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[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.

[Franz]

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.

Depending on where exactly the apex of deformity is, we can consider correction at the same time as lengthening surgery. The cost would be similar, unless we have to add extra osteotomies or devices. That will depend on the xray planning.

Hypermobility can be problematic in terms of joint instability, but should actually not be detrimental in the setting of CLL. Unless it is part of a syndrome.

[Throwaway93]

Thank you, I much appreciate the reply and information. I suppose I will need to wait closer to the time of doing CLL to get a better idea of how it will work with the knock knees.

Good to know the hypermobility shouldn't interfere with healing. I'm starting with an exercise physiologist next week to set up a good exercise program. My plan is to be in the best shape possible before CLL, so the affected ligaments should hopefully be well taken care of. As far as I know, my hypermobility isn't part of a syndrome either.

Thanks again!

[nicko77]

Hi Doc ,

With the fitbone and a patient around 70kgs , and aggressive physical therapy , when do you think  a realistic time to expect to return to a  normal walk unassisted?

[Franz]

Hi Doc ,

With the fitbone and a patient around 70kgs , and aggressive physical therapy , when do you think  a realistic time to expect to return to a  normal walk unassisted?

Even with our current Precice 2.2 protocol it is variable, with our quickest walks unassisted at around 4.5 months or so and some taking longer. Usually the guideline for us is crutch walking 3-6 months and unassisted walking 6-9 months.
I suspect those times would be able to change with new Fitbone. Possible crutch walking (0)-3 months and unassisted 3-6 months.

BUT we simply do not know yet, because we have not got any patient data with the new nails. We will likely have to start out a bit more conservative and then become more aggressive once we see the patient results.

[Staystrong]

Will you have same as Precise 2 or different price for Fitbone Troch?

[Franz]

It will be the same price as our Precice 2.2 package.

[dylan_stt]

hello Dr B, it might be a stupid question, but i wanted to ask u if theres any differences in therms of risks between people who smoke or use nicotine pouches before the surgery, how for example using nicotine pouches before the surgery would affect my healing etc etc... and in case how much earlier before undergoing the surgery a person should stop using them, thank u Dr

[Franz]

hello Dr B, it might be a stupid question, but i wanted to ask u if theres any differences in therms of risks between people who smoke or use nicotine pouches before the surgery, how for example using nicotine pouches before the surgery would affect my healing etc etc... and in case how much earlier before undergoing the surgery a person should stop using them, thank u Dr

Data suggests that nicotine patches slow down bone healing significantly. I would use the same rule as for smokers and say three months clean at least.

[dylan_stt]

Data suggests that nicotine patches slow down bone healing significantly. I would use the same rule as for smokers and say three months clean at least.

got it, thank u dr

[Dragonheart]

Hello Doctor,

I see that you recommend 6.5 cm max for femurs. What is your current recommendation for maximum safe lengthening of tibias with LON method? And do you still accept patients of <165cm or any height is fine (I'm 173cm)?

I wonder about tibias because I really worry that change in mechanical axis due to lengthening over anatomical axis may make knees closer and affect knees or femoral head "resource" in the long run. While tibias since they are just straight bones sound safer in terms of keeping native biomechanics.

Thanks!

[TheStruggler]

Dear Dr Birkholtz

I am enquiring as to how many limb lengthening procedures (cosmetic) you have conducted throughout your career, and were there any cases of fat embolisms? If there were, were you able to rectify them?

Thank you for your time.

Kind regards
The Struggler

[Franz]

Hi

I accept patients on an individual basis, regardless of their starting height within reason. I am more likely to offer stature lengthening to a patient with a starting height of 165 cm than one of 185cm.

Femoral general guideline with nail is 6.5 for optimal safety, but can usually extend to 8cm in most cases.

Tibial nail limit around 4.5-5cm.
LON limit 6cm.

F

[Franz]

I do not count my cases specifically and the percentage fat embolism as a percentage is not a guarantee of safety or risk. It is mainly dependent on genetics.

I did recently have a significant fat embolism syndrome which we picked up within hours, responded to timeously and turned around.

I am comfortable that the protocols we have in place make it as safe as possible.

[TheStruggler]

Thank you Dr Birkholtz for your timely response.

[Dragonheart]

Hi

I accept patients on an individual basis, regardless of their starting height within reason. I am more likely to offer stature lengthening to a patient with a starting height of 165 cm than one of 185cm.

Femoral general guideline with nail is 6.5 for optimal safety, but can usually extend to 8cm in most cases.

Tibial nail limit around 4.5-5cm.
LON limit 6cm.

F

Thank you for the reply, Doctor.

Could you please also tell if using LON for Tibia assumes pins passing through muscles or they are placed closer to frontal part of leg and do not pass muscles and other soft tissues?

[Franz]

We use the well described 'safe zones' based on cross sectional anatomy. To have the greatest biomechanical benefits from circular fixation, the fixation elements need to cross at certain angles. This means that there will be some transfixing of muscle. But we attempt to minimise this as much as possible.

[Growtomars]

Hi Franz,

How long before the desired lenghtening period should you start planning your surgery and recovery.

Sincerely,

Growtomars

[KrP1]

Hi Dr.Franz.

Do you perform prophylactic fasciotomies in tibia lengthenings to prevent compartment syndrome?

[Dragonheart]

Probably last question from me. Dr. Franz, when doing tibia lengthening with LON do you fix fibula to prevent its migration and do you do it on one or both ends of it? In other words, after tibia lengthening with LON, is the fibula/tibia proportion kept 1:1 as it was before surgery?

Thanks!!

[Franz]

Hi Franz,

How long before the desired lenghtening period should you start planning your surgery and recovery.

Sincerely,

Growtomars

Most people plan long in advance. Usually a timeline of around 6 months to prepare for surgery, sort logistics etc.

[Franz]

Hi Dr.Franz.

Do you perform prophylactic fasciotomies in tibia lengthenings to prevent compartment syndrome?

Not routinely no.

[Franz]

Probably last question from me. Dr. Franz, when doing tibia lengthening with LON do you fix fibula to prevent its migration and do you do it on one or both ends of it? In other words, after tibia lengthening with LON, is the fibula/tibia proportion kept 1:1 as it was before surgery?

Thanks!!

Yes, absolutely. Screws at top and bottom.

[sannie1]

How long normally after the surgery can patient walk with crutches themselves?

[Growtomars]

Hi Franz,

I'm planning to do this in 2028 because then i'll be ending a project I'm currently working on. Do you believe this will be a good time to perform LL at your clinic?

Thanks in advance,
Growtomars