On choosing a doctor for LL / What can you tell me about Dr. Pili?

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You can probably ask Pili himself why he believes ATL is generally so needed too. But get more opinions to be safe.

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Quote from: Bruce Wayne on May 02, 2018, 06:35:54 PMAndroid. I thought it's best to use externals for tibia?

Dr. Paley's reasoning is that the benefits outweigh the cons. Cosmetic patients are much pickier, and they often do bilateral lengthening unlike correction patients (e.g. limb length discrepancy), which make discomfort a point of complaint. From what I've read anterior knee pain risk is lowered with the correct technique, so that probably solidified his decision to go all-in with Precice (he is a consultant for them after all).

Edit: typo, "picker" to "pickier".

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Quote from: Android on May 03, 2018, 04:17:23 PMDr. Paley's reasoning is that the benefits outweigh the cons. Cosmetic patients are much picker, and they often do bilateral lengthening unlike correction patients (e.g. limb length discrepancy), which make discomfort a point of complaint. From what I've read anterior knee pain risk is lowered with the correct technique, so that probably solidified his decision to go all-in with Precice (he is a consultant for them after all).

Which one would you rather do or believe is safer?

Femur with PRECICE2/3 by Dr. Paley or Tibia with Hybrid external fixator by Dr. Catagni (If am not mistaken, the best Dr. for external?)

There will be a huge discrepancy in cost between the two although I am not sure which one would result in less long-term complications and loss of functionality.

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Quote from: Bruce Wayne on May 03, 2018, 06:35:10 PMFemur with PRECICE2/3 by Dr. Paley or Tibia with Hybrid external fixator by Dr. Catagni (If am not mistaken, the best Dr. for external?)

HEF with Pili/Catagni on tibiae and PRECICE with Paley but in femurs.

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Quote from: Argent_Lecter on May 03, 2018, 07:01:48 PMHEF with Pili/Catagni on tibiae and PRECICE with Paley but in femurs.

Yeah, I was asking if we had to choose between the two, which one wins?

Thing is lengthening only femurs would not look aesthetically pleasing whereas long tibia and higher knee level will make you look visually taller especially if you're wearing shorts. But safety and athletic recovery are the priority.

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Quote from: Bruce Wayne on May 03, 2018, 06:35:10 PMWhich one would you rather do or believe is safer?

If money was no concern, I'd go with Precice out of convenience. I'd swallow the risk since it'd be a smoother experience overall, plus the ERC would make lengthening a mindless task. Less scars too.

But in reality, I'd go with bilateral external tibias and put the savings toward something else. It's much better tolerated unlike external femurs. As for scars, that's what my leg hairs are for!

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Quote from: Android on May 03, 2018, 07:20:24 PMIf money was no concern, I'd go with Precice out of convenience. I'd swallow the risk since it'd be a smoother experience overall, plus the ERC would make lengthening a mindless task. Less scars too.

But in reality, I'd go with bilateral external tibias and put the savings toward something else. It's much better tolerated unlike external femurs. As for scars, that's what my leg hairs are for!

So you believe that on paper, uniteral external tibias are technically the safest method compared to anything else even when it's not done by Paley? Which doctor is the best for external tibias?

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Quote from: Bruce Wayne on May 03, 2018, 07:46:58 PMSo you believe that on paper, uniteral external tibias are technically the safest method compared to anything else even when it's not done by Paley? Which doctor is the best for external tibias?

Just a reminder that I haven't done CLL yet, so don't take my replies as hard advice. A memorable avatar and posting frequency is no substitute for experience.

That being said, I wouldn't say unilateral external tibias is necessarily safer than bilateral, just more convenient to have a fully working leg (frames are weight bearing though, so not as beneficial as unilateral internals IMO). Doing unilateral means you'd have to go under general anesthesia and take pain killers more times, which can be seen as a risk, not to mention paying more (surgery, hospital stay, PT, accommodation, etc.). In the end you have to balance and decide which pros and cons make sense to you: safety, convenience, duration, pain level, etc.

Even veterans usually only have one doctor, so it's hard to say who is the best (but they certainly have a better idea on what to look for). I tend to agree with what has been echoed in this community: Dr. Catagni/Pili, Dr. Birkholtz, Dr. Parihar, and Dr. Solomin/Kulesh. I even suggest Dr. Mahboubian; his latest diaries are all for Precice, but I believe he still offer externals (who knows, maybe Dr. Rozbruch might too). They're all published contributors in their field and are relatively conservative in their treatment methods.

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What is not spoken of enough about unilateral CLL is that you have to decide on a length while lengthening the first leg and stick to the same length in the other leg afterwards. If you lengthen 7cm on your good leg and your bad leg has bad nerve pain and preconsolidation at 5cm you cannot stop because you would then have a 2cm discrepancy.

If this wasn't an issue I would have recommended unilateral for anyone who can afford it and has the time. Also you will generally have a better and more productive time dealing with one leg at a time.

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Quote from: Android on May 03, 2018, 08:47:34 PMJust a reminder that I haven't done CLL yet, so don't take my replies as hard advice. A memorable avatar and posting frequency is no substitute for experience.

That being said, I wouldn't say unilateral external tibias is necessarily safer than bilateral, just more convenient to have a fully working leg (frames are weight bearing though, so not as beneficial as unilateral internals IMO). Doing unilateral means you'd have to go under general anesthesia and take pain killers more times, which can be seen as a risk, not to mention paying more (surgery, hospital stay, PT, accommodation, etc.). In the end you have to balance and decide which pros and cons make sense to you: safety, convenience, duration, pain level, etc.

Even veterans usually only have one doctor, so it's hard to say who is the best (but they certainly have a better idea on what to look for). I tend to agree with what has been echoed in this community: Dr. Catagni/Pili, Dr. Birkholtz, Dr. Parihar, and Dr. Solomin/Kulesh. I even suggest Dr. Mahboubian; his latest diaries are all for Precice, but I believe he still offer externals (who knows, maybe Dr. Rozbruch might too). They're all published contributors in their field and are relatively conservative in their treatment methods.

Don't worry. Not taking what you said as hard advice but in general I see that you post good stuffs.

Yeah you're right, we should factor the anesthesia and painkillers too. I just thought with unilateral, if the surgery goes south, you'd still have the other healthy leg. But with bilateral, you might lose both legs. Isn't that so? Not to mention less risk for fat embolism.

I think Paley might have decided not to do external because he makes more money doing PRECICE and not because classic Illizarov is obselete.

Quote from: fokid on May 03, 2018, 09:03:49 PMWhat is not spoken of enough about unilateral CLL is that you have to decide on a length while lengthening the first leg and stick to the same length in the other leg afterwards. If you lengthen 7cm on your good leg and your bad leg has bad nerve pain and preconsolidation at 5cm you cannot stop because you would then have a 2cm discrepancy.

If this wasn't an issue I would have recommended unilateral for anyone who can afford it and has the time. Also you will generally have a better and more productive time dealing with one leg at a time.

If we could follow the rules and don't lengthen more than 5cm, do you think it'd still be an issue? I just want the safest scenario possible.