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[ninjabnw]

Hi All.

SURGERY VID LINKS and PICS BELOW

After watching and comparing the surgeries done by Dr. Giotikas and Dr. Munjed Al Muderis, it seems that they both perform the same surgery with the precise nail differently.

I watched Dr. Munjed Al Muderis first, and realized how much importance he placed on maintaining rotational alignment of bones during surgery. He even talks that there is an inevitable 10° discrepancy after the osteotomy is performed (and seems to prove this by showing that the aiming pins are no longer parallel after the osteotomy), and that the rotation must be restored before locking the distal screws.

When looking at a still frame of the x ray after both proximal and distal screws are locked with DR. MUDERIS, the bone looks aligned (pic link below). HOWEVER...
Surgery Vid (8:01 for x ray): https://www.youtube.com/watch?v=3Fn67nWCKe0&list=PLKyxblIhpNMLkWIqfgrrrTX__3QGlHn_z&index=1
Bone Alignment Still Frame: https://imgur.com/a/X3zHGp9

When looking at a still frame of the x ray after both proximal and distal screws are locked with DR. GIOTIKAS, the bone looks COMPLETELY MISALIGNED (pic link below).
Surgery Vid (5:05 for x ray): https://www.youtube.com/watch?v=IP1BSMUR9ME&list=PLKyxblIhpNMLkWIqfgrrrTX__3QGlHn_z&index=2
Bone Alignment Still Frame: https://imgur.com/a/phjR6n3

My question is, am I just tripping out on this still frame or does the x ray of Dr. Giotikas patient's bone look misaligned? If so, are there potential future complications because of this? Posture, permanent gait, etc?

In total, there were 4 discrepancies that I found between the surgeries performed by Dr. Giotikas and Dr. Munjed Al Muderis. I will list them below and let me know if anyone finds any other discrepancies:

1. Dr. Munjed Al Muderis locks proximal screws first whereas Dr. Giotikas locks distal screws first
2. Dr. Munjed Al Muderis uses the Piriformis entry whereas Dr. Giotikas uses the Trochanteric entry
3. Dr. Munjed Al Muderis adjusts rotational alignment between locking of proximal and distal whereas this didn't seem to happen with Dr. Giotikas
4. Dr. Munjed Al Muderis uses that antibiotic cover over the leg whereas Dr. Giotikas doesn't

**Small edit to post**
I just rewatched Dr. Giotikas surgery vid and it also seems that the aiming pins are removed before the proximal screws are inserted. Is this normal? I feel like it can't be.
I'm also going to post the x ray pic of his patients femur during and right after the osteotemy, but before the proximal screws are inserted.
Still frames of before and after locking proximal screws: https://imgur.com/a/zkLnweT

Are these cause for concern?
Thanks in advance!

[V21]

I'm a Giotikas patient and my X rays look like in the picture from the video. I asked a lot of times, and I was reassured that's not misalignment, so I have no idea.

[Masteryourlife]

Dr Al muderis is praised by dr .Rozbruch as one of the bests so that says a lot .
He is specialized in LL and reconstruction while giotikas it's not ; he is an orthopedic surgeon also trained for LL (ALSO not only) while most of other doctors like Lee,Rozbruch,Paley,Thaller,Assayag etc. Are specifically JUST LL doctors and that makes a difference !
Giotikas had many complaints given that he just started and more then 1 person here claimed misalignment with him (not to mention he got a death but I assume at this point everyone should know this ) .

Your topic us very smart/usefull so first I want to thank you for bringing this detailed comparison and 2nd ,from my pov , yes this is cause of concern and if I was you ,I would go with Al muderis if you could , or with doctors that did/do ONLY LL and are renowned in their field.

[indication]

Rozbruch also has a surgery video. Please compare against it.

[ninjabnw]

I'm a Giotikas patient and my X rays look like in the picture from the video. I asked a lot of times, and I was reassured that's not misalignment, so I have no idea.

What explanation did he give about why it isn't misalignment? Have you consulted with other LL doctors about this? I hope this isn't a misalignment for you sake. I know that there are surgeons on this forum, like Dr. Assayag. Maybe he can see this and give us his opinion?

[ninjabnw]

Dr Al muderis is praised by dr .Rozbruch as one of the bests so that says a lot .
He is specialized in LL and reconstruction while giotikas it's not ; he is an orthopedic surgeon also trained for LL (ALSO not only) while most of other doctors like Lee,Rozbruch,Paley,Thaller,Assayag etc. Are specifically JUST LL doctors and that makes a difference !
Giotikas had many complaints given that he just started and more then 1 person here claimed misalignment with him (not to mention he got a death but I assume at this point everyone should know this ) .

Your topic us very smart/usefull so first I want to thank you for bringing this detailed comparison and 2nd ,from my pov , yes this is cause of concern and if I was you ,I would go with Al muderis if you could , or with doctors that did/do ONLY LL and are renowned in their field.

Yeah, it seems insane that someone has already passed away under him. That's really scary that people are already claiming misalignment.

It also seems that the 2 most common deaths (Yush Gupta, and the patient under Dr. Giotikas) were both from the Gnail. I wonder if the type of nail has anything to do with triggering a pulmonary embolism?

[ninjabnw]

Is this the video you're talking about?
https://www.youtube.com/watch?v=C4Hmq4WEpjA

Similar to Dr. Giotikas, it seems that Dr. Rozbruch does not use the antibiotic cover over the leg, and also locks the distal screws first. He does place great importance on making sure the aiming pins maintain parallel when locking the screws

Similar to Dr. Munjed Al Muderis, it seems that Dr. Rozbruch uses Piriformis entry.

I just rewatched Dr. Giotikas surgery vid and it also seems that the aiming pins are removed before the proximal screws are inserted. Is this normal? I feel like it can't be.
I'm also going to post the x ray pic of his patients femur during and right after the osteotemy, but before the proximal screws are inserted.
Still frames of before and after locking proximal screws: https://imgur.com/a/zkLnweT

[Masteryourlife]

Yeah, it seems insane that someone has already passed away under him. That's really scary that people are already claiming misalignment.

It also seems that the 2 most common deaths (Yush Gupta, and the patient under Dr. Giotikas) were both from the Gnail. I wonder if the type of nail has anything to do with triggering a pulmonary embolism?

I brought up this question abkut g nail too but there are no scientific evidences.
My personal opinion is that both doctors are not carefull and probably in both cases was used the 13 mm nail which is very big and I believe that it can someone raise the chances of PE/FE .
So a combination of nail/protocol according to my unprofessional opinion .

[V21]

What explanation did he give about why it isn't misalignment? Have you consulted with other LL doctors about this? I hope this isn't a misalignment for you sake. I know that there are surgeons on this forum, like Dr. Assayag. Maybe he can see this and give us his opinion?

He just told me that this is the shape of my femurs. Nurses said the same. There is an Assayag patient who showed him my X rays and he did not see anything to worry about, but that's only what the patient told me, I haven't spoken to him by myself. The Spanish Dr. who checks my X rays say that all is good cause bone is forming in the inner part and, in the end, the result is a straight femur. For example, my left femur was the one that appeared more misaligned, and now is the one that looks straighter. However, this Dr is not a LL Dr, so who knows.

This are my front X rays one month ago or so: https://imgur.com/a/ECc8ClL
Side view X rays do look perfect.

And by the way, the nail has nothing to do with embolism. There can be another debate about blood thinners etc, but the nail is definitely not the cause.

[eric.cartman]

I did my tibias with Giotikas and had misalignment in both legs during nail insertion. I needed an extra surgery to fix it. I still have a misalignment in my left leg which might require additional surgery in the future.

Betz looked at my x-rays and told me right off the bat that there is a misalignment. He got into some details about the nail insertion angle and rotational axis etc. i While I think Giotikas is a good doctor, he’s not as thorough as some of the other LL doctors. We can all agree that LL has many risks, but imo, rotational misalignment during nail insertion is 100% surgeon’s error.

[Masteryourlife]

I did my tibias with Giotikas and had misalignment in both legs during nail insertion. I needed an extra surgery to fix it. I still have a misalignment in my left leg which might require additional surgery in the future.

Betz looked at my x-rays and told me right off the bat that there is a misalignment. He got into some details about the nail insertion angle and rotational axis etc. i While I think Giotikas is a good doctor, he’s not as thorough as some of the other LL doctors. We can all agree that LL has many risks, but imo, rotational misalignment during nail insertion is 100% surgeon’s error.

If I was you , I would sue him at least to cover the expenses of the extra surgery you had to undergo just because of his mistake .
He is not a good surgeon if he can't even prevent misalignments in 2 bones !
He might be n ok trauma surgeon but not a good LL one

[Achieverr]

Guys,
Should we really be worried abut that ??
I am planning to do the g-nails in my femurs with Dr Giotikas
I understand that things went well for V21 eventually
maybe the misalignment have to do with the diameter of the nail since G-NAILS are 13mm in dia

[Siegfried]

he is an orthopedic surgeon also trained for LL (ALSO not only) while most of other doctors like Lee,Rozbruch,Paley,Thaller,Assayag etc. Are specifically JUST LL doctors and that makes a difference !

Thaller does not only do LL, thats maybe 1% of what he does. He is a trauma surgeon. Probably the majority of surgeons who dd LL are either orthopedic or trauma surgeons, which happen to do ll as well, mostly because they have many leg length discreptancy patients.

[Masteryourlife]

Thaller does not only do LL, thats maybe 1% of what he does. He is a trauma surgeon. Probably the majority of surgeons who dd LL are either orthopedic or trauma surgeons, which happen to do ll as well, mostly because they have many leg length discreptancy patients.

Yes but I believe his traumas are not hip replacements but leg length discrepancies or problems related to that .
He lengthens, for different reasons,  but as far as I saw from his articles/publications and his interview ..all he does is lengthen and save/fix limbs .
He might do it for different porpuses but that is his specialization while giotikas is a general ortho surgeon trained to also do LL ; that is what I got out of my researches.
Idc much about giotikas but if you have more infos about Thaller like him doing something else other then LL related cases , I would love to hear about that since I might reconsider my choiche ; I want a surgeon who performs only LL related surgeries (like Paley,Lee,Rozbruch) and not who offers ALSO that .

[ninjabnw]

I brought up this question abkut g nail too but there are no scientific evidences.
My personal opinion is that both doctors are not carefull and probably in both cases was used the 13 mm nail which is very big and I believe that it can someone raise the chances of PE/FE .
So a combination of nail/protocol according to my unprofessional opinion .

Interesting. So you think it could be the diameter of the nail that affects PE? Isn't improper drainage of the bone canal related to pulmonary embolisms? Or is that just fat embolisms in the first 72 hours?

[ninjabnw]

He just told me that this is the shape of my femurs. Nurses said the same. There is an Assayag patient who showed him my X rays and he did not see anything to worry about, but that's only what the patient told me, I haven't spoken to him by myself. The Spanish Dr. who checks my X rays say that all is good cause bone is forming in the inner part and, in the end, the result is a straight femur. For example, my left femur was the one that appeared more misaligned, and now is the one that looks straighter. However, this Dr is not a LL Dr, so who knows.

This are my front X rays one month ago or so: https://imgur.com/a/ECc8ClL
Side view X rays do look perfect.

And by the way, the nail has nothing to do with embolism. There can be another debate about blood thinners etc, but the nail is definitely not the cause.

Are you able to walk yet/do you feel any awkwardness when walking? Anything that feels like they might be misaligned? That's good that Dr. Assayag said they looked good.
Also, is there a reason you only have 1 proximal screw on each side?

[ninjabnw]

I did my tibias with Giotikas and had misalignment in both legs during nail insertion. I needed an extra surgery to fix it. I still have a misalignment in my left leg which might require additional surgery in the future.

Betz looked at my x-rays and told me right off the bat that there is a misalignment. He got into some details about the nail insertion angle and rotational axis etc. i While I think Giotikas is a good doctor, he’s not as thorough as some of the other LL doctors. We can all agree that LL has many risks, but imo, rotational misalignment during nail insertion is 100% surgeon’s error.

When did you do your tibias with Dr. Giotikas? Can you show us your x rays?

[Masteryourlife]

Interesting. So you think it could be the diameter of the nail that affects PE? Isn't improper drainage of the bone canal related to pulmonary embolisms? Or is that just fat embolisms in the first 72 hours?

I think (my assumption tho) it can have a correlation with PE as well .
13mm is a big nail for femurs of,generally speaking ,short people who have on avarage smaller bones then a 6'5 guy .
Those doctor might have (maybe!?) also damaged some bone tissue to put that in so that could probably lead to problems as well .
Giotikas took 7 h to put the nail in on V21 so...

Again , mine are all assumptions but 2 patient died under the same nail with the same technique since guichet taught giotikas for sure how to put that in and how to work with it .
No other deaths are reported in LL community with other doctors from 1 st world countries so there has to be a correlation somewhere with the nail and/ot the technique ,it can't be just bad luck with the only 2 death cases from CLL.
Also post-OP protocol and care can make a difference too so it's hard to tell but a 13 mm nail ,according to me ,does not help .

[V21]

Are you able to walk yet/do you feel any awkwardness when walking? Anything that feels like they might be misaligned? That's good that Dr. Assayag said they looked good.
Also, is there a reason you only have 1 proximal screw on each side?

I'm at 5 months post op and my walk is normal. I think by next month I will even be able to run if Giotikas thinks it's safe. So no functional problems. My concern was with height: I did 6 cm and when I measured I only had gained 5 cm. But I think that may be due to duck ass. I have been working hard to correct it, and my last measurements show a real gain of 5.4 cm. My back is still somewhat curved, so I hope to get something closer to the 6 cm lenghtened.

[ninjabnw]

That's great! It sounds like you're working hard to correct it. I'm sure you'll get to your full posture and true 6 cm gain soon.