes. The first two cases occurred during single-phase bilateral procedures, the third during unilateral lengthening.

Fat embolism could result from several factors, as reported in the literature. While the bilateral nature of the procedure has been incriminated, the observation of an embolism during a unilateral procedure suggests other factors may be involved. Considerable increase in endomedullary pressure during reaming and insertion of the nail has been demonstrated. At the same time, there is the question as to whether the reduction of the diminution of medullary pressure by corticotomy would be an efficient way of reducing the risk of fat embolism. Based on the analysis of our three cases, we suggest that the best way to avoid fat embolism might be to drill several holes within the area of the osteotomy before reaming, in order to reduce endomedullary pressure. This can be achieved via a short skin incision, sparing the periosteum before low energy osteotomy. Since applying this protocol, the three centers have implanted 17 lengthening nails, without a single case of fat embolism.

http://www.ncbi.nlm.nih.gov/pubmed/18774027

Strategy in the surgical treatment of achondroplasia: techniques applied in the Department of Orthopedics and Traumatology Hospital of Lecco
M.A. Catagni, F. Guerreschi, L. Lovisetti

Between 1982 and 2007, 128 patients with achondroplasia were treated in the Lecco Hospital. 100 of these were treated with sequential bilateral limb lengthening and seven with crossed lengthening. The average tibial lengthening was 14.1 centimeters (range: 6 to 19 cm). The average femoral lengthening was 9.8 centimeters (range: 8 to 12 cm), and the average humeral lengthening 8.3 centimeters (range: 8 to 12 cm).

...

The complications were classified as minor, moderate, and severe. Minor complications were those which required only modification of the apparatus during treatment. Twenty-three percent of the lengthenings required some modification of the device during treatment. Moderate complications were those which required additional procedures during lengthening. Forty-two percent of patients fell into this category. Finally, severe complications were those which required another surgery following treatment or had lasting sequelae of the treatment. Twenty-one percent of patients fell into this category. The most common complication was equinus contractures of the ankle which required treatment by tendoachilles lengthening. Two pulmonary emboli were sustained following percutaneous tendo-achilles lengthening. One patient died as a result of this complication.

http://link.springer.com/article/10.1007%2Fs10261-009-0032-9

[Tyler_Durden]

^^ Actually there are ways you can prevent Fat embolism .
This is what Dr Dror Paley have wrote about it :
http://www.screencast.com/t/aRmHCK8m

[abo]

So you wont be able doing sports after doing this?!

[Samuimw]

This made me so scared.

[Samuimw]

Does anyone know when fat embolism occurs? Can it happen all the way through the LL? Or only a few hours after the surgery?

[heightangel]

Interesting answer, mm. I like this kind of answers more than your other posts. In my humble opinion you're usually too credulous and naive. Too young perhaps? You should be more critical.

[YellowSpike]

Interesting answer, mm. I like this kind of answers more than your other posts. In my humble opinion you're usually too credulous and naive. Too young perhaps? You should be more critical.

Oh snap! Dems are fightin' words! 

[heightangel]

Oh snap! Dems are fightin' words! 

No. I'm just being friendly. I like this post.

[YellowSpike]

No. I'm just being friendly. I like this post.

What you said seemed like a backhanded compliment. You called MM naive lol. But I was only joking...I'll grab some popcorn and stay out of it

[Tylerdurden389]

The opening post to this thread is great, as well as the list of any and all complication that may/will occur during treatment post surgery. It's definitely given me some perspective about LL. I had never honestly considered doing it while I'm still poor (maybe someday I'll be in the working class status if things at my job go well, lol). But honestly, I think if were to ever hit the lottery, I'd get the surgery, only get 5 cm on both bones (for a total of almost 4 inches) and attempt to make myself go from 5-2 (158 cm) to 5-6 (167). And if complications arose that prevented me from being athletic anymore, or worse yet, confined to a wheelchair, I think having my millions of $$$ would make up for it.

Sorry if my post is redundant to the topic but just thought I'd share my tfeelings on this with like-minded individuals

[drewicz]

These are complications of all surgery.
I had once a surgery to cut lump on my arm bone and i must signed a statement that it is possibility that i can't move my hands after that.

Did anyone know someone who all paralyzed or have nerve damage after LL?

[Infinity]

It is not so far fetched that general patients are apprehensive about reporting complication when still lengthening under the care of the surgeon. More so if surgeon regularly visits the forum.

I have personally seen few complications with some renowned European surgeons where patients have lost function. Generally compartment syndrome and foot drop is a very real possibility when doing internal tibias.

[Madmax_01]

I could find information about complications from tibia lenghtening surgery on Wikipedia, which had references from Pubmed. I could not find the link but I remember something about 75% suffered from arthritis. Does anyone have information about long-term complications after INTERNAL FEMUR lenghtening? Any scientific data or studys to back up the infos which are presented in the forum.

[PatientZero]

Interesting answer, mm. I like this kind of answers more than your other posts. In my humble opinion you're usually too credulous and naive. Too young perhaps? You should be more critical.

That's a sh1tty humble opinion and you are 98% wrong. I have met the goddess herself in real life. Desperate is not the same as being naive or credulous.

[Alu]

I could find information about complications from tibia lenghtening surgery on Wikipedia, which had references from Pubmed. I could not find the link but I remember something about 75% suffered from arthritis. Does anyone have information about long-term complications after INTERNAL FEMUR lenghtening? Any scientific data or studys to back up the infos which are presented in the forum.

Internal Femurs aren't relatively old or new, so I doubt there are long term studies into the after effect (I certainly couldn't really find anything). But, I would infer that a huge factor into what might cause Arthritis in relation to LL through the Femurs would be how much one lengthens and how the rods are inserted. I know for a fact Paley likes to insert his nails through the back, and not through the knees.

[Alu]

Also the best/closest things to studies we have are these abstract conference book for an event that occurred about a month ago in which orthopedist congregated and talked about their own experiences.
http://illrsmiami2015.com/abstract-book/

As far as the details go it's very much sparse and vague as it can possibly be; to my knowledge none of the lectures were recorded or are available to the general public. What is interesting about this is that includes the like of Dong-Lee, Paley, and Guichet talking about their results with Cosmetic Limb Lengthening.

[Madmax_01]

Internal Femurs aren't relatively old or new, so I doubt there are long term studies into the after effect (I certainly couldn't really find anything). But, I would infer that a huge factor into what might cause Arthritis in relation to LL through the Femurs would be how much one lengthens and how the rods are inserted. I know for a fact Paley likes to insert his nails through the back, and not through the knees.

Do you have any idea what might be the red line here? Speaking about the insertion of the nail. Do you know if Dr Guichet uses the same technique?

I am asking myself these questions because tibia lenghtening seems to have a lot of correlation when it comes to knee problems. I was wondering if the same applies to femur lenghtening.

Also the best/closest things to studies we have are these abstract conference book for an event that occurred about a month ago in which orthopedist congregated and talked about their own experiences.
http://illrsmiami2015.com/abstract-book/

As far as the details go it's very much sparse and vague as it can possibly be; to my knowledge none of the lectures were recorded or are available to the general public. What is interesting about this is that includes the like of Dong-Lee, Paley, and Guichet talking about their results with Cosmetic Limb Lengthening.

That looks like a great ressource. Thank you! I wish we could find out more about the lectures.

[Alu]

Do you have any idea what might be the red line here? Speaking about the insertion of the nail. Do you know if Dr Guichet uses the same technique?

I am asking myself these questions because tibia lenghtening seems to have a lot of correlation when it comes to knee problems. I was wondering if the same applies to femur lenghtening.

Typically saying 5 CM on either Tibia or Femurs always seems to be a great limit. It give you 2 inches, and if we are just talking about femurs here, 5 cm isn't that much in femurs. In fact, with femurs one might even be able to go as far as 8 cm (5 CM+ on tibia isn't a good idea for max recovery); although after that I wouldn't recommend going for tibia increase since your proportions would look weird.

So honestly If you want max gain of 8-10 and keep good recovery (we have no idea if we can get back to 100%; 90% seems close so far but who knows) then splitting the surgeries would be the most advantageous.

Also this is 4 years outdated but I'm sure it's still the same:

[LLuser1]

Very good comment. There's a clear bias in the forums not to show the complications. I have been attacked several times for writing about what i have seen at a very popular doctor. Nobody gets attacked for writing nice things. Even patients with diaries try to hide negative things (they are still under treatment , how could they dare openly criticise their doctors? ) . They rather stop writing or simply don't tell the truth.
I personally believe if i went to India my experience wouldn't have been worse than what has happened to me in Germany.

Very good comment Metanoia. Popular doctors and their popular patients... don't tell the truth.

[Madmax_01]

Is it true, that you are not allowed to fly on a plane? I have read it on anold forum, that it causes tremendous pain, and it is almost unbearable to fly when you have internal rods. Of course, I mean after the lenghtening phase but before the removal procedure.

[DoingItForMe]

Is it true, that you are not allowed to fly on a plane? I have read it on anold forum, that it causes tremendous pain, and it is almost unbearable to fly when you have internal rods. Of course, I mean after the lenghtening phase but before the removal procedure.

I have internal femur rods and I fly just fine with no pain. Most of the pain might be from sitting for too long while putting pressure on your rods due to the now shorter seats compared to when your femurs were shorter. This can be fixed by putting something under your feet to take the pressure off your rods and onto your feet instead. This only affects people with short tibias like me who can't reach the floor while sitting.

[ub40]

Can we get back to the original topic? Is there ways for doctors to mitigate this or has there been any new techniques?

[kieran19801980]

That's an interesting post. It would be great to hear from people who had internal femurs done and if they have any complications say from two years onwards. The operation is costly both financially and in time. Considering the "cheapest" for internals in Europe is 48,000 euros not including accommodation/physio/food which is possibly another 8000 euros if one decides to stay for the entire lengthening period. ( say three months for 7.5cm) As well the person is out of work which I'm guessing for five months before walking "normally", that is nearly three months for lengthening and two months for consolidation (on crutches). That's five months out of your life and work ( if your job entails walking a lot or doing community work). It's a big sacrifice.

[abo]

http://www.childrenshospital.org/centers-and-services/anterior-cruciate-ligament-program/bridge-enhanced-acl-repair-trial

What do you guys think about this?! if the problem with this operation will be the knee? is it possible to recover 100% from this operation?

[Antonio]

New study shows that increasing Tibia/Femur ratio beyond 0.8 is correlated with long-term arthritis.

Copy paste from link https://www.ncbi.nlm.nih.gov/pubmed/26398436:

The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees.
Weinberg DS1, Liu RW.
Author information
Abstract
BACKGROUND:

When individuals with asymmetric lower extremities present for evaluation of limb-length inequality, correction can occur at the tibia, femur, or in both bones; however, there are limited data available to justify either technique. The aim of this study is to examine the normal ratio of tibia length/femur length (T/F), and to explore the relationship between T/F ratio and osteoarthritis of the spine, hips, and knees.
METHODS:

Bone lengths of 1152 cadaveric femora and tibiae from the Hamann-Todd osteological collection were measured. Degenerative joint disease was graded in the hip, knee, and spine. Correlations between the ratio of T/F and osteoarthritis were evaluated with multiple regression analysis.
RESULTS:

The average ratio of T/F was 0.80±0.03. There was a strong correlation between age and arthritis at all sites, with standardized β ranging from 0.44 to 0.57 (P<0.0005 for all). There was a significant correlation between increasing T/F and hip arthritis (standardized β=0.08, P=0.006), and knee arthritis (standardized β=0.08, P=0.008).
DISCUSSION:

Increasing tibia length relative to femur length was found to be a significant predictor of ipsilateral hip and knee arthritis. Therefore, we recommend that when performing limb lengthening, surgical planning should lean toward recreating the normal ratio of 0.80. In circumstances where one bone is to be overlengthened relative to the other, bias should be toward overlengthening the femur. This same principle can be applied to limb-reduction surgery, where in certain circumstances, one may choose to preferentially shorten the tibia.
CLINICAL RELEVANCE:

This is the first study to report long-term consequences of lower extremity segment disproportion.

[OverrideYourGenetics]

I have:

-Altered sensation in my knees when kneeling or touching them, around the IM nail insertion sites and around the osteotomy sites
-Stiffness in my knees unless I exercise regularly
-Hypersensitivity in my knees when kneeling on a hard surface
-Worse balance than before
-A left ostoetomy scar that's thin and weak, that I have to protect from getting bumped or it'll break and bleed
-Altered mechanics in my legs which led to exertional compartment syndrome when walking, requiring fasciotomy

I hope my posts and diary here don't whitewash the issues I've dealt with and continue to deal with as an LLer.  I did it and got my 3 inches without getting crippled.  Those 3 inches changed my life, but sacrifices were made.  LL is a tradeoff and there are consequences I'll have to live with from now on.

3 inches in the tibias is a lot, and more than what most doctors would recommend. I know LL is costly, but if you're concerned about complications, split the increase in height across the tibias and femurs. That way you can get 2 + 2 inches with far less risk.

how do you suggest we end our own lives?

You can go all high-tech about it

No, seriously, get the money for a top doctor and you'll be fine.

Fat embolism, for example, isn’t a theoretical complication, but a very real risk which is usually silenced in the forum and however happens. And there are patients from the best surgeons in the world who die from it. I’ve been told this by a very reliable source from a medical point of view.

Where did that happen and why wasn't the surgeon sued for malpractice?

Can we do anything to avoid these risks? [...] It’s better not doing more than one segment at once and even avoiding CLL if possible.

Exactly. Paley advises against doing both segments at once. I'll be doing them three weeks apart.

tibia lenghtening seems to have a lot of correlation when it comes to knee problems. I was wondering if the same applies to femur lenghtening.

I've asked Dr. Paley about knee pain following insertion of nail in the tibias. His reply:

Very little if any knee pin in our patients with CLL after tibial lengthening. I think it has to do with the minimally invasive we we insert the rod and avoid damage or irritation to the patellar tendon.

So honestly If you want max gain of 8-10 and keep good recovery (we have no idea if we can get back to 100%; 90% seems close so far but who knows) then splitting the surgeries would be the most advantageous.

Exactly. That's my research too so far after spending weeks reading a ton of patient diaries. Keep your lengthening to 5-6 cm in the femur and 5 in the tibias, and pay attention to when physical therapy during the lengthening phase become suddenly more difficult - and stop there. The extra 1 or 2cm is NOT worth the pain and complications. Think 2 years to return to normal function instead of 6 months. Do you want that? In that year and a half you might as well earn the money to pay the difference between just femurs and femurs+tibias. This is the route I'm taking.

[backrandom]

Where did that happen and why wasn't the surgeon sued for malpractice?

I don't know what doctor MM talks about. All I can say is patients sign a medical consent form where it says that fat embolism is a possible side effect of this surgery. When you get this surgery you must assume that death is a possible, if highly unlikely, risk. Doctors can't be sued if you die from fat embolism since it's a well known, though highly unlikely, side effect of this surgery.