the person responsible for it... in india... is not offering anything
hed fix it if i paid him full price lol
so getting it done in by a top dr now
can get it fixed in 1 surgery
u do think its bad though... look at it... and thats not it
the side view has a bad alignment as well
To add another example like ShyShy, here's Christopherbulder who had 7 cm femur lengthening by Guichet and says after 12 years he is "100%".
http://www.limblengtheningforum.com/index.php?topic=2046.36
It's hard to tell with all that muscle, but the alignment really does look good stationary:
Walking looks a bit peculiar, though that could possibly be just because he's so buff/bulky, rather than due to any misalignment:
I wonder if any of this (how bad the resulting misalignment will be) is predictable based on the angles of preop xrays? The femurs are just so fast and effective if there was any way to know you could get a result like this with good alignment it would still be the best option. Tibias are just so slow.
Okay. I just had a shower and after staring down at my legs for 20 minutes here's my final thoughts for now, as I have to get back to work.
This misalignment problem stems from lengthening the bones along their lengthwise axes ie. via internal implants. Internal implants offer numerous obvious benefits. In particular, they are fast, less prone to infection, and can often allow weightbearing. It is no wonder surgeons and patients find them preferrable. However, if the goal is to maintain the biomechanical axis of the legs, this is not the ideal method.
Under perfect circumstances, a more perfect result can theoretically be obtained via an external Ilizarov apparatus, since an Ilizarov can lengthen along a perfect perpendicular up-down plane to maintain the joint axes in their natural positions. Nothing is necessarily tilted with an Ilizarov, because it can function to affect change in almost any direction.
eg. With fractures:
http://www.llrs.org/images/004.JPG
Now obviously, there are downsides to Ilizarov. It is slow. It requires wheelchairs. Infection and scarring risks are high. Bone fractures/splintering can occur. And there have been a lot of people who have been butchered by crapty Ilizarov surgeons. Perhaps it is difficult to precisely control the direction of distraction with some of these devices? I'm not sure. A lot of people have gotten bent legs or broken nails out of Betz internals too.
At least theoretically, in terms of maintaining natural joint alignment, after everything we've discussed in this thread, Ilizarov seems to have the possibility of being a much better ideal outcome for someone starting with normal knee alignment. I would have to study the mechanics of the Ilizarov a bit better, but I think the outcome would depend largely on exactly how and at what angle the apparatus is fixed into the bone.
I'm curious what you guys think about this concept.
Jeez, dude. Stop thinking so much into this. With such hypochondric attitude you should definitely forget about doing LL. The lateral shift is just about 1 mm per cm lengthened in femurs. There're no studies that actually show or conclude that it does indeed cause knee pain. And how does it even make sense? What about people who are naturally long-legged and have long femurs, do they all suffer from arthrisis? Because wouldn't it be the same, as if someone short-legged lengthened their legs (femurs)?
Quote from: exclide on April 08, 2015, 08:05:34 PMJeez, dude. Stop thinking so much into this. With such hypochondric attitude you should definitely forget about doing LL. The lateral shift is just about 1 mm per cm lengthened in femurs. There're no studies that actually show or conclude that it does indeed cause knee pain. And how does it even make sense? What about people who are naturally long-legged and have long femurs, do they all suffer from arthrisis? Because wouldn't it be the same, as if someone short-legged lengthened their legs (femurs)?
No it is not the same. That's the whole point of the diagram. As I said, when you grow naturally, your growth plates shift to compensate for your growth when weight bearing so that your hinge joints (knees/ankles) will remain parallel to the ground.
This does not happen in leg lengthening because we no longer have growth plates.
I don't think analyzing the risks and benefits of a $80,000-100,000 operation that requires up to 1 year off work being a "hypochondriac". I think it is stupid not to think about all this, when there are so many choices and options out there. And when this is purely cosmetic.
For anyone who actually finds this discussion or these concepts interesting, I've updated my diagram with the Ilizarov. As you can see, at least theoretically, it does offer the advantage of maintaining perfect biomechanical axis. By comparison, all internal lengthening devices will throw off the axis (by definition) to some extent unless you have a favorable (varus) misalignment to begin with.
See next post.
Quote As I said, when you grow naturally, your growth plates shift to compensate for your weight bearing so that your hinge joints (knees/ankles) will remain parallel to the ground.
Do you have just any data to back that assumption up? It just sounds like you're taking this out of your ass, sorry.
(We need PЯOOFS)
Quote from: exclide on April 08, 2015, 08:17:55 PMDo you have just any data to back that assumption up? It just sounds like you're taking this out of your ass, sorry.
(We need PЯOOFS)
This is simply how growth occurs. The growth plate responds to the pressure of weight bearing and muscular pressures around it. This is why kids with cerebral palsy end up with warped bones as they grow. It's also why physio is so important for kids with spinal cord injuries.
You can get abnormalities irrespective (eg. scoliosis), but the hinge joints (knee, and mostly ankle) are BIOLOGICALLY DESIGNED to work along a flat plane. It is not natural to need to tilt that due to internal femur leg lengthening as shown. By definition, it will create some degree of valgus deformity, and you will have to compensate for that. How big the deformity and how well you compensate is obviously individual.
Dr. Birkholz has said the same thing about how this misalignment happens with internal lengthening as quoted here:
http://www.limblengtheningforum.com/index.php?topic=2090.msg33500#msg33500
I think risking some pains in the future due to misalignment from internal LL is probably better than dealing with the complications of external femur lengthening. Even Dr Birkholtz said that internal femur lengthening is preferable to external femur lengthening, even though the latter doesn't give you the misalignment problem.
Quote from: KiloKAHN on April 08, 2015, 08:28:10 PMI think risking some pains in the future due to misalignment from internal LL is probably better than dealing with the complications of external femur lengthening. Even Dr Birkholtz said that internal femur lengthening is preferable to external femur lengthening, even though the latter doesn't give you the misalignment problem.
Certainly for femur I understand external lengthening is not a viable option. But the question I am now wondering is if we should be going back to whatever the best modern external Ilizarov tibial lengthening option is, rather than internal femurs. It may still be that the risks of any Ilizarov procedure outweigh the valgum (x-legs) problem of internal lengthening. Again, I know a lot of people have been butchered by bad Ilizarovs. But for a good Ilizarov if such a thing exists I'm not sure.
The thought of getting leg lengthening AND preserving anatomic function of all the joints is appealing, even if it costs more time and requires you to pop more antibiotics.
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