Does 5cm increase guarantee you'll recover to at least 90-95% of lower mobility?

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Quote from: Improving on July 12, 2020, 05:27:36 PMDear Doctor Assayag,

At first, thank you so much for being active on this forum by giving guidance. I totally agree, some doctors seems to advertize this market and misleading potential patient.

Thus, for us, future patient, it is difficult to have a clear understanding of what to expect.
This forum is great but still not enough as it is only individual experience and after I read many testimonies, it seems that the experience of each varies a lot with some making it really easy and other all the contrary !

I have read your bio and that you have been involved in many surgeries with stryde and seen a lot of patients.
In your experience, for Stryde femur for a reasonnable amount (max 6cm), what should expect the patient in term of timeline (given that the patient is doing the rehab seriously and is young and active patient as we mostly are in this forum)?

I know each patient is different but still in average and in your experience (reality no advertising of course), when the patient should be able to come back to a normal life (basic activities : walk normally long disrance, go up and down stairs...)?
And when should be able to come back to an active life style (hiking, active sports..)

I am asking because as I said, between the advertising of some doctors and the individual experience of person, it is still difficult for me to get a clear timeline for an average patient using femur stryde (reasonnable amount)?

 
On my side, I am planning to do femur stryde for max 6cm in the coming months and I am in the process of choosing a doctors as well as making sure this surgery is really for me.
Thus, your input could be very valuable !

Thank you

You are most welcome!

The young and otherwise healthy patient looking for 6cm (60mm) can look at the following timeline as it pertains to return to activities:
Start lengthening on day 5 after surgery (latency period) at a rate of 4x 0.25mm/day (1mm/ day)
it means that the very fastest you can get to full length is 65 days.

It is not uncommon to slow down lengthening for quality of regenerate, to prevent contractures from settling and giving the chance to eliminate them, or if symptoms of nerve traction injury start appearing. We initially slow down to 0.25 x3 times per day (0.75mm/day), and sometimes , but more rarely, to 0.5mm/day. Remember, slow and steady wins the race. The priority is safety, and avoidance of complications.

Realistically, for 6cm, you would be looking at anywhere between 65 to 90 days of lengthening.
Depending on your starting weight, you are allowed weight bearing as per tolerance (and if i may add, always preferably with assistive devices).

Remember, the forces of walking is up to 2x body weight, and climbing stairs up to 4x body weight.

Most patients by 6 months have mostly healed regenerate and walk without assistive devices. Impact activities are resumed anywhere between 6 to 9 months. (which really is no different than following an ACL reconstruction!!!)

By one year, you can expect to be back to full activities. (depending on your dedication and your pre operative physical condition,  return to pre operative athletic levels may take longer than that).


remember to manage your expectations.: Slow and steady wins the race. If you expect to be back to your pre surgical levels by 6 months, you can only be disappointed. If you expect longer recovery time, then you increase your satisfaction.


I hope this helps! Let me know if that does not fully answer your question and I will add more details.

 Dr. Michael J. Assayag, MD. FRCSC
Limb Lengthening and Reconstruction Surgeon
International Center for Limb Lengthening of Baltimore
http://www.heightrx.com
https://www.limblength.org/conditions/short-stature/
[email protected]
@bonelengthening on Instagram

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Quote from: Michael J. Assayag, MD on July 08, 2020, 01:13:36 PM
Highly unlikely... We use limb lengthening techniques for salvage purposes medically, whereas other surgeons alternative is amputation...

The various ways would be to really drop the ball multiples times again and again and again.

Unrecognized femoral arterial injury that goes unrepaired.

complete Laceration of the sciatic nerve. (somewhat salvageable)

Unrecognized compartment syndrome (even this is salvageable)

Go see a surgeon who knows what he’s doing and none of those should happen.

Dear Dr Assayag，What is the chance of compartment syndrome in femoral surgery?

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Slim to none, especially if done in a supine position . Never seen it reported in any series and it has never happened in our  center.

I have never seen anyone do this surgery on a traction table. But if anyone did it that way, there is a theoretical risk of compartment syndrome for the other leg. Once again: i have never seen or heard of any surgeon doing the surgery in such a way.

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Quote from: Michael J. Assayag, MD on July 13, 2020, 01:17:20 AMYou are most welcome!

The young and otherwise healthy patient looking for 6cm (60mm) can look at the following timeline as it pertains to return to activities:
Start lengthening on day 5 after surgery (latency period) at a rate of 4x 0.25mm/day (1mm/ day)
it means that the very fastest you can get to full length is 65 days.

It is not uncommon to slow down lengthening for quality of regenerate, to prevent contractures from settling and giving the chance to eliminate them, or if symptoms of nerve traction injury start appearing. We initially slow down to 0.25 x3 times per day (0.75mm/day), and sometimes , but more rarely, to 0.5mm/day. Remember, slow and steady wins the race. The priority is safety, and avoidance of complications.

Realistically, for 6cm, you would be looking at anywhere between 65 to 90 days of lengthening.
Depending on your starting weight, you are allowed weight bearing as per tolerance (and if i may add, always preferably with assistive devices).

Remember, the forces of walking is up to 2x body weight, and climbing stairs up to 4x body weight.

Most patients by 6 months have mostly healed regenerate and walk without assistive devices. Impact activities are resumed anywhere between 6 to 9 months. (which really is no different than following an ACL reconstruction!!!)

By one year, you can expect to be back to full activities. (depending on your dedication and your pre operative physical condition,  return to pre operative athletic levels may take longer than that).


remember to manage your expectations.: Slow and steady wins the race. If you expect to be back to your pre surgical levels by 6 months, you can only be disappointed. If you expect longer recovery time, then you increase your satisfaction.


I hope this helps! Let me know if that does not fully answer your question and I will add more details.

 Dr. Michael J. Assayag, MD. FRCSC
Limb Lengthening and Reconstruction Surgeon
International Center for Limb Lengthening of Baltimore
http://www.heightrx.com
https://www.limblength.org/conditions/short-stature/
[email protected]
@bonelengthening on Instagram

Dr. Assayag,

Is it possible to lengthen the femur at .5 mm/day (aka 2 x .25mm) for the entire period of lengthening? Or does that risk premature consolidation?

I ask this because my goal is to do 5 cm femur internal Stryde, and to make a full athletic recovery. I've read that the main issue is usually with soft tissues, and that the slower you lengthen, the easier it is for soft tissues to adapt. Time is not a big deal for me, only my health.

Also, when it comes to soft tissues, from my understanding they undergo distraction histogenesis. Does this mean that all soft tissues (skin, nerves, muscles etc.) will grow along with the bone, or will there be some permanent stretching even with only 5 cm? Will this have any effect on athleticism long term (10-20+ years after lengthening)?

And lastly, with the internal femur method of Stryde, is it possible to prevent/treat knocked knees (I believe it's called valgus deformity)? Does lengthening femurs 5 cm put you at higher risk for arthritis? I've read that since the hips are wider than the knees, lengthening places more horizontal pressure on the knee joints (such as with knock knees) which can lead to arthritis.

Thank you for your time Dr. Assayag, your input is very valuable here

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Quote from: MakeMeTallAF on July 21, 2020, 04:22:08 AMAlso, when it comes to soft tissues, from my understanding they undergo distraction histogenesis. Does this mean that all soft tissues (skin, nerves, muscles etc.) will grow along with the bone, or will there be some permanent stretching even with only 5 cm? Will this have any effect on athleticism long term (10-20+ years after lengthening)?

This is an incredibly good question. I also want to know the answer.

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"You want to increase your odds? use a brace to stretch at night as well. Keep an additive device handy. Don’t believe sleazy marketing . Keep an assistive device handy."

Thank you. What kind of brace and assistive device?

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Quote from: SpeedDialer on December 09, 2020, 01:52:58 AM"You want to increase your odds? use a brace to stretch at night as well. Keep an additive device handy. Don’t believe sleazy marketing . Keep an assistive device handy."

Thank you. What kind of brace and assistive device?

here we use custom made knee braces that provide a constant stretch over time.

Any kind of “turn buckle” brace will work. something like :
this would work but is not convenient for sleep.

https://www.jointactivesystems.com/products/jas-ez-knee-extension

 Hence why we custom make ours

In terms of effect. There are electomyographic changes that occur during even short lengthenings. However it is unclear what the long term effects on athleticism are. We have numerous patients who went back to regular physical activity. Maybe if you’re a professional sports player, if you don’t want to take any chance, avoid limb lengthening until the end of your career.

If you’re a weekend warrior, you should be good.

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Thank you.

1. When a patient does IT band release or gastro recession, do you think he should also do a nerve decompression at the same time in the respective areas?

2. What would you say if you were a patient and his doctor disagreed your view on this?

3. Basically, I imagine this situation:

Patient: "hey doc, why don't you a gastro recession prophylactically, I heard its good if you are doing more than 4 cm" 

Doctor: Nah that's unnecessary

Patient: Won't things hurt more for me if you don't do it? And this other doctor says its good, how much does it cost? And how much does a nerve compression cost too?

Doctor: You want me to do all these things?

What if I pressure a doctor into doing something he doesn't want and he makes a mistake? or are these simple enough that won't be

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Hey speed. There is a video where dr paley said that he doesnt do gastro resection but does the other two watch the video instead.

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I am a fellow 5'8

5'8 to 5'10 doesn't seem worth it for me as well, if it costs 80k and 3 months of my life atleast

If 3 inches was considered as safe as 2 inches is, I'd seriously consider it.

If you see it as 'worth it' though, then by all means go ahead