Q & A With Dr Franz Birkholtz

Well at the risk of looking like a class A tit & eating humble pie (I'm used to it by now!) I'd like to take the opportunity to thank you for your contributions Franz.

I would also like to ask you typically in your opinion what kinda of recovery one can hope to achieve if they are conservative with lengthening (say 5cm?).

From my understanding of the process muscles lengthen through serial sarcomere synthesis as appose to the muscles simply stretching.

Do you see people a few years down the line?  What is there recovery like?  You mentioned arthritis what is the mechanism of this the surgical trauma, the actual increased length of the limb or both?

Sorry for my crudeness about your country earlier.  Like I said I was perhaps ignorant.

Dr. Birkholtz-

Thank you for posting and answering questions on this forum. Can you please elaborate on your following quote.

Quotepotential increased arthritis risk after CLL.

During my consultation with Dr. Rozbruch in New York I asked about this question and he told me that cosmetic limb lengthening itself does not pose a risk for developing arthritis. The risk of arthritis comes from the surgeon not taking the proper precautions in aligning the axis of the joints during surgery and monitoring any changes during lengthening. He also said that 5cm is the safest amount to lengthen but up to 8cm does not increase the risk of arthritis. Going beyond 8cm increases the risk of arthritis because of the change in the ratio on the lengthened bone and excess pressure on the joints.

Do you share the same opinion as Dr. Rozbruch?

Dr. Birkholtz-

Would you also please give your opinion on what happens to the soft tissues (muscles, ligaments, nerves etc.) in the leg during lengthening. Do they simply stretch or are they building new tissue to support the increased length? How long do you estimate for recovery time after lengthening?

What is your opinion on returning to 100% or close to 100% athletic ability after lengthening? Is it possible up to 5cm and can a patient lengthen beyond 5cm and still return to or close to 100% athletic ability?

What is your opinion on the cosmetic or aesthetics of lengthening? How much can a patient lengthen on each bone segment and still look in proportion to the rest of their body before their legs start to look too long for their torso and arms?

Thank you again for posting on this forum and I look forward to your answers.

Hi guys,
It looks like we've opened a real can of worms! Firstly let me just state that any advice I give on a forum like this cannot constitute professional medical advice, and should be seen as general comments

Let me try and batch the answer to encompass all your comments. Distraction osteogenesis creates new bone, but also new soft tissues. Unfortunately this happens at different rates for different tissues. Muscles tend to go slowe than bone, so theres probably a combination of new muscle formation and stretching, hence the joint contracture risk.

Functional recovery is multifactorial but we expect high levels of recovery in lengthenings between 5 and 10 cm.
Cosmetically 10cm still keeps people in proportion.
I would aim for 5-6 cm on femur and 4-5 cm on tibia.
Arthritis is probably due to malalignment, but also increased joint pressures.
This seems to be related to the extent of the lengthening as well.
Hope this answers most of the questions?

Thanks for the reply.  I assume you mean 5-10 cm you are referring to both segments, not 5-10 cm on one limb?

Yep the 5 could be one segment, but 10 definitely two.

Dear Dr. Birkholtz,
could you please explain what malalignment means?

Thank you very much in advance

Quote from: Mime on November 24, 2013, 06:07:57 PMDear Dr. Birkholtz,
could you please explain what malalignment means?

Thank you very much in advance

Apologies. Sometimes we use technical terms without explaining their meaning.
Malalignment simply means when a joint's normal direction of action is changed, or pushed out of alignment. This could be the result of surgery, where the joint is now not 'straight' anymore. This means the forces go through the joint at an abnormal angle and can cause arthritis.