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Risks/Complications Of LL

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Alu
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Posts: 304
Joined: Aug 2015
Posted on Dec 17, 2015, 11:22 pm
#81
Quote from: Madmax_01 on December 17, 2015, 10:40:58 PM
I could find information about complications from tibia lenghtening surgery on Wikipedia, which had references from Pubmed. I could not find the link but I remember something about 75% suffered from arthritis. Does anyone have information about long-term complications after INTERNAL FEMUR lenghtening? Any scientific data or studys to back up the infos which are presented in the forum.

Internal Femurs aren't relatively old or new, so I doubt there are long term studies into the after effect (I certainly couldn't really find anything). But, I would infer that a huge factor into what might cause Arthritis in relation to LL through the Femurs would be how much one lengthens and how the rods are inserted. I know for a fact Paley likes to insert his nails through the back, and not through the knees.
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Alu
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Posts: 466
Joined: Aug 2015
Posted on Dec 17, 2015, 11:29 pm
#82
Also the best/closest things to studies we have are these abstract conference book for an event that occurred about a month ago in which orthopedist congregated and talked about their own experiences.
http://illrsmiami2015.com/abstract-book/

As far as the details go it's very much sparse and vague as it can possibly be; to my knowledge none of the lectures were recorded or are available to the general public. What is interesting about this is that includes the like of Dong-Lee, Paley, and Guichet talking about their results with Cosmetic Limb Lengthening.
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Madmax_01
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Posts: 158
Joined: Dec 2015
Posted on Dec 18, 2015, 1:19 am
#83
Quote from: Alu on December 17, 2015, 11:22:31 PM
Internal Femurs aren't relatively old or new, so I doubt there are long term studies into the after effect (I certainly couldn't really find anything). But, I would infer that a huge factor into what might cause Arthritis in relation to LL through the Femurs would be how much one lengthens and how the rods are inserted. I know for a fact Paley likes to insert his nails through the back, and not through the knees.

Do you have any idea what might be the red line here? Speaking about the insertion of the nail. Do you know if Dr Guichet uses the same technique?

I am asking myself these questions because tibia lenghtening seems to have a lot of correlation when it comes to knee problems. I was wondering if the same applies to femur lenghtening.

Quote from: Alu on December 17, 2015, 11:29:36 PM
Also the best/closest things to studies we have are these abstract conference book for an event that occurred about a month ago in which orthopedist congregated and talked about their own experiences.
http://illrsmiami2015.com/abstract-book/

As far as the details go it's very much sparse and vague as it can possibly be; to my knowledge none of the lectures were recorded or are available to the general public. What is interesting about this is that includes the like of Dong-Lee, Paley, and Guichet talking about their results with Cosmetic Limb Lengthening.

That looks like a great ressource. Thank you! I wish we could find out more about the lectures.
Also the best/closest things to studies we have are these abstract conference book for an event that occurred about a month ago in which orthopedist congregated and talked about their own experiences.
http://illrsmiami2015.com/abstract-book/

As far as the details go it's very much sparse and vague as it can possibly be; to my knowledge none of the lectures were recorded or are available to the general public. What is interesting about this is that includes the like of Dong-Lee, Paley, and Guichet talking about their results with Cosmetic Limb Lengthening.

That looks like a great ressource. Thank you! I wish we could find out more about the lectures.
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Alu
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Posts: 307
Joined: Aug 2015
Posted on Dec 18, 2015, 2:33 am
#84
Quote from: Madmax_01 on December 18, 2015, 01:19:26 AM
Do you have any idea what might be the red line here? Speaking about the insertion of the nail. Do you know if Dr Guichet uses the same technique?

I am asking myself these questions because tibia lenghtening seems to have a lot of correlation when it comes to knee problems. I was wondering if the same applies to femur lenghtening.

Typically saying 5 CM on either Tibia or Femurs always seems to be a great limit. It give you 2 inches, and if we are just talking about femurs here, 5 cm isn't that much in femurs. In fact, with femurs one might even be able to go as far as 8 cm (5 CM+ on tibia isn't a good idea for max recovery); although after that I wouldn't recommend going for tibia increase since your proportions would look weird.

So honestly If you want max gain of 8-10 and keep good recovery (we have no idea if we can get back to 100%; 90% seems close so far but who knows) then splitting the surgeries would be the most advantageous.

Also this is 4 years outdated but I'm sure it's still the same:
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LLuser1
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Posts: 215
Joined: Dec 2015
Posted on Jan 8, 2016, 11:04 pm
#85
Quote from: Metanoia on December 07, 2014, 11:54:47 AM
Very good comment. There's a clear bias in the forums not to show the complications. I have been attacked several times for writing about what i have seen at a very popular doctor. Nobody gets attacked for writing nice things. Even patients with diaries try to hide negative things (they are still under treatment , how could they dare openly criticise their doctors? ) . They rather stop writing or simply don't tell the truth.
I personally believe if i went to India my experience wouldn't have been worse than what has happened to me in Germany.

Very good comment Metanoia. Popular doctors and their popular patients... don't tell the truth.
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Madmax_01
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Posts: 325
Joined: Dec 2015
Posted on Jan 17, 2016, 5:25 pm
#86
Is it true, that you are not allowed to fly on a plane? I have read it on anold forum, that it causes tremendous pain, and it is almost unbearable to fly when you have internal rods. Of course, I mean after the lenghtening phase but before the removal procedure.
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DoingItForMe
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Posts: 485
Joined: Apr 2015
Posted on Jan 18, 2016, 7:04 pm
#87
Quote from: Madmax_01 on January 17, 2016, 05:25:50 PM
Is it true, that you are not allowed to fly on a plane? I have read it on anold forum, that it causes tremendous pain, and it is almost unbearable to fly when you have internal rods. Of course, I mean after the lenghtening phase but before the removal procedure.
I have internal femur rods and I fly just fine with no pain. Most of the pain might be from sitting for too long while putting pressure on your rods due to the now shorter seats compared to when your femurs were shorter. This can be fixed by putting something under your feet to take the pressure off your rods and onto your feet instead. This only affects people with short tibias like me who can't reach the floor while sitting.
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ub40
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Posts: 164
Joined: Jan 2016
Posted on Jan 24, 2016, 10:18 pm
#88
Can we get back to the original topic? Is there ways for doctors to mitigate this or has there been any new techniques?
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ub40
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Posts: 370
Joined: Jan 2016
Posted on Jan 24, 2016, 10:18 pm
#89
Can we get back to the original topic? Is there ways for doctors to mitigate this or has there been any new techniques?
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kieran19801980
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Posts: 106
Joined: Nov 2013
Posted on Feb 16, 2016, 5:43 pm
#90
That's an interesting post. It would be great to hear from people who had internal femurs done and if they have any complications say from two years onwards. The operation is costly both financially and in time. Considering the "cheapest" for internals in Europe is 48,000 euros not including accommodation/physio/food which is possibly another 8000 euros if one decides to stay for the entire lengthening period. ( say three months for 7.5cm) As well the person is out of work which I'm guessing for five months before walking "normally", that is nearly three months for lengthening and two months for consolidation (on crutches). That's five months out of your life and work ( if your job entails walking a lot or doing community work). It's a big sacrifice.
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kieran19801980
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Posts: 197
Joined: Nov 2013
Posted on Feb 16, 2016, 5:43 pm
#91
That's an interesting post. It would be great to hear from people who had internal femurs done and if they have any complications say from two years onwards. The operation is costly both financially and in time. Considering the "cheapest" for internals in Europe is 48,000 euros not including accommodation/physio/food which is possibly another 8000 euros if one decides to stay for the entire lengthening period. ( say three months for 7.5cm) As well the person is out of work which I'm guessing for five months before walking "normally", that is nearly three months for lengthening and two months for consolidation (on crutches). That's five months out of your life and work ( if your job entails walking a lot or doing community work). It's a big sacrifice.
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abo
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Posts: 43
Joined: Apr 2015
Posted on Apr 9, 2016, 6:10 pm
#92
http://www.childrenshospital.org/centers-and-services/anterior-cruciate-ligament-program/bridge-enhanced-acl-repair-trial

What do you guys think about this?! if the problem with this operation will be the knee? is it possible to recover 100% from this operation?
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abo
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Posts: 65
Joined: Apr 2015
Posted on Apr 9, 2016, 6:10 pm
#93
http://www.childrenshospital.org/centers-and-services/anterior-cruciate-ligament-program/bridge-enhanced-acl-repair-trial

What do you guys think about this?! if the problem with this operation will be the knee? is it possible to recover 100% from this operation?
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Antonio
Verified Member
Posts: 316
Joined: Sep 2016
Posted on Feb 15, 2017, 2:42 pm
#94
New study shows that increasing Tibia/Femur ratio beyond 0.8 is correlated with long-term arthritis.

Copy paste from link https://www.ncbi.nlm.nih.gov/pubmed/26398436:

The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees.
Weinberg DS1, Liu RW.
Author information
Abstract
BACKGROUND:

When individuals with asymmetric lower extremities present for evaluation of limb-length inequality, correction can occur at the tibia, femur, or in both bones; however, there are limited data available to justify either technique. The aim of this study is to examine the normal ratio of tibia length/femur length (T/F), and to explore the relationship between T/F ratio and osteoarthritis of the spine, hips, and knees.
METHODS:

Bone lengths of 1152 cadaveric femora and tibiae from the Hamann-Todd osteological collection were measured. Degenerative joint disease was graded in the hip, knee, and spine. Correlations between the ratio of T/F and osteoarthritis were evaluated with multiple regression analysis.
RESULTS:

The average ratio of T/F was 0.80±0.03. There was a strong correlation between age and arthritis at all sites, with standardized β ranging from 0.44 to 0.57 (P<0.0005 for all). There was a significant correlation between increasing T/F and hip arthritis (standardized β=0.08, P=0.006), and knee arthritis (standardized β=0.08, P=0.008).
DISCUSSION:

Increasing tibia length relative to femur length was found to be a significant predictor of ipsilateral hip and knee arthritis. Therefore, we recommend that when performing limb lengthening, surgical planning should lean toward recreating the normal ratio of 0.80. In circumstances where one bone is to be overlengthened relative to the other, bias should be toward overlengthening the femur. This same principle can be applied to limb-reduction surgery, where in certain circumstances, one may choose to preferentially shorten the tibia.
CLINICAL RELEVANCE:

This is the first study to report long-term consequences of lower extremity segment disproportion.
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Antonio
Verified Member
Posts: 330
Joined: Sep 2016
Posted on Feb 15, 2017, 2:42 pm
#95
New study shows that increasing Tibia/Femur ratio beyond 0.8 is correlated with long-term arthritis.

Copy paste from link https://www.ncbi.nlm.nih.gov/pubmed/26398436:

The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees.
Weinberg DS1, Liu RW.
Author information
Abstract
BACKGROUND:

When individuals with asymmetric lower extremities present for evaluation of limb-length inequality, correction can occur at the tibia, femur, or in both bones; however, there are limited data available to justify either technique. The aim of this study is to examine the normal ratio of tibia length/femur length (T/F), and to explore the relationship between T/F ratio and osteoarthritis of the spine, hips, and knees.
METHODS:

Bone lengths of 1152 cadaveric femora and tibiae from the Hamann-Todd osteological collection were measured. Degenerative joint disease was graded in the hip, knee, and spine. Correlations between the ratio of T/F and osteoarthritis were evaluated with multiple regression analysis.
RESULTS:

The average ratio of T/F was 0.80±0.03. There was a strong correlation between age and arthritis at all sites, with standardized β ranging from 0.44 to 0.57 (P<0.0005 for all). There was a significant correlation between increasing T/F and hip arthritis (standardized β=0.08, P=0.006), and knee arthritis (standardized β=0.08, P=0.008).
DISCUSSION:

Increasing tibia length relative to femur length was found to be a significant predictor of ipsilateral hip and knee arthritis. Therefore, we recommend that when performing limb lengthening, surgical planning should lean toward recreating the normal ratio of 0.80. In circumstances where one bone is to be overlengthened relative to the other, bias should be toward overlengthening the femur. This same principle can be applied to limb-reduction surgery, where in certain circumstances, one may choose to preferentially shorten the tibia.
CLINICAL RELEVANCE:

This is the first study to report long-term consequences of lower extremity segment disproportion.
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O
OverrideYourGenetics
Verified Member
Posts: 332
Joined: Sep 2017
Posted on Feb 10, 2018, 12:25 am
#96
Quote from: Medium Drink Of Water on May 20, 2014, 08:39:50 PM
I have:

-Altered sensation in my knees when kneeling or touching them, around the IM nail insertion sites and around the osteotomy sites
-Stiffness in my knees unless I exercise regularly
-Hypersensitivity in my knees when kneeling on a hard surface
-Worse balance than before
-A left ostoetomy scar that's thin and weak, that I have to protect from getting bumped or it'll break and bleed
-Altered mechanics in my legs which led to exertional compartment syndrome when walking, requiring fasciotomy

I hope my posts and diary here don't whitewash the issues I've dealt with and continue to deal with as an LLer.  I did it and got my 3 inches without getting crippled.  Those 3 inches changed my life, but sacrifices were made.  LL is a tradeoff and there are consequences I'll have to live with from now on.

3 inches in the tibias is a lot, and more than what most doctors would recommend. I know LL is costly, but if you're concerned about complications, split the increase in height across the tibias and femurs. That way you can get 2 + 2 inches with far less risk.

Quote from: alps on December 07, 2014, 01:11:04 PM
how do you suggest we end our own lives?

You can go all high-tech about it :)

No, seriously, get the money for a top doctor and you'll be fine.

Quote from: musicmaker on February 10, 2015, 05:43:27 PM
Fat embolism, for example, isn’t a theoretical complication, but a very real risk which is usually silenced in the forum and however happens. And there are patients from the best surgeons in the world who die from it. I’ve been told this by a very reliable source from a medical point of view.

Where did that happen and why wasn't the surgeon sued for malpractice?

Quote from: musicmaker on February 10, 2015, 05:43:27 PMCan we do anything to avoid these risks? [...] It’s better not doing more than one segment at once and even avoiding CLL if possible.

Exactly. Paley advises against doing both segments at once. I'll be doing them three weeks apart.

Quote from: Madmax_01 on December 18, 2015, 01:19:26 AMtibia lenghtening seems to have a lot of correlation when it comes to knee problems. I was wondering if the same applies to femur lenghtening.

I've asked Dr. Paley about knee pain following insertion of nail in the tibias. His reply:

QuoteVery little if any knee pin in our patients with CLL after tibial lengthening. I think it has to do with the minimally invasive we we insert the rod and avoid damage or irritation to the patellar tendon.

Quote from: Alu on December 18, 2015, 02:33:53 AMSo honestly If you want max gain of 8-10 and keep good recovery (we have no idea if we can get back to 100%; 90% seems close so far but who knows) then splitting the surgeries would be the most advantageous.

Exactly. That's my research too so far after spending weeks reading a ton of patient diaries. Keep your lengthening to 5-6 cm in the femur and 5 in the tibias, and pay attention to when physical therapy during the lengthening phase become suddenly more difficult - and stop there. The extra 1 or 2cm is NOT worth the pain and complications. Think 2 years to return to normal function instead of 6 months. Do you want that? In that year and a half you might as well earn the money to pay the difference between just femurs and femurs+tibias. This is the route I'm taking.
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OverrideYourGenetics
Verified Member
Posts: 244
Joined: Sep 2017
Posted on Feb 10, 2018, 12:25 am
#97
Quote from: Medium Drink Of Water on May 20, 2014, 08:39:50 PM
I have:

-Altered sensation in my knees when kneeling or touching them, around the IM nail insertion sites and around the osteotomy sites
-Stiffness in my knees unless I exercise regularly
-Hypersensitivity in my knees when kneeling on a hard surface
-Worse balance than before
-A left ostoetomy scar that's thin and weak, that I have to protect from getting bumped or it'll break and bleed
-Altered mechanics in my legs which led to exertional compartment syndrome when walking, requiring fasciotomy

I hope my posts and diary here don't whitewash the issues I've dealt with and continue to deal with as an LLer.  I did it and got my 3 inches without getting crippled.  Those 3 inches changed my life, but sacrifices were made.  LL is a tradeoff and there are consequences I'll have to live with from now on.

3 inches in the tibias is a lot, and more than what most doctors would recommend. I know LL is costly, but if you're concerned about complications, split the increase in height across the tibias and femurs. That way you can get 2 + 2 inches with far less risk.

Quote from: alps on December 07, 2014, 01:11:04 PM
how do you suggest we end our own lives?

You can go all high-tech about it :)

No, seriously, get the money for a top doctor and you'll be fine.

Quote from: musicmaker on February 10, 2015, 05:43:27 PM
Fat embolism, for example, isn’t a theoretical complication, but a very real risk which is usually silenced in the forum and however happens. And there are patients from the best surgeons in the world who die from it. I’ve been told this by a very reliable source from a medical point of view.

Where did that happen and why wasn't the surgeon sued for malpractice?

Quote from: musicmaker on February 10, 2015, 05:43:27 PMCan we do anything to avoid these risks? [...] It’s better not doing more than one segment at once and even avoiding CLL if possible.

Exactly. Paley advises against doing both segments at once. I'll be doing them three weeks apart.

Quote from: Madmax_01 on December 18, 2015, 01:19:26 AMtibia lenghtening seems to have a lot of correlation when it comes to knee problems. I was wondering if the same applies to femur lenghtening.

I've asked Dr. Paley about knee pain following insertion of nail in the tibias. His reply:

QuoteVery little if any knee pin in our patients with CLL after tibial lengthening. I think it has to do with the minimally invasive we we insert the rod and avoid damage or irritation to the patellar tendon.

Quote from: Alu on December 18, 2015, 02:33:53 AMSo honestly If you want max gain of 8-10 and keep good recovery (we have no idea if we can get back to 100%; 90% seems close so far but who knows) then splitting the surgeries would be the most advantageous.

Exactly. That's my research too so far after spending weeks reading a ton of patient diaries. Keep your lengthening to 5-6 cm in the femur and 5 in the tibias, and pay attention to when physical therapy during the lengthening phase become suddenly more difficult - and stop there. The extra 1 or 2cm is NOT worth the pain and complications. Think 2 years to return to normal function instead of 6 months. Do you want that? In that year and a half you might as well earn the money to pay the difference between just femurs and femurs+tibias. This is the route I'm taking.
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backrandom
Verified Member
Posts: 370
Joined: Aug 2017
Posted on Feb 10, 2018, 8:17 pm
#98
Quote from: fivefive on February 10, 2018, 12:25:44 AM

Where did that happen and why wasn't the surgeon sued for malpractice?


I don't know what doctor MM talks about. All I can say is patients sign a medical consent form where it says that fat embolism is a possible side effect of this surgery. When you get this surgery you must assume that death is a possible, if highly unlikely, risk. Doctors can't be sued if you die from fat embolism since it's a well known, though highly unlikely, side effect of this surgery.
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backrandom
Verified Member
Posts: 201
Joined: Aug 2017
Posted on Feb 10, 2018, 8:17 pm
#99
Quote from: fivefive on February 10, 2018, 12:25:44 AM

Where did that happen and why wasn't the surgeon sued for malpractice?


I don't know what doctor MM talks about. All I can say is patients sign a medical consent form where it says that fat embolism is a possible side effect of this surgery. When you get this surgery you must assume that death is a possible, if highly unlikely, risk. Doctors can't be sued if you die from fat embolism since it's a well known, though highly unlikely, side effect of this surgery.
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7
7231
Verified Member
Posts: 14
Joined: Apr 2018
Posted on Apr 7, 2018, 4:24 am
#100
reviving the thread since  I also want onions on pitfalls on lon/latn vs complete external. In pm many people  advised me against latn/lon, but going full external woyld mean 9 months out of job.
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