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[Muse]

Here are the responses from Dr Alex Monegal of Clinica Diagonal based in Barcelona, Spain.

Note: please refer to our disclaimer about The Doctors Directory http://www.limblengtheningforum.com/index.php?topic=55.0

Method of Surgery

Presentation Fitbone: 
http://www.mediafire.com/view/he6f42q1r3fqfa9/Presentaci%C3%B3n_Fitbone.pdf

" I recommend to use intramedullar devices. I use Fitbone since 2009. We can lengthen up to 8cm in fémur and 6 in tibia. It depends on your current height and the tibio-femoral proportion What i might advice you to lengthen. Other options are external fixators but i do not use It for Cosmetic, just for trauma.

My advice is to do one limb and then the other. Walking on crutches is straight away after surgery (15-20k of bearing). Lengthening time for 6cm is approximately 3 months and 6 to 8 weeks after you must be fully weight bearing. I recommend to perform second limb when the first one is fully recovered.
 
It is very important to achieve proportion.  It is obviously more expensive to do all 4 bones but result is better in terms of Cosmetic.

I am using the most recent version of the Fitbone technologies as I am official Fitbone user here in Spain. So I use the Fitbone 4. They are currently working on a new version but won't be released until 2017-2018.

My advice is to start with one leg doing 1 or 2 segments (femur and tibia), and then proceed with the other one.

Reasons for performing a Two stage lengthening are extremely important.

First of all the risk of fat embolism syndrome increases. I do bilateral in dwarfism on a regular basis. Problem is that post operative management is far away much worst. If for instance we do perform both tibias at the same time patient must remain on a wheelchair with both limbo extended as you might have seen in the presentation I sent you. On the other hand if we do a Two stage lengthening you will be Able to walk with crutches loading 18-20kg on the operated limb.

Second limb will be performed 6 to 8 weeks first limb is completed depending on how the first limb recovers and how fast you create new bone.

Wanna do a 1 stage procedure? We can discuss It but My advice remains the same. I would do 2 stage. "


Pricing

"The plan for Cosmetic is to perform first one leg and then the other one. 

There are 2 options for treatment. To lengthen 1 segment or 2 segments on each limb.

Total cost for bilateral 1 segment lengthening is 2 x 17900€ (Euros) =  35800€

Total cost for bilateral 2 segment lengthening is 2 x 30600€ (Euros) = 61200€

Budget will include

- Hospital stay Includes 4 nights
- Operating Room
- Scrub nurse
- Anesthesist
- Assistants
- Surgeon  Including 2 Surgeons
- Implants 

After procedure is completed implants must be removed.   Implants need to be removed 2 years after finishing lengthening.  I will not charge you for removal of implants. You will have to Pay only for hospital expenses which might be 1500-2000€. "

Doctor's Background

" All doctors allowed to use Fitbone are trained by the company and It takes more than 2 year to be approved by the company. So all surgeons are limb lengthening specialists and we do meet on a regular basis at Fitbone users meeting.

My training in lengthening has been beside the most experienced doctor in bone distraction Ignacio Ginebreda and José María Vilarrubias. I spent 9 years with them. I have Also been trained in Germany with Reiner Baumgart and i go to operate with Him on a regular basis since 2009. I have been working at University Hospitals coventry Warwickshire for 18 months performing complex limb reconstruction. I have Also been in Baltimore USA last summer with Dr Standard and Herzemberg where they introduced me to Precice technique

We always use the latest version of Fitbone implants as the company brings the latest version to us. There are few Fitbone users worlwide and we are selected surgeons trainned by them for such procedure.

You will see patients sitting on a wheelchair as they did both femur/tibia at the same time. This is very dangerous.  So my advice is to do first one limb and then the other one.
 
Number of Lengthenings well beyond 500 segments.  Using Fitbone technique more than 50 in the last 5 years. Sorry I can't say an exact number."

Contact Info:
 
Dr Alejandro Monegal Avila
Clinica Diagonal

Email : dralmon1@hotmail.com,  info@clinicadiagonal.com

Website:  http://www.clinicadiagonal.com/en/trauma-and-orthopaedic-surgery

Tel: 902 88 33 55 / 932 05 32 13

Address: C/ Sant Mateu, 24-26 08950 Esplugues de Llobregat, Barcelona Spain

[ShortyMcShort]

Im also quite confused about the pricing, mainly the wording of it. Could you please clarify?
Is segment 1 the tibia or femur? Or doesnt it matter?

Also regarding the hospital stay that is included in the packaged price, how many days in the hospital is it for? The whole distraction phase or 4-5 days and then leave?

[Medium Drink Of Water]

A segment refers to either the tibiae or the femurs.

[Muse]

Hello. Im from spain. The price for lengthening both tibias is 35.800 euros? And tibias and femurs 61.200?

Im also quite confused about the pricing, mainly the wording of it. Could you please clarify?
Is segment 1 the tibia or femur? Or doesnt it matter?   Also regarding the hospital stay that is included in the packaged price, how many days in the hospital is it for? The whole distraction phase or 4-5 days and then leave?

I've updated the pricing information and also the presentation fitbone file of Dr Alex Monegal (mainly written in Spanish with some English text).   Hope this helps.

[mediocre]

Living in Spain sounds very appealing. Perhaps they'd offer Precice soon as well.

[ShortyMcShort]

So if someone wanted to do both the tibias and femurs, this doctor would do it on one leg first then the other once the first one has consolidated? Or did I misread that? He prefers to do a 2 stage over a one stage operation?
How does one combat the height difference between the two legs while lengthening? Say one leg is 10-12 cms more than the other. Wonder how long that would take to finish.

61200€ for all 4 segments sounds very appealing

[Dingo]

From what I've seen in the presentation, it seems like this doctor inserts the Fitbone nails into the femur canal through the knee, and also breaks the femur quite close to the knee.

Knowing what we know from patients that have had nails inserted like this into their tibias and their high rate of permanent knee pain problems, this is a big no no.

I wonder if he'd insert the nails through the side of the hip, like other doctors do, if we asked him.

[Dr Monegal]

Hello all.

I am Dr Monegal And i have been working with Dr Ginebreda for 9 years. I have been the guy in Charge of Fitbone project in Dexeus And I changed clinic a few months ago. Dr Ginebreda continues performing cases but he is not very keen to perform cosmetic. If you want to contact him you will fins his contact details at www.fitbone.com
About pricing, in the new clinica it is 5000 to 6000€ cheaper per segment. And when I say segment I am refering to bone (fémur or tibia)

About the discussion of performing a 1 or a 2 stage lengthenning i must say I have done both. Life quality And recovery is much better with a 2 stage. Apart from that, from a Medical Point of view it is much safer. We presented some cosmetic cases performed in 1 stage at Last years Fitbone users meeting in Aalborg (denmark) And all Fitbone users found them extremely risky.
It is true we create a temporary limb lenght discrepancy which can be compensated othopedically. But believe me it is much better to deal with this rather than with fat embolism syndrome.

My best regards for all

[Metaller]

Hi,

What is the total price here? fitbone is expensive, right? I could not find the price on that website.

[Dr Monegal]

Implant price is 13700€ for unilateral And 11000€ for bilateral lengthenning.
Price is set by the Company.
Then you have to add Medical expenses end Clinic expenses.

For a unilateral procedure it is approximately 19500-20000€
For bilateral 2 femur or 2 tibia 32000-34000€

[Dr Monegal]

Femoral lengthenning can be done either antegrade (from the hip) or retrograde (through the knee). Indication depends on the axial correction you need to achieve.
In the knee approach a transtendon access can be done as well as a parapatellar tendon access which avoids speading the tendon.

Another possibility for tibia lengthenning is to perform a suprapatellar approach. In this case we Also avoids to damage patelar tendon.
In all procedures we chose the best approach for the patient on each case.
Every procedure and every approach is deeply studied And plannified.
We are doctors, not just limb lengthenners And when we do perform a procedure we consider the best option And any issue that may arise after surgery.

[TRS]

Another possibility for tibia lengthenning is to perform a suprapatellar approach. In this case we Also avoids to damage patelar tendon.

Hey Dr.Monegal
Does the supra patellar approach avoid the permanent knee pain that many patients complain about after nail insertion into their tibias?
What is your opinion on permanent knee pain after tibial nail insertion?

[Adriano]

what is th total price for bilateral femural lengthenning including 1 week hospistal stay?

I think this is the cost that everyone else in interested to know.

Does the doctor allow paitents to return home to complete distraction?

How muc is the maximum possible height gain with the fitbone nail used?
When does the doctor allow paitents to partially weight bear with cructches?

Thanks Dr for participating in our forum.

[Greek-Semidget]

Don't like this doctor, One leg and after the other? jesus!!! And this price is pretty damn high

[Dingo]

Dr Monegal, thank you for participating in this forum.

I live 900km from Barcelona, so your clinic would be a good choice for me, but I'm finding it hard to understand the pricing.

Could you post the current prices like this:


TWO STAGE LENGTHENING:

1 leg (femur + tibia) + the other leg later (femur + tibia) = ... euros

1 femur + the other femur later = ... euros

1 tibia + the other tibia later = ... euros

----------------------------------------------------------------

ONE STAGE LENGTHENING

2 femurs in a single operation = ... euros

2 tibias in a single operation = ... euros


Also, if I do a two stage 6cm femur lengthening with Fitbone how many months would I have to wait from the first operation to the second operation?

[paco1]

you have to wait 2 or 3 months depending how it is your cosolidation.
The Price is 34000 euros for tibias and the same for femurs.
Cheers, Paco.

[GROWtalORdieTRYING1]

this is all very confusing.

have you thought about doing Full external femur (NOT LON) followed by internal femur or LON femur(if they have monorail).

 doing this back to back could allow you to do surgery in 9 months for both.

[Dr Monegal]

Dear All.

Can you please write me at my email address?
dralmon1@hotmail.com

It is very important that all of you understand that doing a bilateral procedure in one stage it s very risky for your life. I am aware there have been cases of fat embolism syndrome that cause death to patients. Fortunately never happened to me and i do not want to put life of my patients into risk. This Was discussed Last week in Toulouse at the Fitbone users meeting.

"Don t like this doctor" I would ask for respect to all participants. You have to be aware bone lengthenning is a complicated procedure And I am guiding my patients through the proper path.

People asked for pricing. I am obviously not in charge of preparing budgets at my Clinic. Variation can be caused by the OR, medication, anaesthesia total time or the Clinic expenses. Implants And my team is always the same.

[Leonardo2013]

For Spanish Speakers, here's a YouTube video about Clinica Diagonal that shows the premises and staff.

[ReadRothbard]

I have two questions, Dr. Mongel. First, do you think it would be possible to lengthen 6.5-7.0 cm in the tibias? I know other doctors, such as Dr. Paley, do allow that much lengthening in that segment. Second, why do you think it is necessary to lengthen one leg at a time? Most other leg lengthening doctors seem to suggest simultaneous lengthening; why do you think differently?

[Leonardo2013]

Readrothbard,

From what I've read this doctor seems very conservative and his rational is that if lengthening both legs at the same time the patient would be wheel-chair bound during the distraction period, and that's why he prefers one leg at a time. I've e-mailed him with other questions I had, and he's pretty good at answering. His e-mail: dralmon1@hotmail.com

[JP]

Hi Dr. Monegal

Assuming you lengthened the “second leg after the first one is fully recovered”

Can you please explain how soon (months) can I get both femurs lengthened?


Do I pay in full before the 1st femur operation or separately after the 2nd femur operation ?
Thank you,
drew

[KrP1]

hello, i had an appointment with Dr Monegal one week ago in Barcelona. The clinic is really big and modern, doctor Monegal told me that it has only 2 years.
I have been talking with Dr Monegal around 2 hours about lengthening methods and my personal options for  treatment.
He took some photos of me  to look my proportions and do a mock up of how i will look with the elongation. he measures me at 165.5cm tall.i have done some X-Rays of my legs and he told me that i have good bones for the surgery. We have been talking more about LON metod because Fitbone is out of my Budget. I have seen the monorails he uses for this propose and them look pretty well, he told me that he could do corrections with them, them are triaxx monorails.
He says that with LON method we could do both tibias or both femurs at the same time, because the risk of fat embolism is less than with internal metods.
Dr Monegal seems like a nice guy, when our appointment finished it was 22.00 hours so he approached me to my hotel in his car.

[ShortyMcShort]

What did he quote you for LON on either the tibias or femurs?

[KrP1]

What did he quote you for LON on either the tibias or femurs?

We have been talking about femurs. Because my tibias are 37cm long and femurs 42cm

[TomD]

We have been talking about femurs. Because my tibias are 37cm long and femurs 42cm

Did he give you a price for the procedure to do both femurs with LON?

[TomD]

At first it seems bizarre to have one leg lengthened 4 to 6 inches doing 1 femur and 1 tib .

My first thought was hopping around with this dangling leg too big for me , but then I realized that all I had to do was to wear increasing elevator shoes. As my other leg grew, I add on for my short leg to even it out.

When I first was introduced to LL, it was on old forum  and I told all the guys there I was so excited about it I went and built 6 inch blocks out of 1x4 wood . I made boxes six inches high by 5 inches wide and then attached a rope through it and tied my feet to it.

I stomped around my house and it was quite strange. The world was really built for short folks. The toilet was now way too small. So was the sink. The fridge. Everything. Being over 6ft gets some getting used to.

As for the lengthening, with all the troubles with ballerina and wandering around in a wheel chair for months on end, why not just use a professional prosthesis and crutches to help strengthen the healing leg?

Makes a hell of a lot of sense to me.

[KrP1]

Did he give you a price for the procedure to do both femurs with LON?

we have not detailed the exact Price

[galaxy1]

Way beyond my budget, but this doctor prefers to lengthen one leg at a time, both the tibia and femur, and the benefits of this is you have one pain free leg. Less chance of embolism and better mobility since this is for the fistbone method. He prefers not to use external fixators for cosmetic, but for trauma. 

[TomD]

I have emailed the Doc asking him how much in one price it would be to go have 1 tibia and femur then one year later go do the other leg.

[Leonardo2013]

Hey, Dr Monegal mentioned in his medical backgraound that he did some training with Precise nail. Quote "I have Also been in Baltimore USA last summer with Dr Standard and Herzemberg where they introduced me to Precice technique." Who knows, maybe in the short term Precise will be available in Barcelona. I'll e-mail and see what he replies.