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Dr Dimitrios Giotikas (Athens, Greece)

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Android
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Posted on Dec 27, 2017, 12:50 am
#1
Note: please refer to our disclaimer about The Doctors Directory
http://www.limblengtheningforum.com/index.php?topic=55.0

Everything below was simply copied off of their site unless noted.


Dr Dimitrios Giotikas, MD, PhD
​Consultant Surgeon in Trauma & Orthopaedics
​Athens BJR Clinical Director
Hon. Senior Clinical Lecturer of the faculty of Medical Science at Anglia Ruskin University, Cambridge, UK.

Full profile including training, qualifications, work history, publications, and memberships


Cost & Pricing of Cosmetic Limb Lengthening
  • Femoral lengthening with Precise-2 nails: 36950 Euro
  • Tibia lengthening with TSF (Smith & Nephew) circular frames: 22600 Euro
  • Tibia lengthening with Precise-2 nails: 38950 Euro
  • Four segment cross-leg lengthening (femurs and tibias in two stages within 6 months) lengthening: 54000 Euro​
​​
What is included in the above prices:
  • Pre-operative and post-operative blood tests
  • Pre-operative and post-operative x-rays,
  • full board hospital stay for 4 nights in two bed bedroom,
  • Pre- and post-operative medications
  • Anaesthetist's fees,
  • Surgeon's fee,
  • Surgical assistant's fee,
  • Implants,   
  • Soft tissue procedures (tendon or IT band releases) which will be performed at the same setting with the main operation
  • in hospital physiotherapy until discharge.
  • Crutches and wheelchair
  • Post-operative (after discharge) physiotherapy, (5 sessions/week for the first two weeks, 3 sessions/week for the following 8 weeks. total 10 weeks,  34 sessions)
​
What is NOT included
  • Accommodations in Athens.
  • Travel to and from Athens.
  • Transportations in Athens.
  • Food and other supplies during your stay in Athens.
  • Entertainment and/or Internet costs.
  • Home health aides (nurses, homemakers, etc.).

Consultation
You can book a free 15 minute consultation online. (Note: not sure how successive consults are handled.)

Contact Info
Athens Bone & Joint Reconstruction Centre
Athens Towers 20th floor, 2-4 Messogion Av, 11527, Athens, Greece
​
Tel: +30 210 74 54 367
Mon-Fri:  09.00-18.00  (Time zone: UTC+02.00)
​
email: [email protected]
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Posted on Dec 27, 2017, 12:59 am
#2
I sent an email a couple months ago with some questions. Emphasis in responses are his.




I have questions regarding four-segment cross-leg lengthening mentioned here:
https://www.athensbjr.com/cost-and-pricing-of-cosmetic-limb-lengthening.html

1. Which methods are used for these procedures? Is it a mix of internal/external methods or are all segments the same (all external, all internal)?

I do four-segment-cross leg lengthening with Precise-2 nail in the femur and Taylor Spatial Frame (TSF) external fixator with clickers on the opposite leg. The main advantage of this approach is that patients are able to have a limb to stand and walk on with full weight bearing at all times during the lengthening and consolidation phases. This greatly helps with physiotherapy, muscle preservation and allows patients to continue with their usual daily activities with the least disturbance ( Looking after themselves, seeing friends, going out, even return to work, etc).  If a patient is interested in four-segment lengthening with Precise nails only, I do both femurs (or tibias) first and both tibias (or femurs) at a later stage, (i.e not cross-leg). I do not do femoral lengthening with external fixators for cosmetic reasons.

2. The page says "two stages within 6 months," does that mean lengthening and consolidation is completed before starting on the next segments? Or can it be sooner? Trying to estimate the required time commitment.

For 6-7 cm lengthening on femur, the time to allow full weight bearing is approximately 6 months. This is the time when the second stage is done. With regards to time commitment, my aim is to have the patient completely finished, full-weight bearing and with the TSF frames removed within a year or 15 months (for 11 or 13 cm of lengthening respectively). The required time of stay in Athens at each stage is  2,5-3 months. With shorter lengthening the timings are shorter.

3. What is the recommended amount of lengthening per segment if I am 165cm?

The recommended amount per segment depends on your desired height goal, the current lengths of femur and tibia and and the length-ratio between femur and tibia. I usually suggest up to 6 cm in femur and 5 cm in tibia, but I can go for up to 7 cm and 6 cm respectively, after having appropriately counselled the patient.

4. How many limb procedures has Dr. Giotikas performed, both cosmetic and non-cosmetic patients?

I specialized in limb reconstruction at Cambridge University Hospital NHS foundation Trust in the United Kingdom since 2012 and I continue to work there in a permanent post. We are a team of three specialists there sharing a workload of approximately 100 limb reconstruction cases/year. These cases are  pathological, infected or post-traumatic limb length discrepancy, bone defects and deformities and, to a lesser degree, constitutional short height related to bone dysplasias.  We use TSF fixators, Precise nails and LRS systems for lengthening over nails or plates, depending on the case.

My involvement in these complex cases, especially on patients with serious injuries or infections (where the difficulty and complications increase because of the compromised soft tissue condition) has equipped me with significant experience on the surgical technique and on the overall management of these patients ( non-traumatic corticotomy of bone, frame configuration for increased stability,  assessment of progression of regenerate, adjustment of lengthening rate, weight bearing progression, prevention of complications, counselling and coaching of the patients).  Athens BJR is based on the transfer of the above  experience to the field of cosmetic limb lengthening.

5. Are there any photos of CLL patients?

No, I am sorry, there aren't.
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onemorefoot
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Posted on Dec 27, 2017, 2:52 am
#3
Makes sense everything the doc wrote, maybe is a good option, I like the idea of TSF frames.
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Stadiometers
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Posted on Jan 6, 2018, 3:52 pm
#4
Link: https://www.athensbjr.com/dr-dimitrios-giotikas.html

Great find Android. His credentials look rock solid, strong emphasis on safety, very affordable for PRECICE & TSF, fees include everything except living expenses.

Conversion to U.S. Dollar: 6-January-2018

TSF Tibia: $27,000

PRECICE Femur: $44,500

PRECICE Tibia: $46,850

Four Segment Cross Lengthening: $65,000
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Stadiometers
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Posted on Jan 6, 2018, 3:53 pm
#5
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Android
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Posted on Jan 6, 2018, 11:13 pm
#6
Quote from: Stadiometers on January 06, 2018, 03:52:01 PM
Link: https://www.athensbjr.com/dr-dimitrios-giotikas.html

Great find Android. His credentials look rock solid, strong emphasis on safety, very affordable for PRECICE & TSF, fees include everything except living expenses.

Actually found him through these very forums in this thread. He does look quite good, he's on my shortlist.
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T
Time4LL
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Joined: Oct 2013
Posted on Jan 19, 2018, 3:57 pm
#7
Is anyone considering this doctor? I think he seems like a great option.
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myloginacct
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Posts: 421
Joined: Nov 2017
Posted on Apr 26, 2018, 12:18 am
#8
Quote from: Android on December 27, 2017, 12:59:00 AM
1. Which methods are used for these procedures? Is it a mix of internal/external methods or are all segments the same (all external, all internal)?

I do four-segment-cross leg lengthening with Precise-2 nail in the femur and Taylor Spatial Frame (TSF) external fixator with clickers on the opposite leg. The main advantage of this approach is that patients are able to have a limb to stand and walk on with full weight bearing at all times during the lengthening and consolidation phases. This greatly helps with physiotherapy, muscle preservation and allows patients to continue with their usual daily activities with the least disturbance ( Looking after themselves, seeing friends, going out, even return to work, etc).  If a patient is interested in four-segment lengthening with Precise nails only, I do both femurs (or tibias) first and both tibias (or femurs) at a later stage, (i.e not cross-leg). I do not do femoral lengthening with external fixators for cosmetic reasons.

Interesting approach for cross-lateral. Is Giotikas the only doctor mixing internals and externals for cross-lateral?
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Android
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Posted on Apr 26, 2018, 4:50 am
#9
Quote from: myloginacct on April 26, 2018, 12:18:43 AM
Interesting approach for cross-lateral. Is Giotikas the only doctor mixing internals and externals for cross-lateral?

I haven't seen it advertised as an option anywhere else. Though using TSF, it seems to be classic Ilizarov without LON/LATN (needs confirmation).

You could probably ask a clinic that offers both externals and internals if it's an option though, since Dr. Birkholtz has mentioned cross-lateral lengthening in the past (and he offers both fixator types). While Dr. Paley doesn't offer it anywhere for CLL patients, Dr. Mahboubian's site still mentions TSF.
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Great321
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Posted on May 1, 2018, 6:51 am
#10
I posted the answers in my topic already http://www.limblengtheningforum.com/index.php?topic=5412.0
but as it also fits in here, here is my e-mail correspondence:

I sent my questions yesterday (On Mon, Apr 30, 2018 at 5:38 PM) and they responded today at 07:47 AM (that was sooner than I expected.)

1.   How long do you have to wait for an appointment (consultation and surgery)?
You can see available dates for online consultations and consultations at Mediterraneo Hospital in Athens by clicking here. Generally the waiting time is approximately 2 weeks. For surgeries, we plan at least two months in advance. The shortest available surgery date for you, would be on 5 or 6 July 2018 and then in September.

2.   Do you recommend staying in Greece for the whole lengthening process or is it still safe to travel back to Germany for consolidation?
We require that patients remain in Athens during the lengthening period only, but we allow them to return back home during the consolidation period. We provide a detailed schedule for physio, online consultations and x-rays for after their repatriation.

3.   I am interested in the cross-leg lengthening method. I have read from another doctor that by doing externals for tibia the risk of permanent knee pain (due to the nail insertion and removal) is lesser. Why do you recommend the Precise 2 for tibias?
Cross-leg lengthening is in our opinion the best strategy for patients aiming for more than 8 cm of lengthening. Anterior knee pain is a rare (less than 3%) risk of tibia nailing; even when it happens it tends to improve gradually. We offer the option of Precise-2 in tibia for patients who do not want external ring fixators.

4.   Does it make a difference concerning the duration of the healing process which method someone chooses?
No, it doesn't.

5.   I am 1,60m how long would it take for me to walk normally again if I aim about 10cm more?
For 10 cm of lengthening in two stages with cross-leg lengthening it will take approximately 9 to 10 months to walk without walking aides. During all this time you will be able to walk independently with crutches and full weight bearing on the leg that has the ring fixator frame.


6.   How many CLL patients have you had so far?
Dr Dimitrios Giotikas discusses all questions about his clinical experience, including the volume of cases, during a free introductory 15 min consultation via Skype or phone, which you can book now.

7.   I have read about MESKA (Mediterranean rehabilitation Centre), how long can you stay there and how much does it cost per month? Are there inexpensive places a patient can stay safely close to your clinic?
MESKA costs approximately 200Euro/day but includes full board meals, hydrotherapy, daily physiotherapy, transportations etc. There are indeed  inexpensive options for accommodation (hotel rooms and Airbnb apartments) near to our clinic.
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Great321
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Joined: May 2018
Posted on May 4, 2018, 9:42 am
#11
1. Other doctors say that often times Achilles tendo lengthening is necessary. They charge you extra money. How is that handled with you? And is the frame removal included in your price?
Thank you for your email. Answering to your questions:
We do not do Achilles lengthening as it almost always results in some degree of permanent loss of strength of the calf muscles which patients feel as weakness during their walking or their standing on their toes. In our opinion it is not a "fair trade" to trade function for lengthening. If equinus deformity (ballarina foot) is encountered, we treat it with a temporary extension of the frame to the foot during the lengthening phase. This method very reliably stretches the tendon and restores the position of the foot. It is a rather minor procedure, which is done as a day case, but it requires anaesthesia and extra frame parts so there is an associated additional cost of 1000 for one leg and 1500 for bilateral done simultaneously. The need for this procedure will be assessed before your main lengthening surgery. The frame removal is not included in the price as many patients choose to have them removed in their country rather than traveling back to us. The cost for frame removal with us is 950 Euro


2. Is the 4-5months recovery with TSF an average because with HEF for example I was told that they take off your frames 7-11months later.
The timing for frame removal depends on the  lengthening goal, patient's age and healing rate.The numbers mentioned is an average (plus/minus 6 weeks).

3. Do I need some kind of VISA for staying multiple months (4-5months) in Greece as a German citizen?
For 5 cm of lengthening, we need you to stay in Greece for a minimum of 2.5 months. Greece is a member state of the EU so as a German citizen you do not need any special Visa or residency status and you can stay for as much time as you wish.
We remain at your disposal for any further information and assistance.
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Body Builder
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Posted on May 4, 2018, 12:07 pm
#12
Τhe answer about atl make me believe that Giotikas is a respectable doctor who knows what he is talking about.
He is completely right about what he says and I really wonder how doctors like Catagni and Pili still perform atl which destroys feet capabilities.

I would have a close look to that doctor. He seems very promising and it is time to trust new doctors with better prices but still on first world countries (like Greece) because, except from USA where Paley and Rozbruch are really the top doctors in the world, there aren't any doctors who personally I'd trust completely for internal femurs, especially for their prices.
So it is time to give a chance to new, promising doctors like him who seem to really know what they are talking about.

We'll see.
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Great321
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Posted on May 4, 2018, 2:40 pm
#13
Yes, I feel also safer with Greece and plan to make an appointment soon.

I forgot to post this e-mail exchange which fits in here
I asked them about the recovery time and about proportions:

1. With bilateral TSFs for 5cm lengthening in tibias the estimated time for frame removal is 4 to 5 months. You will be able to walk with the frames and with full weight bearing since immediately after your surgery.

2. With bilateral Precise-2 nail for 5cm lengthening in femurs the estimated time for walking without crutches is 4 months. Until then you will need to use wheelchair and walker or crutches. The same applies to tibias with precise nail, but tibias may take a bit more until walking without crutches (4 to 5 months)

3. I don't expect that your proportions will look strange after lengthening the tibias and before doing the femurs. In any case,  we use Athena Method -a method developed and presented by Dr Dimitrios Giotikas- to accurately inform our patients about their proportions before and after the lengthening. So,you will know exactly, how each cm of lengthening in tibia and femur is going to affect your body proportions.
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Stadiometer, Esq
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Posted on May 5, 2018, 5:49 pm
#14
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AlphaX
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Posted on May 15, 2018, 10:08 pm
#15
Hi friends !  ;D

I enclose the answer given to me by the doctor's service concerning the operation of both limbs (femur and tibia) on both legs (54k).

They answered me very quickly (one day), I find it really nice of them. Some of my questions are probably trivial for some of you but in case some ask them I prefer the posted.

1 - First, I would like to know what physical condition is required to be eligible for this type of operation? I am not overweight, but I do not know if I have the muscular mass required for such surgery.

"The muscle condition is not a prerequisite for cosmetic limb lengthening (CLL). Contraindications for CLL are: Morbid obesity, Smoking, Immuno-suppression, Chronic infection,  Diabetes, Psychiatric disorders with poor compliance, Anaesthetic related contraindications. "

-> I find it pretty cool, unlike the method of doctor Guichet, we do not need to be an athlete to get surgery!

2 - Can you confirm that the final price for this type of intervention (cross lateral) is well 54.000 euros TTC?

" Prices shown are TTC."

3 - I would like to understand that it is preferential to have surgery done externally or internally the tibia? Which of his methods allows for faster recovery and no future pain? On the other hand, I'm not sure I understood what "PRECICE 1" and "PRECICE2" mean?

"Both external and internal fixation give satisfactory results in tibia. The choice in each case is based on patient's preference, cost considerations and appropriate counselling by Dr Giotikas about the pros and cons of each method. Precise 1 was the first version of the nail which is not routinely used anymore. Precise 2 is the subsequent improved version of the nail."

->I think I discuss this part in more detail with the doctor during a consultation. Indeed, I would like to know better the advantages of this or that method.

4 - I could see that many had complications with other doctors for the operation of a single limb (tibia or femur). Your service proposes to operate both successively, is that not more risky?

"Four segment lengthening (either cross-leg or not) is the only solution for people who want to go beyond 8 cm and consent to accept the related risk after having received appropriate counselling by Dr Dimitrios Giotikas. It is obviously statistically riskier than having lengthening of femur or tibia only."

->It was an obvious and logical answer to the question but other service of LL would not have had this frankness I think.

5 - How long does it take to finally get surgery and consolidate the 4 members to operate? While removing the fixers éxternes of the TSF?

"he actual timings depend on the lengthening goal to be achieved. We generally plan to have the patients back to their lives without frames within 12 months from first surgery."

6 - Finally how long does it take to get a date of intervention after the consultation at athénes?

"Two months, but sometimes can be sooner."

I then add questions that I will send you answers at parties!

1 - In case of possible physical complications following the operation. Should we take charge of any additional operations / treatments that this would induce?

2 - The payment of the entire process must be done before the transaction or it can be staggered?

3 - From what I could understand. You operate initially 2 segments (namely the tibia and the femur) of one leg then the other one after consolidation. (I may have misunderstood) Would not it be better to operate for example the two femur together then the two shins?

4 - All preoperative examinations are made during the initial consultation at athénes?


If you have other ideas of questions that I do not ask yet I'm interested! I intend to book an online service of 15 minutes to try a first approach. ;D
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..
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Posted on May 15, 2018, 10:41 pm
#16
Quote from: AlphaX on May 15, 2018, 10:08:59 PM
Hi friends !  ;D

I enclose the answer given to me by the doctor's service concerning the operation of both limbs (femur and tibia) on both legs (54k).

They answered me very quickly (one day), I find it really nice of them. Some of my questions are probably trivial for some of you but in case some ask them I prefer the posted.

1 - First, I would like to know what physical condition is required to be eligible for this type of operation? I am not overweight, but I do not know if I have the muscular mass required for such surgery.

"The muscle condition is not a prerequisite for cosmetic limb lengthening (CLL). Contraindications for CLL are: Morbid obesity, Smoking, Immuno-suppression, Chronic infection,  Diabetes, Psychiatric disorders with poor compliance, Anaesthetic related contraindications. "

-> I find it pretty cool, unlike the method of doctor Guichet, we do not need to be an athlete to get surgery!

2 - Can you confirm that the final price for this type of intervention (cross lateral) is well 54.000 euros TTC?

" Prices shown are TTC."

3 - I would like to understand that it is preferential to have surgery done externally or internally the tibia? Which of his methods allows for faster recovery and no future pain? On the other hand, I'm not sure I understood what "PRECICE 1" and "PRECICE2" mean?

"Both external and internal fixation give satisfactory results in tibia. The choice in each case is based on patient's preference, cost considerations and appropriate counselling by Dr Giotikas about the pros and cons of each method. Precise 1 was the first version of the nail which is not routinely used anymore. Precise 2 is the subsequent improved version of the nail."

->I think I discuss this part in more detail with the doctor during a consultation. Indeed, I would like to know better the advantages of this or that method.

4 - I could see that many had complications with other doctors for the operation of a single limb (tibia or femur). Your service proposes to operate both successively, is that not more risky?

"Four segment lengthening (either cross-leg or not) is the only solution for people who want to go beyond 8 cm and consent to accept the related risk after having received appropriate counselling by Dr Dimitrios Giotikas. It is obviously statistically riskier than having lengthening of femur or tibia only."

->It was an obvious and logical answer to the question but other service of LL would not have had this frankness I think.

5 - How long does it take to finally get surgery and consolidate the 4 members to operate? While removing the fixers éxternes of the TSF?

"he actual timings depend on the lengthening goal to be achieved. We generally plan to have the patients back to their lives without frames within 12 months from first surgery."

6 - Finally how long does it take to get a date of intervention after the consultation at athénes?

"Two months, but sometimes can be sooner."

I then add questions that I will send you answers at parties!

1 - In case of possible physical complications following the operation. Should we take charge of any additional operations / treatments that this would induce?

2 - The payment of the entire process must be done before the transaction or it can be staggered?

3 - From what I could understand. You operate initially 2 segments (namely the tibia and the femur) of one leg then the other one after consolidation. (I may have misunderstood) Would not it be better to operate for example the two femur together then the two shins?

4 - All preoperative examinations are made during the initial consultation at athénes?


If you have other ideas of questions that I do not ask yet I'm interested! I intend to book an online service of 15 minutes to try a first approach. ;D

That's great man. I also plan to do the free online consultation.
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Great321
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Joined: May 2018
Posted on May 15, 2018, 11:24 pm
#17
Here's my list of questions I want to ask him next months, but if you want you can ask some of them before (at your online consultation), let me then know which one you chose:

1. How many patients did you have concerning limb lengthening. How many CLL patients did you have so far?
2. How many cross leg lengthenings have you done so far?
3. Is cross leg lengthening far more dangerous than doing tibias or femurs separate?
4. What are the most common risks with each method you offer? And which ones occured to your former patients?
5. What will I be able to do during lengthening and consolidation (walking, driving, sightseeing, sitting for a longer time?)

6. How close should the appartment I'll rent be to the clinic?
7. Will the Physio therapist visit me at my place of stay?
8. After the 10 weeks of PT you offer, how long and how often per week should I hire a PT?
9. Are there PT's in Athens you recommend after the surgery? (who aren't too expensive)
10. Is there something I can do before surgery to improve my recovery?

11. What kind of doctors are able to remove such frames if you choose to do it in your home country?
12. Do you have an emergency number in case something happens?
13. Did you notice if a certain amount of lengthening (cm) is more safe?
14. I have read that having longer tibias can be bad for your health, so should I start femurs first or will it make no difference if the lengthening of the other segments will be done about a year afterwards?
15. If someone does cross LL how long after the first surgery will the second will be done?

16. I am just 117 lbs. Does this make a difference concerning recovery and mobility?
17. Will it be worth waiting for Stryde for femurs ? Will it cost a lot more?
18. What can you do if for example with Cross LL the first surgery+lengthening+consolidation goes fine but the second time complications occur, wouldn't you have a discrepancy if you have to stop lengthening?
19. Can the so called "duck ass" or "ballerina foot" be avoided somehow?
20. If I go home for consolidation phase whom should I contact If something happens like infection? What kind of doctors in my home country would be able to treat that?
21. Does the frame removal cost 950€ in total or for each frame? (if you do cross ll )



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H
Honore
Verified Member
Posts: 69
Joined: Dec 2017
Posted on May 16, 2018, 12:26 am
#18
excellent work guys.

I am at 165cm and want to do also 10cm on femurs(5/6) and tibia(5/4), just like you guys. My main question would be, in case everything goes well, how much time from operation till walking unaided/resuming normal activities?
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Android
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Posted on May 16, 2018, 12:29 am
#19
Quote from: Honore on May 16, 2018, 12:26:15 AM
I am at 165cm and want to do also 10cm on femurs(5/6) and tibia(5/4), just like you guys. My main question would be, in case everything goes well, how much time from operation till walking unaided/resuming normal activities?

That has been answered previously:

Quote
With regards to time commitment, my aim is to have the patient completely finished, full-weight bearing and with the TSF frames removed within a year or 15 months (for 11 or 13 cm of lengthening respectively).
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AlphaX
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Posts: 249
Joined: May 2018
Posted on May 16, 2018, 3:23 pm
#20
Here are the answers to my questions (always super responsive).

1 - In case of possible physical complications following the operation. Should we take charge of any additional operations / treatments that this would induce?


"Although we try to reduce the cost as low as possible in the treatment of an adverse event, there may be additional cost if unexpected interventions are required. We generally advise our patients to have an additional 4000 euros for such a case."

2 - The payment of the entire process must be done before the transaction or it can be staggered?

Payments are paid in full tbefore the surgery date.

3 - From what I could understand. You operate initially 2 segments (namely the tibia and the femur) of one leg then the other one after consolidation. (I may have misunderstood) Would not it be better to operate for example the two femur together then the two shins?

"The main advantage of the four segment cross-leg is that it allows full weight bearing on one side through out the whole procedure.  Doing both tibias (or femurs) first and then the other parts can also be done."

4 - All preoperative examinations are made during the initial consultation at athénes?

"Yes, they are."

@Great321 Thank you so much !! I find your questions super perceptive and precise. I did not think about it but many of them are important.

I will ask these 5: 2-4-5-10-18 and tell you what I give as an answer.

Subsequently I think to agree to an online appointment for a first approach ..

Thank you all!
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