PMAX femurs in June (Paley)

Age: mid-40s male
Date of surgery: June 16, 2026
Surgery location:  Paley Institute in Florida
Surgery goal:  PMAX Femurs 8cm
Current morning height:  5'6" to 5'7"
Current morning weight:  139 lb.

Hi everyone, I'm scheduled for femur surgery in June.  I thought I'd share my planning progress to keep focused and hear suggestions.

The biggest hurdle will be finding a way to take care of my kids while I'm not there for 8 weeks.  (The plan is for my family to be in Florida for the first month.)  It'll be hard for my wife to do everything for them once they go back home.  I'm spending more time on preparations for that than stretching or other conditioning.

Nevertheless, for stretching/conditioning Moshe Roth says "long lean" leg muscles is what you want, so do a lot of biking and running prior to surgery.

Interestingly, I asked Dr.Paley and Dr.Robbins this question during the initial interview.  If big leg muscles can cause more pain.  Dr.Paley said that was rubbish.

My wife has booked flights and researched the hotels.  The plan is to live in an AirBnb which has accommodations conducive to my kids for the first month.  Afterwards I'll move to the Homewood Suites to be able to socialize with other patients.

I am taking a leave from work, using PTO and FMLA.  My boss said to make sure my co-workers can cover my duties while I'm away.

I'm hoping to return to work immediately after returning from Florida.  My job is half at the computer and half walking around interfacing with equipment, so I think it would be too much to crutch all the time, and would need a wheelchair handy.

I'm also attempting to bulk up the upper body.  I'll check my current levels later today.

Thanks!

I did not continue the topic after Dr.Paley said it was nonsense;  I was a bit intimidated

I haven't heard anyone say that strong legs are good, but I've read several people say to weaken your legs, and Moshe said lean legs are good.  Most agree that pre-surgery stretching is beneficial.

Yeah, I've heard bodybuilders say that before, that muscles remember how big they were and "snap back" more quickly to their original size.

Measurements today, for progress tracking:

I can do one pull up, and 100 lbs. for reps on bench and 65? lbs. seated row for reps (it's hard to tell because there are two machines and the weight numbers feel different, but on the easy machine I can do 78 lbs. for reps)

My thighs are 6.5" across at widest point.

--

Am getting PMAX, it says "Bilateral femoral lengthening with PRECICE-MAX lengthener" on the invoice.

I humbly request to all whom it is relevant to, please let's be nice if possible?

shortbutnosmall, thank you for your questions, I enjoy all the discussion as it's helpful to generating a better outcome for myself and others I think.

PMAX can be used in tibia, but weight limits apply (from the Paley Institute stature lengthening guide):

https://postimg.cc/HVQDj3n1

Here are a couple pieces from the guide:

If you want the full guide I think they will be happy to send it if you fill out that web form on the Paley Institute website.  Ask them for the PMAX Stature Lengthening Guide.  It has a full breakdown of costs and answers a lot of questions.

"How long do we need to use
assistive devices with the 
PMAX Nail?
For the P2.2 - Most patients use crutches or a walker for
two to five months after surgery (for 8cm femurs and 5cm
tibias.). A wheelchair is needed for long distance transport.
We teach patients how to do partial weight bearing in our
physical therapy department.
For the PMAX – Patients are encouraged to use crutches or
at least one crutch or a cane to offload the bodyweight on
the lengthening limbs for as long as needed. The surgeon
and physical therapist will inform you what is appropriate
for your status."

"How much weight bearing is
allowed during lengthening?
During distraction the bone ends are held separated by the
implantable rod. This rod is secured to the bone by screws at
either end. The diameter of the rod ranges from 8.5-10.7
12.5mms. The screws have a diameter ranging from 4-5mms.
With enough repeated loading the screws of any implant will
bend or break. No implant of any make or design is immune
to this. The heavier the patient the greater this risk. This is true of
any implantable lengthening nail no matter what the material it is
made of and no matter what you are told by the manufacturer
or the surgeon.
We permit full WB when we see complete bridging of the
bone on the x-ray. At that point the bone is taking the load
and protecting the rod. During the lengthening we allow WB
using crutches or a walker and unweighting the legs using the
arms. The amount of WB allowed depends on several factors:
the weight of the patient, the diameter of the rod and the bone
being lengthened. For the largest diameter Precice2, 12.5mms,
we allow up to 75 lbs (34 kgs) on each leg. This means that
when a patient is standing on two legs with two crutches on the
ground they can take up to 150lbs or (68 kgs). However, when
walking and transferring load from one leg to the other a patient
MUST USE TWO CRUTCHES on the ground and unweight
themselves to the 75lbs (34kgs) weight with each step. Patients
must NEVER walk with one crutch during the distraction phase
no matter how much they weigh. During the consolidation phase
the same rules apply until the surgeon increases the WB quota.
To know how much WB is being done a patient can stand on a
bathroom scale till it reaches the desired e.g. 75lbs number. For
the smaller diameter rods 10.7mms and 8.5mms no more than
50lbs  (23kgs) is allowed per leg.
For a patient lengthening with the PMAX, they may walk with
walker or crutches initially until they are able to assist themselves
properly with one crutch or a cane during the distraction phase to
help offset their full body weight on their limbs. This helps to protect
the rod from bending or breakage."