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[ReachingForTheStars]

Hi there,

I have a lot of questions regarding LLS and I was hoping you guys could help me.
I'm especially looking for people who had other health conditions prior to have their LL surgery done but I'm open to hear from anyone.

1) I know this is a bit of a controversial question but what is the current safest and best method to reach a minimum of 10cm? My dream height would require 15cm of lengthening but unfortunately, I understand that this is probably impossible or at least, impossible to do safely.

2) Are there any concerns for flexibility prior to surgery? I hear a lot about people stretching their legs beforehand. I have hypermobility and I'm wondering if this will be beneficial or not to LLS.

3) Has anyone else had other medical conditions prior to LLS? I have a blood clotting disorder and have always been advised to have a blood clotting infusion before any surgery. I'm concerned about flying to a different country and trying to organize this. I know this will largely depend on the Doctor but it would be comforting to hear from anyone in a similar boat or someone who has other medical conditions / medication requirements.

4) Is there a height limit amongst LLS doctors? Like if someone is too tall pre-op?

Thank you for your time, looking forward to hearing from you guys!

[zaozari]

Hi there,

I have a lot of questions regarding LLS and I was hoping you guys could help me.
I'm especially looking for people who had other health conditions prior to have their LL surgery done but I'm open to hear from anyone.

1) I know this is a bit of a controversial question but what is the current safest and best method to reach a minimum of 10cm? My dream height would require 15cm of lengthening but unfortunately, I understand that this is probably impossible or at least, impossible to do safely. I would say that a total of 15 cm is never safer at least if considered previously, and for 10 cm you need two segments elongation, wich of course doubles the risks, possible worse final outcome, pain and time duration, physiotherapy efforts and money.

2) Are there any concerns for flexibility prior to surgery? I hear a lot about people stretching their legs beforehand. I have hypermobility and I'm wondering if this will be beneficial or not to LLS.

3) Has anyone else had other medical conditions prior to LLS? I have a blood clotting disorder and have always been advised to have a blood clotting infusion before any surgery. I'm concerned about flying to a different country and trying to organize this. I know this will largely depend on the Doctor but it would be comforting to hear from anyone in a similar boat or someone who has other medical conditions / medication requirements.

4) Is there a height limit amongst LLS doctors? Like if someone is too tall pre-op?

Thank you for your time, looking forward to hearing from you guys!

1) Really  the best answer you get by exploring the topics. Ultimately  it's your decision. Everybody here has an opinion, apparently only one is an orthopedic surgeon but he's specialised in one method only,. There are pros and cons in all methods and doing either tibias or femurs. Few consensus seem to be that you shouldn't elongate more than 20% of bone original lenght, never elongate two diferent segments at the same time, etc  But these are more exclusions than saying what is the "best". It's also an aesthetical option. After reading some topics it would be a good idea to have consultations and talk about it with surgeons doing diferent methods, if  you can afford it  let's say, 4 doctors?

2) Yes, you should improve flexibility and do stretches of tendons and muscles. It also would help you in recovery (autonomy and mobility) if you have upper muscles strengthened (arms, shoulders....).

3) I have that problem and take 150 mg of aspirin daily. I still don't know if it's safely manageable to avoid a too high risk of cloting. Everybody doing LL take anticloting medicines. I suppose in the best case scenario either we should take more or diferent.

4) That depends entirely on the surgeon ethics, personal opinion and, I would say, greed. It also depends on the best judgement if the "patient" has body dysphoria or not, if this is investigated and if he/she has tried unsuccessfully psychotherapy before. Some surgeons refuse doing LL on people with body dysphoria, others operate any candidate despite that. My very personal opinion is that I would never risk the life and health of people within one statistical standard deviation below the average. But I respect other personal views and people with height neurosis that they deem untreatable by psychotherapy.

[Delorcha234]

For femur, you will want to focus on glutes and quads stretches.

[thaw1010]

How tall are you? 15cm doesn't sound that insane in 2 procedures.

[ReachingForTheStars]

1) Really  the best answer you get by exploring the topics. Ultimately  it's your decision. Everybody here has an opinion, apparently only one is an orthopedic surgeon but he's specialised in one method only,. There are pros and cons in all methods and doing either tibias or femurs. Few consensus seem to be that you shouldn't elongate more than 20% of bone original lenght, never elongate two diferent segments at the same time, etc  But these are more exclusions than saying what is the "best". It's also an aesthetical option. After reading some topics it would be a good idea to have consultations and talk about it with surgeons doing diferent methods, if  you can afford it  let's say, 4 doctors?

2) Yes, you should improve flexibility and do stretches of tendons and muscles. It also would help you in recovery (autonomy and mobility) if you have upper muscles strengthened (arms, shoulders....).

3) I have that problem and take 150 mg of aspirin daily. I still don't know if it's safely manageable to avoid a too high risk of cloting. Everybody doing LL take anticloting medicines. I suppose in the best case scenario either we should take more or diferent.

4) That depends entirely on the surgeon ethics, personal opinion and, I would say, greed. It also depends on the best judgement if the "patient" has body dysphoria or not, if this is investigated and if he/she has tried unsuccessfully psychotherapy before. Some surgeons refuse doing LL on people with body dysphoria, others operate any candidate despite that. My very personal opinion is that I would never risk the life and health of people within one statistical standard deviation below the average. But I respect other personal views and people with height neurosis that they deem untreatable by psychotherapy.

Thank you very much for your answers.

With 3. I probably should have mentioned that my clotting disorder is the other way around, so my issue is that my blood doesn't clot. I guess I will have to see. If they put everyone on anti-clotting medication, that might be great news for me as I naturally don't clot anyway.

[ReachingForTheStars]

How tall are you? 15cm doesn't sound that insane in 2 procedures.

Are you sure about this? I've seen that 5-8cm is recommended for Femurs (and generally the lower end) and then 4-5cm for Tibias, which.. Assuming I did the maximum of both, that would be 13cm.

[zaozari]

Thank you very much for your answers.

With 3. I probably should have mentioned that my clotting disorder is the other way around, so my issue is that my blood doesn't clot. I guess I will have to see. If they put everyone on anti-clotting medication, that might be great news for me as I naturally don't clot anyway.

But don’t forget you may have to count on that for other reasons, for example more dangerous hemorragic accidents, especially in crude methods like LON. In your case and also due to other multiple reasons, for lower legs you probably should opt for Ilizarov classic or adapted  external fixators (that's my option for example). It's much less confortable but safer, and with other advantages like better treatment of non unions and misalignments. Pin external infections are common but allmost always easily treated. But Ilizarov specially imply minimal loss of blood. You may need extra Vitamin K and if I were you,  altough good hospitals don't lack blood for transfusions, I would previously make a self blood "donation" for a possible need of an "autologous" transfusion to yourself. Donation of a compatible family member or friend might also be a good idea.

[HateLAPELoveSTEM]

Are you sure about this? I've seen that 5-8cm is recommended for Femurs (and generally the lower end) and then 4-5cm for Tibias, which.. Assuming I did the maximum of both, that would be 13cm.

If you do Paley's Option 5, then 15cm does not sound insane. But I think quadrilateral lengthening just for once is indeed dangerous.

[ReachingForTheStars]

But don’t forget you may have to count on that for other reasons, for example more dangerous hemorragic accidents, especially in crude methods like LON. In your case and also due to other multiple reasons, for lower legs you probably should opt for Ilizarov classic or adapted  external fixators (that's my option for example). It's much less confortable but safer, and with other advantages like better treatment of non unions and misalignments. Pin external infections are common but allmost always easily treated. But Ilizarov specially imply minimal loss of blood. You may need extra Vitamin K and if I were you,  altough good hospitals don't lack blood for transfusions, I would previously make a self blood "donation" for a possible need of an "autologous" transfusion to yourself. Donation of a compatible family member or friend might also be a good idea.

Ah.. Yes that's a very good idea. I'll have to see about doing that, thank you.

I also have the issue that I am allergic to multiple families of antibiotics. I am really not the ideal patient for LLS but I'm hoping to find a Doctor that is okay with this and has a plan for if anything happens. I'm still quite scared regardless.

I have no preference on whether or not I have internal or external, as long as I don't have to do clicking (Like BetzBone). I don't think I could do it, even with Dr. Betz seemingly being the perfect Dr. for my desired height.

[ReachingForTheStars]

If you do Paley's Option 5, then 15cm does not sound insane. But I think quadrilateral lengthening just for once is indeed dangerous.

Yeah.. Especially considering I have health issues and allergies to medications. I think I'll take it slow and go with 2 procedures. There would be no point in reaching 15cm if it's going to severely impact my health.

[zaozari]

Are you sure about this? I've seen that 5-8cm is recommended for Femurs (and generally the lower end) and then 4-5cm for Tibias, which.. Assuming I did the maximum of both, that would be 13cm.

15 cm total is maybe not insane but it's not safe at least if considered before direct observation of biological response. Also, total safe lenghtening should not be considered automatically the sum of safe limits for tibias and safe limit for femurs.
And "rebraking" bones for more procedures is multiplying all risks and push too much. We should respect our body and health, not play with it, like with articulations stress. "Rebreaking" should and is done in drastic cases of pathologies like achondroplasia. For an a healthy guy it's in my opinion not much less than a crime, at leadt a gross violation of Hypocrates very basic principles.

If taken this forum only but also some doctors information compared, "real" safe limits seem to be 5 cm both in tibias and femurs. But this has an average of "top safety". Many go up to 7 cm in tbias with externals and intense physiotherapy or Aquilles tendon lengthening. And relatively to femurs (with nails), 6cm is common and when things seem to be running ok, many go up to more if the surgeon is not very "conservative" and patient is stubborn. But average lenghtening of femurs for example with Dr. Guichet is around 6 cm. 7 cm + 8  cm to get those 15 cm for example doesn't result in good outcome if reading this forum and some articles. Worst: it carries many more risks than more reasonable amounts.
Of course this depends on lots of things: age, bone density and speed of consolidation, general resistance to pain and intense physiotherapy, QUALITY and EXPERIENCE of surgeon, etc.