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[Dayward]

Dr. Birkholtz,

I am interesting in getting LL but I am not confident on choosing how much to lengthen my bones and which bones. Do you just let patients choose lengthening targets or do you also recommend how much to lengthen the tibia/femur according to a patient's existing proportions?

I think this is an aesthetic detail and there's not really any "rules" in current practice on how much lengthening a person should get (outside of not being too much for their body to handle).

Regards.

[Bob]

Our 'standard' quote includes a ten day period in the hospital and then an additional 14 days in the rehab facility with meals and physio included.

Beyond that, the patient can stay on in rehab unit, or alternative accommodation options are available.

Your 'standard' quote includes a ten day period in the hospital and then an additional 14 days in the rehab facility with meals and physio included.

What is the price per day for stay on in your rehab unit with meals after the 14 days?

[nicko77]

does anyone know if @DrStrangehas a diary anywhere?

[youyin12]

Dis/cord

[nicko77]

i cant find it my friend

[TheDream]

Dr. Franz have you ever considered doing a small study on the athletic recovery of stature (CLL) patients?

Right now we only have a study by Dr. Lee from South Korea which involved a sort of questioner to his former patient who underwent LON and/or LATN tibia from what I remember. But having a study with actual testing, maybe looking at statistical differences between tibia and femur patients and also by lengthening amounts could be very interesting.

Assuming somehow the sample size would be statistically relevant couldn’t one do a physical test with simple exercises for patients who have completed the procedure years ago?

One should of course be careful that factors like age and fitness level do not contaminate the results. Therefore maybe studying the gait (how people walk or run), joint flexibility and range of motion. However one could also maybe do a running exercise or muscle strength test and then use statistical methods like factor analysis to take into account age, fitness level etc. to still have some results here.

I know it would be difficult to get enough patients to return to participate. Maybe a few at a time over many years if they were offered a paid holiday in South Africa? Maybe the Paley Institute is more equipped for such a thing though as I know they’ve almost made an industry out of CLL.

[Franz]

Updated prices and package details

https://birkholtz.thec4llective.com/

[1team]

Updated prices and package details

https://birkholtz.thec4llective.com/

Assume nail is Precise 2.2 and you don't have access to a weight bearing nail?

[bruhh]

Updated prices and package details

https://birkholtz.thec4llective.com/

For humeral lengthening, is it utilizing Precice 2.2 and what is the recommended/max lengthening achieved?

[Beemer m3]

yeah humerous lengthening but im not staying in south africa lol. but 63k femur precice for dr birkholtz is almost 75k in usa precice max. just without the airbnb.

[nicko77]

Im actually waiting on the precise max to be available, and i will be doing my surgery with Dr Franz too.
 Please keep us informed on your progress

[Franz]

Hi,

Our standard package is an inclusive package for the full three months. It includes hospital, fees, nails, PT, Xrays, accommodation and food.

F

[Franz]

Lengthening targets are very individual and is a discussion between the doctor and patient and is often adjusted during the realities of lengthening.

The vast majority of patients get 6.5cm femurs safely. Some get to 8cm.

[Franz]

Good suggestion

[Franz]

Indeed

[Franz]

Yes it is with Precice 2.2.

Usually patients need around 5cm.

[wes07]

Hello Doc, do you think that I'll recover 99% if I get 6-7 cm on femurs? I want to be able to jump and sprint as I used to after surgery?

[Franz]

It does tend to depend on a lot of factors, but a lengthening of that magnitude generally does not impact athletic ability in the long term for most people.

[Alcibiades]

Dr. Birkholtz, two questions:

1. During a live episode with Victor, you said 9-12 months post-surgery was a reasonable amount of time to return to office work.

I was surprised, as patient diaries here describe being able to walk anywhere you need, albeit with a limp and a cane, soon after distraction. Could you elaborate on this?

2. How do you advise patients obtain X-rays for their initial remote consultation with you, and what kind of X-rays should they request?

[Franz]

Hi

1) Return to walking and office based work depends on a number of factors eg age, quality of bone, amount lengthened, nails used, complications etc. Also, office based work may include long commutes to get there, climbing stairs etc. Taking all this in consideration, 9 months is a conservative estimate, but realistically, most patients would come off crutches between 6 and 9 months.

2) The standard xray is a longleg standing alignment xray with the patellae facing forward and visible size marker - Ap and Lat views.
This can be done by any good radiology department, but depending on where you are, you may need a local doctor to prescribe the xray.

[wes07]

He'll Doctor,

Is there a way to avoid permanent or longterm knee pain when using an internal nail for tibia lengthening? I've heard that many tibia CLL patients have developed longterm knee pain after consolidation when they've used internal nails such as Precise and LON

[Alcibiades]

Good question Wes.

The research indicates risk of permanent knee pain can be minimized by keeping the nail tip out of the proximal third and the prominence less than 5 mm, so a better question might be whether those things can be avoided.

Thank you Dr. Birkholtz!

[wes07]

Good question Wes.

The research indicates risk of permanent knee pain can be minimized by keeping the nail tip out of the proximal third and the prominence less than 5 mm, so a better question might be whether those things can be avoided.

Thank you Dr. Birkholtz!

Can those be avoided?

[Tallerin2025]

Are you offering Precise Max?

[Franz]

Can those be avoided?

Good questions.
In principle, a nail can be inserted and seated properly.
Still, knee pain may still be present. There is a portion of patients who get tibial nails who still have knee pain afterwards. A suprapatellar nail entry may help in limiting the risk.

[Franz]

Good questions.
In principle, a nail can be inserted and seated properly.
Still, knee pain may still be present. There is a portion of patients who get tibial nails who still have knee pain afterwards. A suprapatellar nail entry may help in limiting the risk.

Nobody offers Precice Max at the moment, as the nail has been withdrawn ‘temporarily’.

At least, this is my understanding.

[1team]

Nobody offers Precice Max at the moment, as the nail has been withdrawn ‘temporarily’.

At least, this is my understanding.

Hello Dr Franz
What about the Orthofix weight bearing nail you talked about with Cyborg4life about a year ago? Can you use that one?

[Franz]

Yes, that was the Fitbone Troch entry nail.
It is made from steel rather than titanium, so more resistance to bending.
Likely stronger. But like the PMax, it will not be called weight bearing by the FDA or the company.
I do believe it will allow us a more aggressive rehab protocol.
We should have it available soon.

[wes07]

Hello Dr, are you a fan of the Fitbone? How soon will you get it at your clinic? And how much will it be or approximately cost? Will it be cheaper than Precice 2.2?

[Franz]

Hello Dr, are you a fan of the Fitbone? How soon will you get it at your clinic? And how much will it be or approximately cost? Will it be cheaper than Precice 2.2?

Hi,

I use the Fitbone for a variety of indications yes. It is a good nail with a good track record. The main issue up to now has been limited length options, as well as well as a single locking bolt at the one end. These will be changed in the new TE nail.

Timeline is fuzzy, but hopefully soon.

Prices not finalised but likely at the same price as my other packages.

[Throwaway93]

Hello Dr Birkholtz, I'm considering LLS eventually and would like to know if you fix deformities in combination with lengthening? I have knock knees that don't quite count as severe enough for medically necessary surgery though it may become so later on.

If you do offer correction + lengthening in one procedure, is the price point the same as for just CLL (and includes the rest of the package on your site)?

Lastly, does hypermobility, specifically in the legs, affect recovery or possible lengthening goals at all? I've unfortunately not been able to find information on this anywhere.

Thank you.