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[6CMFemurs]

I am currently 15 days post op from tibial derotation osteotomy and tibia lengthening on my left leg with Dr. Assayag. Dr. Assayag also removed the precice 2 nail out of my femur after over 8 years!! So far everything has gone pretty smoothly and I am excited to go back home to California in a couple days. All of the doctors, nurses, PA's, PT's Nuvasive reps, Northwest hospital staff, Sinai staff, and Hackerman-Patz employees have been nothing short of awesome, and I have gotten amazing treatment all across the board. Yesterday I started lengthening, and today Dr. Assayag confirmed that the a) deformity is fixed and b) the nail is lengthening properly.

Pain after surgery hasn't been too bad, and I was able to return to working full time remotely after taking just two sick days (and a weekend). During the day I am in no pain and use Tylenol sparingly. I luckily have never had any pain that has gone above a 6 (and that was very brief). Nights however have been kind of a struggle. I just feel a constant discomfort that starts when I fall asleep. I always try to sleep the proper way (on my back with my leg raised), but also end up uncomfortably on my side. I take an oxy and 2 melatonin and am able to sleep for 3-4 hours max. If I am lucky I am able to nap for an hour or so later in the morning. Dr. Assayag assured me this will improve with time.

My mobility on one leg has been pretty good. I was able to go out to dinner and see friends, and family less than a week post-op, and I am genuinely surprised how normal life feels right now, even while still in Baltimore. Hopefully everything will stay normal when I start ramping up the lengthening.

[motoboarder]

Tibia pains should subside after 2 weeks post op. 4-6 weeks post ops your tibias should feel very good like there was almost no surgery. Of course this holds true with consistent stretching exercises. This was my experience.

Where did you have your femur surgery? Why did you wait 8y to remove the nails? -Thanks!

[6CMFemurs]

Tibia pains should subside after 2 weeks post op. 4-6 weeks post ops your tibias should feel very good like there was almost no surgery. Of course this holds true with consistent stretching exercises. This was my experience.

Where did you have your femur surgery? Why did you wait 8y to remove the nails? -Thanks!

Now three weeks out, I rarely feel pain but it’s definitely still hard to find a comfortable position to sleep. Stretching at nighttime does seem to help.

I did my femurs with Paley. I waited so long because a) I was hoping to possibly relengthen sleeper nail and b) every CLL surgeon wanted tens of thousands of dollars to take them out. I went to some local  non CLL surgeons and they didn’t inspire much confidence in me they could get them out. Some told me not to bother and just take my chances leaving them in. Of all the docs who took insurance, Assayag made me feel the most comfortable that I was in good hands while also giving me an honest assessment of the pros and cons of removal.

[Californian]

nice meetin you mah boi

[6CMFemurs]

nice meetin you mah boi

Nice meeting you too bro! See ya on the West Coast!

[6CMFemurs]

I will start at the beginning and then try to be better about updating on a more regular basis....

[6CMFemurs]

The Consultation- March 2021

I first stopped by Sinai Hospital in March 2021. I was in town to visit family in Maryland and friends on the East Coast and decided to consult with Dr. Assayag about removing nails and proximal screws from my femurs and correcting my out-toeing deformity.

After looking at my X-rays, Dr Assayag told me he would try to take the nails and screws out. However, since they had been in my body so long, there was a chance that either the nails would break apart or he wouldn't be able to get the whole thing out. Nevertheless in his opinion it was worth trying since if I needed an MRI or joint replacement down the road, it would be best if the nails were out. Dr. Assayag performed a Craig Test and a Thigh-Foot Angle test and determined my out-toeing was due to a rotational deformity of the tibia, external tibial torsion. I was hoping the deformity came from the femur and that we could somehow use the same hardware to fix it, as I was initially not excited about the prospect of jamming a rod into my knee and cutting the tib/fib.

Dr. Assayag put me at ease, explaining that proximal tibial deformities could be fixed using the same osteotomy site used for tibial lengthening and that the procedure and hospitalization could be covered by insurance, as long as I could pay for the lengthening device out of pocket. He gave me  the option of using an Ex-Fix or the Precice 2.2 IM nail. I decided to go with the Precice nail.

[6CMFemurs]

Post-Consultation

After the consultation, I needed to get a CT scan to definitively prove that my out-toeing was coming from my shin bones and that it was severe enough to meet the criteria for insurance coverage. Because I only had California insurance at the time, I had to get the scan at home. Dr. Assayag was extremely helpful through the whole process, calling the CT Tech and coaching him on how to do the correct test. My insurance initially rejected coverage for the test, but Assayag's office called them and I was able to get all my imaging fully covered. After a few weeks it was determined that both my legs easily qualified as a medical necessary and would be covered by insurance. However, since my insurance only worked in California, I had to change policies to an East Coast based policy where Dr. A was in-network.

Finally after many months, I scheduled my surgery for December 2021. I eventually postponed this date until Feb. 2022 so I could do the corrections and removals one leg at a time and do them in the same calendar year so they would be covered under the same insurance deductible. Even though it took nearly a year between the initial consultation and my surgery date, I don't regret the wait at all. I had one of the best years of my life career wise, made unforgettable memories with friends and family, and traveled to some really cool places. I got into really good shape for the surgery, hiking and trail running multiple times a week in the Hollywood Hills and Griffith Park, and going on an epic volcano hiking trip in Iceland. 

[6CMFemurs]

Pre-Surgery

I arrived in Baltimore ten days before surgery to hang out with family. My work was awesome, allowing me to be fully remote during this period. A week pre-op, I went to Sinai hospital and did all my pre-surgery blood work and pre-anesthesia screening. If you are a Sinai patient from out of town, I would highly recommend doing all your pre-ops in Baltimore instead of trying to fax everything over. It was just way easier doing it on-site and the staff at Sinai were all super nice and helpful.

On the weekend before the surgery I went up to New York to visit some buddies. It was super fun but the blistering cold combined with running through the city to meet friends in dress shoes really hurt my knees. People with excessive external tibial torsion suffer from patellofemoral pain syndrome (frontal knee pain), and I definitely aggravated it on one freezing NY night in particular. I remember limping around a lot the night I got back to Baltimore lol.

On the Monday before my op, I met with Dr. Assayag at his office in Owings Mills. I was super nervous for the surgery and asked Dr A every question I could think of. He definitely has the best bedside manner of any doctor I have ever met, patiently answering my questions and really putting my mind at ease. At the appointment we took a fresh set of X-rays and he remeasured my thigh foot angle. I totally forgot to ask him for a stadiometer measurement or to take pics together for "before and after" comparisons.

I spent the last few days before the surgery in Baltimore, trying to get ahead on my work, not knowing how incapacitated I would be post-op. I also tried to rest my aching knees that I had jacked up in New York. Tbh I was super nervous thinking about how painful and debilitating the next few weeks could be. I met up with Victor from the Cyborg Youtube channel and took some videos running and jumping (notice the out-toeing from my tibia deformity) around a wet parking lot between a verifiably awesome chicken restaurant and a seemingly mediocre strip club.



The night before my surgery I checked into the Hackerman-Patz house which is fantastic and only costs $15 a night. My Dad flew into town late that night to be with me for the surgery.

[GoaT]

Any update?