How LL (inevitably?) misaligns joints, creates x-legs, and causes joint pain

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I think the exaggerated nature of the diagrams I used to demonstrate this are throwing off the discussion. Let's stick to more anatomically correct diagrams. This diagram shows the natural alignment of a good mechanical axis with the feet naturally apart as one would generally stand (with the ankles pretty much directly under the femoral heads, and the knees lining up along that axis perfectly with their joint line perfectly horizontal):



Do you recognize that if you lengthen the femur along it's anatomical axis, when standing with the feet similarly spaced so the ankles are still under the femoral heads (as they must be for natural stability and weight bearing), you will no longer be able to draw this straight line through the exact middles of the femoral head, knee, and ankle?

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There is a lot of good info in this thread.  But there is another variable to consider.  How does ballspan affect the mechanical axis and does it eventually cause joint pain?

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Quote from: Blackhawk on April 12, 2015, 03:17:21 PMThere is a lot of good info in this thread.  But there is another variable to consider.  How does ballspan affect the mechanical axis and does it eventually cause joint pain?

The issue of the anatomical ballspan is a complicated one that frequently split the scientific consensus. Many questions remain before a unified theory about balls can be presented: do we measure ballspan in cold or warm temperature? What about hairy balls? Are the balls balls beyond the balls and just how many balls are there?

One thing is for certain though: with a proper ballspan, there is no limit to how far you can go. Godspeed and may your balls never shrink or drop below your knees.

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Quote from: Uppland on April 12, 2015, 03:25:02 PMThe issue of the anatomical ballspan is a complicated one that frequently split the scientific consensus. Many questions remain before a unified theory about balls can be presented: do we measure ballspan in cold or warm temperature? What about hairy balls? Are the balls balls beyond the balls and just how many balls are there?

One thing is for certain though: with a proper ballspan, there is no limit to how far you can go. Godspeed and may your balls never shrink or drop below your knees.

Lol!!!  I agree, the issue of ballspan is indeed a complicated issue.

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I just want to provide a brief update on my thought process regarding this issue (in the interest of continuing to think out loud for whatever it's worth to anyone else).

I've looked at the distal femoral opening wedge osteotomy a bit more, and I know now why it's not offered. It's no small surgery. You're looking at large, deep incisions (at least 5-6" long), and significant tissue spreading to good exposure of the bone for plating. And then you've got that hardware in you which could cause pain by itself. Going back to remove the hardware is going to be equally invasive and risky.

So basically the best options as I see them in LL are:

1) Get internal femurs and live with the valgum shift. Realize it could put you at risk for chronic joint pain secondary to axis misalignment. But there's no way to know if it will for sure.

or:

2) Get external tibias via Hexapod or Taylor Spatial Frame. Internal tibias are an option too but with the risk of anterior knee pain like MDOW has secondary to patellar tendon or bursa damage.

Unless my preop xrays show a major varus to my knees, I'm almost certainly going to go with the second option. It's slower and more painful in the short run, but done by a competent doctor I think it has the lowest probability of any LL surgery of causing chronic joint/nerve/pain problems.

I'd rather take an extra few months to get my lengthening done that way and suffer in the frames than take a shortcut and pay for it in 5-10 years (and for the rest of my life).

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Bump for a very interesting post and to bring to peoples attention!