Hi All.
SURGERY VID LINKS and PICS BELOW
After watching and comparing the surgeries done by Dr. Giotikas and Dr. Munjed Al Muderis, it seems that they both perform the same surgery with the precise nail differently.
I watched Dr. Munjed Al Muderis first, and realized how much importance he placed on maintaining rotational alignment of bones during surgery. He even talks that there is an inevitable 10° discrepancy after the osteotomy is performed (and seems to prove this by showing that the aiming pins are no longer parallel after the osteotomy), and that the rotation must be restored before locking the distal screws.
When looking at a still frame of the x ray after both proximal and distal screws are locked with DR. MUDERIS, the bone looks aligned (pic link below). HOWEVER...
Surgery Vid (8:01 for x ray): https://www.youtube.com/watch?v=3Fn67nWCKe0&list=PLKyxblIhpNMLkWIqfgrrrTX__3QGlHn_z&index=1
Bone Alignment Still Frame: https://imgur.com/a/X3zHGp9
When looking at a still frame of the x ray after both proximal and distal screws are locked with DR. GIOTIKAS, the bone looks COMPLETELY MISALIGNED (pic link below).
Surgery Vid (5:05 for x ray): https://www.youtube.com/watch?v=IP1BSMUR9ME&list=PLKyxblIhpNMLkWIqfgrrrTX__3QGlHn_z&index=2
Bone Alignment Still Frame: https://imgur.com/a/phjR6n3
My question is, am I just tripping out on this still frame or does the x ray of Dr. Giotikas patient's bone look misaligned? If so, are there potential future complications because of this? Posture, permanent gait, etc?
In total, there were 4 discrepancies that I found between the surgeries performed by Dr. Giotikas and Dr. Munjed Al Muderis. I will list them below and let me know if anyone finds any other discrepancies:
1. Dr. Munjed Al Muderis locks proximal screws first whereas Dr. Giotikas locks distal screws first
2. Dr. Munjed Al Muderis uses the Piriformis entry whereas Dr. Giotikas uses the Trochanteric entry
3. Dr. Munjed Al Muderis adjusts rotational alignment between locking of proximal and distal whereas this didn't seem to happen with Dr. Giotikas
4. Dr. Munjed Al Muderis uses that antibiotic cover over the leg whereas Dr. Giotikas doesn't
**Small edit to post**
I just rewatched Dr. Giotikas surgery vid and it also seems that the aiming pins are removed before the proximal screws are inserted. Is this normal? I feel like it can't be.
I'm also going to post the x ray pic of his patients femur during and right after the osteotemy, but before the proximal screws are inserted.
Still frames of before and after locking proximal screws: https://imgur.com/a/zkLnweT
Are these cause for concern?
Thanks in advance!
Rotational Alignment of Femurs after Osteotomy? Giotikas vs Al Muderis PICS&VIDS
I'm a Giotikas patient and my X rays look like in the picture from the video. I asked a lot of times, and I was reassured that's not misalignment, so I have no idea.
Dr Al muderis is praised by dr .Rozbruch as one of the bests so that says a lot .
He is specialized in LL and reconstruction while giotikas it's not ; he is an orthopedic surgeon also trained for LL (ALSO not only) while most of other doctors like Lee,Rozbruch,Paley,Thaller,Assayag etc. Are specifically JUST LL doctors and that makes a difference !
Giotikas had many complaints given that he just started and more then 1 person here claimed misalignment with him (not to mention he got a death but I assume at this point everyone should know this ) .
Your topic us very smart/usefull so first I want to thank you for bringing this detailed comparison and 2nd ,from my pov , yes this is cause of concern and if I was you ,I would go with Al muderis if you could , or with doctors that did/do ONLY LL and are renowned in their field.
Rozbruch also has a surgery video. Please compare against it.
Quote from: V21 on January 29, 2022, 06:37:36 PMI'm a Giotikas patient and my X rays look like in the picture from the video. I asked a lot of times, and I was reassured that's not misalignment, so I have no idea.
What explanation did he give about why it isn't misalignment? Have you consulted with other LL doctors about this? I hope this isn't a misalignment for you sake. I know that there are surgeons on this forum, like Dr. Assayag. Maybe he can see this and give us his opinion?
Quote from: Masteryourlife on January 29, 2022, 07:27:09 PMDr Al muderis is praised by dr .Rozbruch as one of the bests so that says a lot .
He is specialized in LL and reconstruction while giotikas it's not ; he is an orthopedic surgeon also trained for LL (ALSO not only) while most of other doctors like Lee,Rozbruch,Paley,Thaller,Assayag etc. Are specifically JUST LL doctors and that makes a difference !
Giotikas had many complaints given that he just started and more then 1 person here claimed misalignment with him (not to mention he got a death but I assume at this point everyone should know this ) .
Your topic us very smart/usefull so first I want to thank you for bringing this detailed comparison and 2nd ,from my pov , yes this is cause of concern and if I was you ,I would go with Al muderis if you could , or with doctors that did/do ONLY LL and are renowned in their field.
Yeah, it seems insane that someone has already passed away under him. That's really scary that people are already claiming misalignment.
It also seems that the 2 most common deaths (Yush Gupta, and the patient under Dr. Giotikas) were both from the Gnail. I wonder if the type of nail has anything to do with triggering a pulmonary embolism?
Is this the video you're talking about?
https://www.youtube.com/watch?v=C4Hmq4WEpjA
Similar to Dr. Giotikas, it seems that Dr. Rozbruch does not use the antibiotic cover over the leg, and also locks the distal screws first. He does place great importance on making sure the aiming pins maintain parallel when locking the screws
Similar to Dr. Munjed Al Muderis, it seems that Dr. Rozbruch uses Piriformis entry.
I just rewatched Dr. Giotikas surgery vid and it also seems that the aiming pins are removed before the proximal screws are inserted. Is this normal? I feel like it can't be.
I'm also going to post the x ray pic of his patients femur during and right after the osteotemy, but before the proximal screws are inserted.
Still frames of before and after locking proximal screws: https://imgur.com/a/zkLnweT
Quote from: ninjabnw on January 29, 2022, 08:45:29 PMYeah, it seems insane that someone has already passed away under him. That's really scary that people are already claiming misalignment.
It also seems that the 2 most common deaths (Yush Gupta, and the patient under Dr. Giotikas) were both from the Gnail. I wonder if the type of nail has anything to do with triggering a pulmonary embolism?
I brought up this question abkut g nail too but there are no scientific evidences.
My personal opinion is that both doctors are not carefull and probably in both cases was used the 13 mm nail which is very big and I believe that it can someone raise the chances of PE/FE .
So a combination of nail/protocol according to my unprofessional opinion .
Quote from: ninjabnw on January 29, 2022, 08:41:37 PMWhat explanation did he give about why it isn't misalignment? Have you consulted with other LL doctors about this? I hope this isn't a misalignment for you sake. I know that there are surgeons on this forum, like Dr. Assayag. Maybe he can see this and give us his opinion?
He just told me that this is the shape of my femurs. Nurses said the same. There is an Assayag patient who showed him my X rays and he did not see anything to worry about, but that's only what the patient told me, I haven't spoken to him by myself. The Spanish Dr. who checks my X rays say that all is good cause bone is forming in the inner part and, in the end, the result is a straight femur. For example, my left femur was the one that appeared more misaligned, and now is the one that looks straighter. However, this Dr is not a LL Dr, so who knows.
This are my front X rays one month ago or so: https://imgur.com/a/ECc8ClL
Side view X rays do look perfect.
And by the way, the nail has nothing to do with embolism. There can be another debate about blood thinners etc, but the nail is definitely not the cause.
I did my tibias with Giotikas and had misalignment in both legs during nail insertion. I needed an extra surgery to fix it. I still have a misalignment in my left leg which might require additional surgery in the future.
Betz looked at my x-rays and told me right off the bat that there is a misalignment. He got into some details about the nail insertion angle and rotational axis etc. i While I think Giotikas is a good doctor, he’s not as thorough as some of the other LL doctors. We can all agree that LL has many risks, but imo, rotational misalignment during nail insertion is 100% surgeon’s error.
You must be logged in to post a reply.