Limb lengthening at London Surgery Museum: Are exhibits influencing patient decisions

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Hi everyone, I'm considering limb lengthening at the London Surgery Museum and I was wondering if the exhibits there are influencing patient decisions. Have any of you visited the museum and felt like the exhibits swayed your choice of procedure or device?

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Honestly, the cost and rehab time were my main concerns when I underwent limb lengthening surgery. The pain during the first 2 weeks was brutal, but it was worth it in the end. I paid around $50,000 for the procedure and spent about 6 months in rehab. The exhibits at the London Surgery Museum didn't really influence my decision, but they did give me a better understanding of the process.

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I'm not sure if it's worth the risk of non-union or other complications. I read that the ISKD device has a pretty high mechanical complication rate. Has anyone had a good experience with this device?

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Physiological Mechanisms of Distraction Osteogenesis

Distraction osteogenesis is a complex process influenced by factors including the stability of fixation, rate of distraction, and quality of the bone regenerate. Intramedullary lengthening devices, such as the Fitbone or ISKD, provide stable fixation but are associated with risks including mechanical complications and issues with rate control. The ISKD, for example, has a diameter of 10.5 – 14.5 mm and a maximum achievable distraction of 5–8 cm, with activation requiring approximately 30° foot rotation for each distraction event, which can lead to difficulties in rate control.

Key Considerations for Patients

• Device selection should be based on a thorough evaluation of the pros and cons of each device, including cost, complication rates, and rehabilitation requirements. For instance, the Fitbone has a lengthening capacity of approximately 8.5 cm for the femur and 6 cm for the tibia, with a higher overall success rate than the ISKD but also a notably higher cost.
• Surgical technique is paramount, and patients should ensure their surgeon is experienced in the chosen procedure, understanding the underlying physiological mechanisms and the potential for complications such as nail fracture, motor failure, or leg-length discrepancy.
• Post-operative care must adhere strictly to the rehabilitation protocol to minimize the risk of complications and optimize the consolidation process, recognizing that consolidation rates can vary significantly between devices and patients, with factors such as distraction rate and stability of fixation playing critical roles.

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I agree with @LimbLengthened, the rehab time was a major factor for me. I'm considering the Precice device, has anyone had experience with this one?

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@SkepticalSarah, I understand your concerns about non-union, but I've read that the risk can be minimized with proper surgical technique and post-operative care. It's essential to discuss these risks with your surgeon and carefully evaluate the potential benefits and drawbacks of each device.

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@BoneAfide, your summary of the physiological mechanisms is spot on. I've also been researching the literature and it's clear that the distraction rate and stability of fixation are critical factors in determining the success of the procedure.