Quote from: mb53 on November 16, 2015, 07:23:16 PMI had the x-ray done today but apparently I won't get Paley's results back for about a week... lol. In the meantime, my walk is almost back to normal. The reason my gait was stiff was because (in addition to not walking for 3 months) I completely forgot about the iliotibial band stretch. After doing it a few times, my gait is much better.
According to Precice 2's manufacturer's manual on the Precice 2, the patient can be walking after 3 out of the 4 cortices (i.e. walls or sides) of the femur is solidly healed. So you can sort of figure out the answer for yourself by looking at your x-ray and checking the 4 sides of your gap (front, left, right, back). If at least 3 of them are healed, you are full weight bearing according to Ellipse.
What's interesting is out of the 155 times that the Precice 1 was installed, it only broke 3 times. And it broke where the welds are that connected the nail together. The Precice 2 has no welds, and is reportedly 4 times as strong because of it. This might explain why you've been able to walk with the Precice 2 without much issues. And I have a feeling that Dr. Paley and Ellipse are very very conservative with their safety measures and don't let you walk until they're absolutely certain that you have very little chance of breaking their nail. I personally have a feeling that it's very difficult to break the nail, because I took a few baby steps recently even though I haven't fully consolidated, and I didn't have much issues. I'm not going to do it again, but I'm almost 99.9% certain that the Precice 2 is stronger than they lead us to believe for liability and safety reasons.
Bilateral Femur Lengthening with Dr. Paley 2015 (Q&A, not Journal)
in the recent paley study there was one instance of the precice 2 nail breaking out of 58. I guess the odds are really low and it's up to you if you feel walking a few weeks early is worth that risk, but I appreciate conservatism considering the additional surgery/money/time required to fix a broken nail
here's the exact text from the study:
"In our P2 group, there was 1 nail breakage during late consolidation (Fig. 7). The nail silently bent into varus and produced a noticeable bump on the lateral side of the thigh. The patient continued to walk without pain and complained only about a thigh bump. This patient had disregarded the weight-bearing restrictions that were reinforced in writing to him each time he sent a follow-up radiograph during the consolidation phase. He too had stopped using crutches without being released to do so."
here's a link to the study. there are pics of the xrays where you can see the broken nail and amount of consolidation
http://journals.lww.com/techortho/Fulltext/2015/09000/Stature_Lengthening_Using_the_PRECICE.6.aspx#
Thanks for that study. It reaffirmed my theory that the welds no longer are the weakest link, and is only a weakness in Precice 1. Then in Precice 2, you see that the femur was broken too low during surgery for the one case where the nail broke. The femur should have been broken higher up to allow more bone to protect the new weak point, which is the 1 cm gap that connects the two rods together. Another patient while I was here also had his femur broken too low, and he had to stop 1 cm short of his goal of 8 cm or else he'd risk the same issue. I guess Paley became more cautious of the new weak point. Also the Precice 2 had fins at the end instead of being one circular piece. This made the end even more weak, as only one fin had to be broken out of the four to cause a total failure of the rod. The precice 2.1 released in Dec 2014 had fixed this issue by replacing the fin design with more complete circular design. From the link you posted: "Breakages of the crown and fins have been identified in some cases including this patient (Fig. 9). To strengthen the nail and avoid crown failures, Ellipse Technologies released the P2.1 in December 2014, which has a modified keying feature without “thru-slots” or tack welds." Also in my x-ray, I see the breakage point of my femur is higher up, so there is at least 1-2 cm of bone surrounding that weak point. I don't know what the new weak point is now, since there's no Precice 2.1 breakage yet. And I don't want to be the first one to find out, so I'm going to wait until I get the OK before I walk without support again. But looks to me that Precice 2.1 is harder to break, especially if you have bone surrounding the weak point. The paper recommends 3 cm of bone surrounding the weak point.
Something interesting to read in that same paper: "At our center we have seen patients from all over the world who arrive with disabling complications after failed SSL. These include: equinus deformity due to Achilles tendon contracture (ballerina feet); fascia lata contractures with hip flexion contracture and hyperlordosis (duckass); partial or complete failed regenerate bone formation, including fixators that cannot be removed due to failed healing; bent and broken hardware; malunions and nonunions of the tibia, fibula, and femur; proximal migration of the fibula; and many more. We must remind ourselves that these patients start functionally at 100%. The treatment goal is to end up with the same 100% functional level. Anything less than this is neither a good outcome nor a reasonable tradeoff for a few centimeters. Disablement is too often an outcome of this surgery when performed by unqualified or inexperienced surgeons, which leaves patients with debilitating conditions and gives this surgery a bad reputation.
A few years ago the senior author (D.P.) saw 7 patients in the course of 2 years who were disabled by complications from bilateral tibial lengthening. All of these had been treated by a single surgeon. This resulted in 7 separate malpractice lawsuits and ultimately the loss of that surgeon’s medical license. Such cases give SSL and undeserved bad reputation."
Stuff like this made me glad that I went to Paley.
I haven't posted in a while (obviously), but I decided to check out the site today and saw that a lot of people were having complications. I must be fortunate in that regard, since my recovery is going perfectly, and pain is nonexistent. I stopped taking painkillers months ago. I'm walking fine, and as I'm slightly weaker in one leg than the other right now, nobody's questioned my story that I tore my ACL. I can jog and walk on my hands again, though I still can't run, and working out/sprinting is out of the question (at least for now). My legs are almost fully healed, as I've had some pretty bad falls (some while sober, some while drunk) but I recover after about a day.
Contrary to some of my fellow patients who are regretting doing the procedure, this has gone better than I could have ever have hoped for. I'm no longer ashamed of my size when I interact with people. Yes, at 5'7" I'm still short, and I'm still quite aware that most people are taller than me, but I just don't care anymore. Before the surgery, socializing would drain the life out of me, but now it's the exact opposite - I enjoy it. I've told so many people that I tore my ACL that I've started to believe it, and I can go for days without even remembering that I spent half a year doing such an insane procedure. Sometimes the scars (which are still in the process of healing so they look pretty bad) don't even bring back my memories. I didn't repress anything, I'm fully aware of what I did, but I'm able to forget about LL and enjoy myself.
My experience sadly seems to be an outlier, but deciding to get LL was probably the greatest decision of my life.
how is yoru recovery going?
I thought my post kind of made that clear...
so you cant run, and have to tell people you tore an acl... which means that you dont walk 100% normally
but you're perfect
good for you
Quote from: mb53 on February 26, 2016, 08:50:32 PMI thought my post kind of made that clear...
Oops... I missed that post haha
Quote from: crimsontide on February 26, 2016, 09:02:27 PMso you cant run, and have to tell people you tore an acl... which means that you dont walk 100% normally
but you're perfect
good for you
I tell people I tore my ACL because I needed to explain why I took a semester off from school. And I can't run because I'm still in recovery. But kudos on the passive aggressive response.
Quote from: TIBIKE200 on February 26, 2016, 09:21:36 PMOops... I missed that post haha
It's fine, haha
In what sense does your experience is an outliner?
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