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[5cm Stryde]

Hi all,

I managed to find almost all the information regarding the process but the long term effect of LL is still not clear.
Thus, I looked on different medical studies and I would like to share it to have a discussion about it.

For Femur Lengthening, antegrade technique is almost always used (retrograde is linked to knee pain as refered in many topic of this forum.  But which was never stated in the forum is the fact that antegrade technique leads to hips pain.
There is various studies indicated it but I share for instance one :  https://core.ac.uk/download/pdf/154417652.pdf (starting page 87 for long term outcome) and printscreen of result attached. As you can see most of the patient still have some trouble to walk long distance years after surgery (single shaft fracture, relatively young patients, without apparent other major trauma so they seems to be like any other CLL patient).

I already asked to various CLL doctors but so far, the answers was it does not happen with them in CLL (but without concrete explanation why). And I find it a bit strange to be honest.

Thus, as I said, I would be happy to get also the opinion of previous patients regarding this aspect not discussed yet on the forum for antegrade femoral lengthening.

Thank you!

[184dream]

same here paley said that knee pain happens with only 10-15 percent thats pretty big number and in the numerous studies it does reach 85 percent  and he has a theory that the way he put the rod decrease the odds >a theory = what the hell is that am i guinea pig
also paley is a merchant he is not an angel .
so now i am considering ex tibia only

[Michael J. Assayag, MD]

to tell you guys the truth, be careful with some of these surgeons out there whose only goal is to get you on their table

Front knee pain does happen with antegrade tibia lengthening and retrograde femur lengthening.

Lateral hip pain does happen with antegrade tibia lengthening. It may be lessened with trochanteric insertion points rather than piriformis. However trochanteric nails come with their own set of problems, namely  varus deformity of the hip during lengthening nd persistent glutes weakness, trochanteric fractures, and so on.

There is no actual number in the world of CLL simply because it has not been studied. However we are studying this right now in our center! It is easier for a surgeon to say ''it doesnt happen to my patients'' than to actually admit we don't know...

Everything in this world is compromise.. same thing for achieving 3 inches of newfound height!

[MakeMeTallAF]

Can you say what the cause of this pain is?

Is this something that can be treatable with stem cells or any other type of tissue engineering coming in the future?

[184dream]

may be a central senstization iam not a doctor but i guess
dr assayng had commented on antegrade tibia and retrograde femur but may he  forgot to comment on antegrade femur which was mentioned here in the previous comment with the link above also what does the study say?  i read it but i didnt understand something about entry point of the nail which should be lateral maybe to decrease the tissue damage and it depends on nail type . i dont know if stryde nail has this lateral thing ........

[SpeedDialer]

Thank you.

1. If your patient developed knee pain from internal leg lengthening, what kind of treatments should he look into?

"Lateral hip pain does happen with antegrade tibia lengthening. It may be lessened with trochanteric insertion points rather than piriformis. However trochanteric nails come with their own set of problems, namely  varus deformity of the hip during lengthening nd persistent glutes weakness, trochanteric fractures, and so on. "

2. If you were a patient, what would be a good way to phrase things to bring this to your doctor to find out if he does something that increases the odds of hip/knee pain? I'm not sure if this below is the right wording, I'm trying to think of how to word it. I and am envisioning it now in the limited time I will get in a consultation after flying over to Dr. Giotikas someday in the future:

Me: Hello! Doctor X and Doctor Y mentioned that there are bad ways to do the surgery that increase the odds of knee pain, here's what they said. I don't quite understand what it means technically but do you do it the bad ways?

Doctor Giotikas: ?? Huh, what are you saying? Of course I don't try to hurt my patients?

I am thinking of going with Giotikas in about two years after covid/vaccine has been distributed.

[Michael J. Assayag, MD]

Thank you.

1. If your patient developed knee pain from internal leg lengthening, what kind of treatments should he look into?

"Lateral hip pain does happen with antegrade tibia lengthening. It may be lessened with trochanteric insertion points rather than piriformis. However trochanteric nails come with their own set of problems, namely  varus deformity of the hip during lengthening nd persistent glutes weakness, trochanteric fractures, and so on. "

2. If you were a patient, what would be a good way to phrase things to bring this to your doctor to find out if he does something that increases the odds of hip/knee pain? I'm not sure if this below is the right wording, I'm trying to think of how to word it. I and am envisioning it now in the limited time I will get in a consultation after flying over to Dr. Giotikas someday in the future:

Me: Hello! Doctor X and Doctor Y mentioned that there are bad ways to do the surgery that increase the odds of knee pain, here's what they said. I don't quite understand what it means technically but do you do it the bad ways?

Doctor Giotikas: ?? Huh, what are you saying? Of course I don't try to hurt my patients?

I am thinking of going with Giotikas in about two years after covid/vaccine has been distributed.

It was a lapsus: I really mean Lateral hip pain in antegrade femur lengthening.


We don’t fully know why the entry point matters, piriformis vs trochanteric, nor do we know exactly what causes the pain.

We believe it’s inflammation or scar tissue created at the insertion point of some muscles.


If a patient presents to my office with persistent pain, the first intervention is conservative, with Ice application, gentle stretches, and muscle strengthening. In most cases that takes care of it.

i remove all my lengthening nails, so the cause of “symptomatic hardware “ is also eliminated