Limb Lengthening Forum
Limb Lengthening Surgery => Limb Lengthening Discussions => Topic started by: V21 on April 23, 2021, 06:41:04 AM
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Dude, I'm devastated. I had surgery booked for 23 june with Precice.
Giotikas sends this today https://www.athensbjr.com/update-on-the-nuvasive-specialized-orthopedics-precice-device-system/
I think I am going to have to do externals, since I just want 5 cm. Please, can someone give advice?
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is it banned only in europe or everywhere? it says some CE certificate is now removed. what does that mean for U.S.A. ??
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v21, sorry bubba, but I think you should wait for precice to be back
externals are a pain and everyone will know your doing this procedure
aesthetically long tibias dont look great.
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Waiting is not a choice for me man, have to do it this summer. Luckily, from proportions point of view, my tibias were short. About pain I don't care, about funcionality is recovery in the long run the same? I don't even know if LATN or LON is better.
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Mr Donghoon Lee of Korea has published a study of functional recovery after LON lengthening at his practice. the results are promising. But there is no comparison between results between tibias and femurs anywhere.
Mr Rob Rozbruch of NYC said in an interview to our boy cyborg4life that he prefers femurs because it is surrounded by vascularity and heals faster. but is the final outcome comparable? I dont think there are any studies on this honestly.
you should consider going to Korea coz they do LON all the time. he has a youtube channel which shows good recovery from several LON patients.
atleast with external you are doing an age old technique which has no unknowns like precice and stryde do. I think you simply cannot wait for precice you would be ok with externals mate.
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v21, sorry bubba, but I think you should wait for precice to be back
externals are a pain and everyone will know your doing this procedure
aesthetically long tibias dont look great.
Long tibias look good lol what are you talking about
Femurs make your knees sit shorter while tibias make your knees slightly higher
Your tibias are naturally shorter than femurs anyways
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Besides the scarring and heaviness of external fixators, they are pretty much the same as internal, arguably better in that they are fully weight bearing and have a long track record of being biocompatible. The intramedullary rods used in LON/LATN are typically titanium and highly biocompatible with bones, similar to those rods used in trauma surgeries. The only downside is that is pin infections are very common and the chances of deep infection still could be present(similar to internal rods).
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Besides the scarring and heaviness of external fixators, they are pretty much the same as internal, arguably better in that they are fully weight bearing and have a long track record of being biocompatible. The intramedullary rods used in LON/LATN are typically titanium and highly biocompatible with bones, similar to those rods used in trauma surgeries. The only downside is that is pin infections are very common and the chances of deep infection still could be present(similar to internal rods).
Yeah, my worry is that 5 cm femurs is considered really really safe, while 5 cm tibia, while safe, is much more taxing (like 7 femur?). I care a lot about athletic recovery, I guess it also depends on proportions. I think my tibia is short, but must get X rays to really be sure about ratio. I also know there is knee pain risk, but as far as I know it's not that high. Has anyone has experience on long run athletic recovery win 5 CM LATN?
And is it full weightbearing or just crutches? Thanks and sorry for the noob questions, I had done deep research but just about femurs, but not much about tibia
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https://youtu.be/8OS3vqvInc4
https://youtu.be/g1n1o046EDI
This Japanese man did LON a few years ago, still pretty active recently and doing well! You could take a look at his channel
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https://youtu.be/8OS3vqvInc4
https://youtu.be/g1n1o046EDI
This Japanese man did LON nearly 2 years ago, still pretty active recently! You could take a look at his channel
Lol, 10 cm
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Granted the same height, a shorter femur could make someone run faster than a longer femur, given the shorter range of motions, u can run faster with a short femur and a long tibia than a long femur and short tibia
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There is also a worldwide shipping hold of precise products according to that article, so the US could also be affected.
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https://youtu.be/8OS3vqvInc4
https://youtu.be/g1n1o046EDI
This Japanese man did LON a few years ago, still pretty active recently and doing well! You could take a look at his channel
this guy did cross or quadri with full externals?
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Please inform if some other surgeon gives an update about Precice
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this guy did cross or quadri with full externals?
He did cross lengthening with LON externals (even on Femurs yes,) through two stages
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Ilizarov frames are full weight bearing, and I got zero pin infections. It's not so bad.
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Next monday I have appointment whit Giotikas where he will evaluate my proportions. If doing tibia is feasible I will consider it, as I think my tibia is quite short and +5 cm would make good ratio. However, I'm quite sad to be honest. Height dysphoria has destroyed my life and I decided not to give up: 8 months ago I had no money, and I created my own business just to pay for this surgery, working like 15 hour per day. I finally got the money, and Stryde is out and now Precice too lol. Accomodation and fligths for June are also paid.
Anyway, my choice will depend on my proportions and on certainty about Precice comeback. If it's certain it will be back in late august, I can wait. If not... tibias here we go. I really felt much better about femurs, since 5 cm is quite safe for them.
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for a positive note, even though it doesnt mean much:
bad situation but
on the other hand you saved quite a bit of money and can potentially do a stryde in a year or two when it comes back. u can do 4cm tibias, work ur ass off and recover quickly, then work ur ass off in your job and recover financially quickly, stryde will be back and you do 6cm femurs a year or two later, maybe even work from home cuz stryde, maybe this is the long game and better
sry bro
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for a positive note, even though it doesnt mean much:
bad situation but
on the other hand you saved quite a bit of money and can potentially do a stryde in a year or two when it comes back. u can do 4cm tibias, work ur ass off and recover quickly, then work ur ass off in your job and recover financially quickly, stryde will be back and you do 6cm femurs a year or two later, maybe even work from home cuz stryde, maybe this is the long game and better
sry bro
Thanks for the encouragement man, but I am doing only one surgery. I'm happy with 5 real cm, don't need more. I also find it weird that no one has talked about this. In theory it happened weeks ago.
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Yeah, I don't know how we as a community missed this CE mark thingy.
Also, one honest opinion about 5cm LON tibias:
This is the most common surgery in South Korea- being the 5cm-6cm LON tibias. Donghoon Lee does LON dozens of time a year, since Koreans usually can't afford Precice/Stryde due to Nuvasive rods just charging so much. They all are really happy with the result.
They all look absolutely great and even look "taller" than they actually are afterwards, because the tibia is usually short. You will have very very good proportions. KiloKahn the moderator of this forum did 6cm LON tibias. He looks really good, you will look just as good if not better since knees won't be as high proportionally to the entire femur and leg length.
5cm LON is going to be great man. Honestly.
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Yeah, I don't know how we as a community missed this CE mark thingy.
Also, one honest opinion about 5cm LON tibias:
This is the most common surgery in South Korea- being the 5cm-6cm LON tibias. Donghoon Lee does LON dozens of time a year, since Koreans usually can't afford Precice/Stryde due to Nuvasive rods just charging so much. They all are really happy with the result.
They all look absolutely great and even look "taller" than they actually are afterwards, because the tibia is usually short. You will have very very good proportions. KiloKahn the moderator of this forum did 6cm LON tibias. He looks really good, you will look just as good if not better since knees won't be as high proportionally to the entire femur and leg length.
5cm LON is going to be great man. Honestly.
Yes don't worry about proportions especially not with that amount. But doesn't Donghoon Lee do 3-4cm usually? Only rarely I see 6 or 7cm tibia patients of him but I may be wrong here.
Thanks for the encouragement man, but I am doing only one surgery. I'm happy with 5 real cm, don't need more. I also find it weird that no one has talked about this. In theory it happened weeks ago.
If it's still going in the US, maybe that's why. How about doing it in the US? Or how about another weight bearing alternative like Guichetnail or Betz?
If both is no option do LON but do tibias. Don't do LATN.
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I see far far more 5-6cm than 3-4cm on his youtube, like 5x the amount. The only 3-4cm I see are non-cosmetics (leg length difference) and even then there are just 2 or 3 of those videos.
Donghoon Lee definitely does not do 3-4cm more than 5-6cm.
5-6cm videos:
https://www.youtube.com/watch?v=xQhwARDh4Ok
https://www.youtube.com/watch?v=sy4XQsdwAkA
https://www.youtube.com/watch?v=5PMb53KfNtc
https://www.youtube.com/watch?v=KXMQv7QgBrE
https://www.youtube.com/watch?v=mXLsRW2XrHw
https://www.youtube.com/watch?v=4KjGT810zB0
https://www.youtube.com/watch?v=y5soVnzkgMA
https://www.youtube.com/watch?v=HATaz57u2v4
https://www.youtube.com/watch?v=IKMxgwUe7Cg
https://www.youtube.com/watch?v=IfyLy8XkVRY
https://www.youtube.com/watch?v=2ww_h8QfWIg
7cm:
https://www.youtube.com/watch?v=Iu9WmFnjbZw
https://www.youtube.com/watch?v=KXMQv7QgBrE
https://www.youtube.com/watch?v=HDBkSAFVe3A
https://www.youtube.com/watch?v=VIfFccvV2Jk
https://www.youtube.com/watch?v=oqN8ozsN3TE
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Yes don't worry about proportions especially not with that amount. But doesn't Donghoon Lee do 3-4cm usually? Only rarely I see 6 or 7cm tibia patients of him but I may be wrong here.
If it's still going in the US, maybe that's why. How about doing it in the US? Or how about another weight bearing alternative like Guichetnail or Betz?
If both is no option do LON but do tibias. Don't do LATN.
Can't afford them man, also hotel and all paid, it must be with Giotikas. Also when I talk about proportions I dont mean looks, I dont care about that too much, I care about how it can affect funcionality. I think the Nuvasive paper says that it's on hold worlwide, but not sure. Also, Giotikas said LATN is better, because there is less risk of deep bone infection. Could you please elaborate on why choosing LON?
Another thing that worries me: when I was a kid, I had a mild case of ballerina foot that was solved with PT. I did not want to touch tibias because I fear that my body may be naturally "predisposed" to developing ballerina
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Got news. Chris Yunker from Nuvasive responded this to my email:
Hello,
We apologize for the inconvenience and are working hard to return things to normalcy as quickly as possible. We anticipate a return to market much sooner than September in the EU with Precice so that should definitely be a reasonable time to book. Have a nice weekend.
Chris
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I see far far more 5-6cm than 3-4cm on his youtube, like 5x the amount. The only 3-4cm I see are non-cosmetics (leg length difference) and even then there are just 2 or 3 of those videos.
Donghoon Lee definitely does not do 3-4cm more than 5-6cm.
5-6cm videos:
Okay maybe you are right. Looks good honestly great results up there. If you can get 7cm tibias it's a dream. How long does one have to wear the fixator with LON when you go for 7cm tibias?
Can't afford them man, also hotel and all paid, it must be with Giotikas. Also when I talk about proportions I dont mean looks, I dont care about that too much, I care about how it can affect funcionality. I think the Nuvasive paper says that it's on hold worlwide, but not sure. Also, Giotikas said LATN is better, because there is less risk of deep bone infection. Could you please elaborate on why choosing LON?
Another thing that worries me: when I was a kid, I had a mild case of ballerina foot that was solved with PT. I did not want to touch tibias because I fear that my body may be naturally "predisposed" to developing ballerina
Ah I understand. that is for sure unfortunate. LATN: Extra surgery, risk of causing more harm (like misalignement) to the weak bone when inserting the nail after lengthening phase. You always have a risk of deep bone infection. And with externals it's your duty to keep the pins sterile. Idk in general I wouldn't want to go with external methods but if I had to choose I would do LON.
Ah I understand. Just make sure to report it to doctors as soon as it arises and you should be fine.
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Okay maybe you are right. Looks good honestly great results up there. If you can get 7cm tibias it's a dream. How long does one have to wear the fixator with LON when you go for 7cm tibias?
Probably 4-5 months for frame removal. And then another 4-5 months to be able to finally walk somewhat normally.
I wouldn't recommend 7cm tibias, I actually think that's pretty dangerous. Achilles gets absolutely stretched beyond it's limits and you always end up with ballerina that needs significant physical therapy to "try to fix".
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Ahh pissed precise is now gone :(
Correct me if wrong, So as it stands now the methods available for cosmetic LL are:
Guichet nail
Beztbone
LON
LATN
What would be the preferred choice for femur or Tibia. Taking into consideration the cost, reliability and successful patient outcomes?
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Ahh pissed precise is now gone :(
Correct me if wrong, So as it stands now the methods available for cosmetic LL are:
Guichet nail
Beztbone
LON
LATN
What would be the preferred choice for femur or Tibia. Taking into consideration the cost, reliability and successful patient outcomes?
Lon
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Opinions from other surgeons would be useful in order to know if we can expect precice back soon
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Lon
ok, recon even for femur?
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Lon tibia only
No recommendation for femur
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Opinions from other surgeons would be useful in order to know if we can expect precice back soon
True
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Lon tibia only
No recommendation for femur
I do hear this frequently throughout the forum. However I also read of patients achieving their LL goals with LON Femur, so i'm like wtf?
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Dude, I'm devastated. I had surgery booked for 23 june with Precice.
Giotikas sends this today https://www.athensbjr.com/update-on-the-nuvasive-specialized-orthopedics-precice-device-system/
I think I am going to have to do externals, since I just want 5 cm. Please, can someone give advice?
Go for externals.
It is the safest and less painful way of doing LL and for only 5cm you won't have much time the frames and the cost will be half of precise.
For me, even if precise-stryde were in market, I would still have gone for pure externals if I wanted only one LL.
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Go for externals.
It is the safest and less painful way of doing LL and for only 5cm you won't have much time the frames and the cost will be half of precise.
For me, even if precise-stryde were in market, I would still have gone for pure externals if I wanted only one LL.
I see your point but I can't be months and months with the frames because of my circunstances, so I would have to do LATN, not pure externals. I would very much prefer 5 cm on femurs, which is a very very safe amount on that segment. Anyway, on Monday Giotikas will evaluate my proportions, if I'm measuring correctly my Tibia/femur ratio is 36/45-46
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I
Ahh pissed precise is now gone :(
Correct me if wrong, So as it stands now the methods available for cosmetic LL are:
Guichet nail
Beztbone
LON
LATN
What would be the preferred choice for femur or Tibia. Taking into consideration the cost, reliability and successful patient outcomes?
For femur I think betzbone is reasonable. There are a lot of good diaries with betzbone in the last years. About guichet idk. LON and LATN for femur, don‘t. For Tibia I‘d say wait for STRYDE or LON.
Just my two cents about it/
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Go for externals.
It is the safest and less painful way of doing LL and for only 5cm you won't have much time the frames and the cost will be half of precise.
For me, even if precise-stryde were in market, I would still have gone for pure externals if I wanted only one LL.
5cm externals will be anywhere from a best case scenario 7.5months to a more realistic 9-10 months in frames. All for 5cm. That is alot of time in frames it's not short at all
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5cm externals will be anywhere from a best case scenario 7.5months to a more realistic 9-10 months in frames. All for 5cm. That is alot of time in frames it's not short at all
yes true, only externals is very tough mentally. If you can deal with that go for it (plus you only need 1 surgery right?)
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I have been told that Rozbruch and the doctors on the Poland Paley Institute also seem very confident that Precice will be back soon: june in the US and july in the EU. Just hope it's true, any info from your doctos would be much appreciated.
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Wait so the old school titanium precise is off the market in the US now too? Haven't they ton like thousands of lengthenings over 10 years with it already?
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Wait so the old school titanium precise is off the market in the US now too? Haven't they ton like thousands of lengthenings over 10 years with it already?
The product lost the CE mark, and in the rest of the world the suspension is voluntary until all is solved. However, everyone seems to say it will be solved soon... I hope it's true, don't want to do tibias.
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5cm externals will be anywhere from a best case scenario 7.5months to a more realistic 9-10 months in frames. All for 5cm. That is alot of time in frames it's not short at all
The average time you need for 1cm LL from surgery till frame removal is 40 days.
So no, 5cm don't need realistically 10 months but 7-7,5 at max for an average person.
I needed 11 months for 7.5 cm after all which is 50% more than 5cm and the more you lengthen the more the rehabilitation is.
So the difference between lon and pure externals is about 4 months without ilizarov in your feet.
But you'll have a less invasive surgery, no nail removal surgery (which is a major surgery too), you'll need less money and it is safer and less painful.
So for me it is easily a far preferable choice than lon or latn for only 5cm.
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The average time you need for 1cm LL from surgery till frame removal is 40 days.
So no, 5cm don't need realistically 10 months but 7-7,5 at max for an average person.
I needed 11 months for 7.5 cm after all which is 50% more than 5cm and the more you lengthen the more the rehabilitation is.
So the difference between lon and pure externals is about 4 months without ilizarov in your feet.
But you'll have a less invasive surgery, no nail removal surgery (which is a major surgery too), you'll need less money and it is safer and less painful.
So for me it is easily a far preferable choice than lon or latn for only 5cm.
Out of curiosity, how big of an event is the removal of externals? Is it under local anesthesia, how long does it take, etc. ?
And would you say 7.5cm with pure externals is feasible or did you push it too much?
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dude just buy precice nail off of aliexpress and give it to your surgeon
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Wait so the old school titanium precise is off the market in the US now too? Haven't they ton like thousands of lengthenings over 10 years with it already?
Precice is Titanium and Stryde is... Steel?
Is that why my Precice rods never set metal detectors, but the Stryde ones usually do?
(Nevertheless, I guess I need to get these removed pronto.)
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Ahhh.....
So no stryde either I imagine?
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Precice is Titanium and Stryde is... Steel?
Is that why my Precice rods never set metal detectors, but the Stryde ones usually do?
(Nevertheless, I guess I need to get these removed pronto.)
Stryde is stainless steel yeah
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Ahhh.....
So no stryde either I imagine?
seems like you took a hiatus for a bit and missed out on alot. In February this year a doctor reported Stryde nails to european health committee after observing corrosion and
thus Stryde has a corrosion scandal that was happening in many many patients and was recalled by nuvasive worldwide and is now not allowed to be used until they bring it back which is probably next year.
they are probably going to redesign the nail
precice was also temporarily banned at first but lifted in certain countries but not some countries in the EU. but now ce seal of precice is gone so i guess it's gone worldwide again.
as far as we know precice doesn't have any of these corrosion problems
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Precice is Titanium and Stryde is... Steel?
Is that why my Precice rods never set metal detectors, but the Stryde ones usually do?
(Nevertheless, I guess I need to get these removed pronto.)
My Stryde nails have never set off a metal detector and I've gone through airport security seven times since my surgery.
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What I don't understand is why they suspended Precice again. FDA said all ok, and it was also used in Europe in March. I will ask Giotikas tomorrow, but this time everyone seems quite confident it will be solved soon
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What I don't understand is why they suspended Precice again. FDA said all ok, and it was also used in Europe in March. I will ask Giotikas tomorrow, but this time everyone seems quite confident it will be solved soon
Dont think so
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My Stryde nails have never set off a metal detector and I've gone through airport security seven times since my surgery.
Interesting -- wonder if the femur/tibia difference could come into play?
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I think they are upgrading the precise with new screws
https://www.prweb.com/releases/diamond_orthopedic_announces_supply_agreement_with_nuvasive_specialized_orthopedics/prweb17653993.htm
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I think they are upgrading the precise with new screws
https://www.prweb.com/releases/diamond_orthopedic_announces_supply_agreement_with_nuvasive_specialized_orthopedics/prweb17653993.htm
That's not the precice rod used for adult stature lengthening. Thats the precice plate used for little kids, not relevant to the precice lengthening nail
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I just talked to Giotikas. He advised me to wait for Precice, because he expects it to be back in july, or at worst on August. Of course, he can't guarantee it, but thinks it's very reasonable to book the surgery for 24 August.
Another representative from Nuvasive told me this:
"Thanks for your email.
Yes, for me August sounds very realistic.
But as you know, I can’t guarantee you a specific date before all the work is done"
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Read online today that June is a possible date for stryde return.
any truth to this?
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Read online today that June is a possible date for stryde return.
any truth to this?
name your source bruh
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Read online today that June is a possible date for stryde return.
any truth to this?
Giotikas did not say anything about this, so I really doubt it. It does not make sense that precice won't be available until july-august but Stryde in june. I really doubt it
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Halil Buldu - said it.
I contacted manufacturer and they said its for precice most likely
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Giotikas did not say anything about this, so I really doubt it. It does not make sense that precice won't be available until july-august but Stryde in june. I really doubt it
They said the end of Q3, so June wouldn't be completely out of the realm of possibility.
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All Nuvasive and Giotikas said was that Precice would come back around July, nothing about Stryde. So I don't think Stryde is coming back that soon, there has been no news on that regard
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Is there an update on when Precise two will return in europe?
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Is there an update on when Precise two will return in europe?
Two weeks ago everyone was 100% sure it would be back soon. Even the Nuvasive guy who answered my email said "definitely sooner than september". However, I asked yesterday with other accounts and all answers were much more random, like "we don't have a date". A few doctors told me they are not booking surgeries before september just in case. I don't like the tone this is getting compared with a few weeks ago. My surgery is booked for late August, and Precice is now available in all the world except in the EU, so one thinks it should not take long...
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They are probably studying the rare earth magnet in the nail. I think it hasn't been studied before.
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They are probably studying the rare earth magnet in the nail. I think it hasn't been studied before.
But it's incredibly bad luck that it's available everywhere but in the EU. My surgery has already been moved twice lol. Just hope it will be back August-September
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But it's incredibly bad luck that it's available everywhere but in the EU...
They stopped shipping everywhere, not only Europe.
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They stopped shipping everywhere, not only Europe.
I know US surgeons are still performing and scheduling Precise 2.2 surgeries, mine is in 3 weeks. Hopefully it won’t be rescheduled but if it is, beats waiting a year for Stryde. I have a call with the office tomorrow and if mine is rescheduled I’ll post here (if not then I probably won’t which you can take as meaning that precise is available right now)
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They stopped shipping everywhere, not only Europe.
The doctors I have emailed say that the issue has been quickly resolvend in US and India. So Precice is being already shipped to all those places... and not to Europe until they get CE mark back
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The doctors I have emailed say that the issue has been quickly resolvend in US and India. So Precice is being already shipped to all those places... and not to Europe until they get CE mark back
Which doctor told you about India?
I don't think you have an option but to wait dude. US is too expensive and I don't think it's safe to enter India. Or you can RB's route and get it done with Betz. Or external tibias.
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Which doctor told you about India?
I don't think you have an option but to wait dude. US is too expensive and I don't think it's safe to enter India. Or you can RB's route and get it done with Betz. Or external tibias.
Parihar said Precice is available there. I have no choice but to wait, I already paid deposit for Greece. The thing is that the surgery was delayed to late August, and I'm freaking out about Precice not being back by then. I can't aford betzbone either
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Guys, thing are again getting slowly delayed. In May I was told that Precice would be back on July-August. Now I got this message:
"Thank you for your email. In their update on the 8th June, the manufacturer said that Precise-2 is expected back in September 2021 sometime. The next update will be on the 29th June. We remain at your disposal for any further information and assistance".
This is crazy man. If it gets delayed later than September, I would have to wait until December, and it seems like that is what is going to happen.
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Yeah what nuvasive has been pulling of this year is ridiculous. They can be happy there is no competition on the market yet.
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But Precice it's already available everywhere else. It's crazy Europe is taking that long.
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Lon tibia only
No recommendation for femur
LATN better than LON for bone infection.. Not for femurs, I agree.
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Hey guys, more news. The nuvasive european representative said this:
"From what we know today, September should be the very latest moment for the return of Precice.
We all assume a much earlier return, but the final decision is with the authorities and therefore we cannot say with any certainty when the authorities will have completed their internal work.
Since we do not want to risk any further delays, we have not communicated an earlier date"
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Hey guys, more news. The nuvasive european representative said this:
"From what we know today, September should be the very latest moment for the return of Precice.
We all assume a much earlier return, but the final decision is with the authorities and therefore we cannot say with any certainty when the authorities will have completed their internal work.
Since we do not want to risk any further delays, we have not communicated an earlier date"
That's useful and sounds promising. Thanks for sharing!
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That's useful and sounds promising. Thanks for sharing!
I can wait at worst until september, so I'm crossing my fingers lol.
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Bureaucracy in the EU has always been a problem, so I’m not surprised that it’s already available everywhere else.
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New update from Giotikas:
"Thank you for your email. The update of the 28th June said that they are on good track for the return of Precise-2 nail until late August 2021 or early September"
Being two months away, I'm somewhat hopeful it's true or that at worst precice will be back late september.
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New update from Giotikas today:
Thank you for your email. The update from Nuvasive today said that everything is ready and they are just awaiting the official announcement from the EMA (the FDA equivalent in EU). Obviously they cannot control the timing but it should be by the second half of August or Early September at the latest. They are preparing their production line for Precise-2 nails, according to the pre-orders they have (yours included!). The next update will be on the 29th July.
We remain at your disposal for any further information and assistance
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Hm... does this affect us if we want to do LL in say late 2022/early 2023? Is it likely precise and stryde will be back?
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.