Q&A With Dr Mangal Parihar

Do you think femur leng. with Lon is safe ?

I asked Dr Parihar for his thoughts on cross-lateral lengthening when I sent in my latest x-rays, because I remembered him telling me before that he wouldn't want to perform it. Here was his reply.

Dr Parihar: The advantage of doing cross lengthening is that you are putting less lengthening strain on the leg. i.e. if you are doing the same side femur and tibia, even if you distract at 1 mm per day, the limb overall is lengthening at 2 mm per day. 2 mm per day in the limb may not be good for the other soft tissues like nerves etc. Therefore one would probably need to go at about .5 mm or .75 per day at each lengthening site, making up a total of 1 or 1.5 mm lengthening per day for the limb. The disadvantage of cross lengthening, is that for any reason if lengthening had to be abandoned during or after the first phase, (infection, patient not able to continue due to pain or other reasons, cost issues etc), then the patient would be left with the same overall leg length while standing (presuming equal lengthening in tibia and femur) but while sitting one knee would be higher than the other (longer tibia side), and the other knee would be pushing forward (femur longer side). It's realistically doable only with internal methods. With external methods, having a frame on the tibia as well as femur at the same time, risks knee stiffness. If i ever had a patient who was insistent on cross lengthening, i would probably need to do a very detailed consent, outlining the above. Given the cost of the nails, I don’t see myself needing to do one of those anytime soon.

I asked Dr Parihar for his thoughts on cross-lateral lengthening when I sent in my latest x-rays, because I remembered him telling me before that he wouldn't want to perform it. Here was his reply.

Dr Parihar: The advantage of doing cross lengthening is that you are putting less lengthening strain on the leg. i.e. if you are doing the same side femur and tibia, even if you distract at 1 mm per day, the limb overall is lengthening at 2 mm per day. 2 mm per day in the limb may not be good for the other soft tissues like nerves etc. Therefore one would probably need to go at about .5 mm or .75 per day at each lengthening site, making up a total of 1 or 1.5 mm lengthening per day for the limb. The disadvantage of cross lengthening, is that for any reason if lengthening had to be abandoned during or after the first phase, (infection, patient not able to continue due to pain or other reasons, cost issues etc), then the patient would be left with the same overall leg length while standing (presuming equal lengthening in tibia and femur) but while sitting one knee would be higher than the other (longer tibia side), and the other knee would be pushing forward (femur longer side). It's realistically doable only with internal methods. With external methods, having a frame on the tibia as well as femur at the same time, risks knee stiffness. If i ever had a patient who was insistent on cross lengthening, i would probably need to do a very detailed consent, outlining the above. Given the cost of the nails, I don’t see myself needing to do one of those anytime soon.

Please ask him if he has done a precice surgery in India already

Quote from: SAD on February 10, 2016, 08:55:12 AMPlease ask him if he has done a precice surgery in India already

He hasn't. I'll be his first this year.

Quote from: Penguinn on February 10, 2016, 09:01:45 AMHe hasn't. I'll be his first this year.

yeah? I guess people in India generally can't afford Precice nails.

Quote from: SAD on February 10, 2016, 03:06:41 PMyeah? I guess people in India generally can't afford Precice nails.

Yeah, even for financially well off Indians, the dollar to rupee exchange rate is outrageous.

Quote from: Penguinn on February 10, 2016, 05:15:49 PMYeah, even for financially well off Indians, the dollar to rupee exchange rate is outrageous.

Bad for locals interested in doing CLL with him, good for foreign patients (unless locals get a cheaper rate like they did in China, but I've never asked him about that as it would be pretty rude). Dr Parihar's cost for surgery was 900,000 INR back in 2008 when I first messaged him inquiring about leg lengthening after I stumbled onto his website, and that would have been roughly $20,000 USD just for surgery. When I got the surgery 2 years ago it was $14,977 USD. Now the exchange rate comes out to $13,257.

Quote from: Sean Connery on November 16, 2015, 06:06:06 PMI've been to the Netherlands and it truly is awful compared to places like France, Spain and Italy strictly in terms of dating beautiful women. Most of the women there are really big and oafish. Good for gathering firewood in the harsh winters, but not good for getting you excited.


Now on topic... I read that Dr. Parihar does not like to to releases for cosmetic lengthening when there are other doctors including Paley who do it as a routine. Why does he prefer to wait and see instead of doing the releases as standard procedure for every case?

I just returned from Amsterdam today and it was really weird To be honest I didnt see many natives. almost everybody was Brittish, German, Scandinavian. I stumbled across on a few occasion on groups of 5-6 women all of them 180+ .... not only they are tall, but also fat and big boned with that being saidm there were some reasonably tall women that have model bodies and are really attractive.

Overall the trip to Amsterdam encouraged me to proceed with the surgery as planned next year. I will however go with Dr. Mitkovic and just do 5.5 to reach 181 , (183 with formal shoes) and be done with it. I am now in my mid 20s , maybe in early 30s or mid 30s if I am rich and the technology improved to allow for a speedy recovery in a matter of 2-3 months at most, I will do some other 4-5 cm but most probably I will just do 5.5 with Mitkovic and move on.

Q&A with Dr Mangal Parihar - Clarification regarding LON vs LATN

Question(me):
My understanding is that LATN supports full weight bearing and even better structural rigidity over LON during consolidation, as a bigger nail can be inserted after distraction. Could you please let me know if my understanding is right.

I'm looking for an option where I don't have to wear frames during consolidation without compromising on full weight bearing.

Response:
LATN better than LON for weight bearing - not true. still need protected weight bearing till callus / regenerate is sound.

option of no frames, without compromising on full weight bearing - does not exist

Question(me):
Thanks for the quick response Sir.

When you say "need protected weight bearing" - I believe you're referring to Zimmer frame or Crutches, and not any additional frames around the legs. Please confirm.

Also, Could you please let me know how long would it typically take for weight bearing using LON during consolidation, for say lengthening of 5 cms in Tibia. My concern is whether I'll be able to physical exercises or do physio therapy without being able to weight bear. I'm worried that this might delay the consolidation - or may be I'm just paranoid.

Response:
zimmer frame / crtuches - yes

how long - varies with the individual. the nail is put in to avoid the inconvenience of an external fixator. not to allow earlier full weight bearing. healing is the same, with or without nail and may take unto 7 -8 months for unassisted weight bearing.