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[V21]

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?

[las vegas baby]

is it banned only in europe or everywhere? it says some CE certificate is now removed. what does that mean for U.S.A. ??

[las vegas baby]

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.

[V21]

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.

[las vegas baby]

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.

[Activatedxx]

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

[LengtheningDream]

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).

[V21]

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

[LengtheningDream]

This Japanese man did LON a few years ago, still pretty active recently and doing well! You could take a look at his channel

[V21]

This Japanese man did LON nearly 2 years ago, still pretty active recently! You could take a look at his channel

Lol, 10 cm

[LengtheningDream]

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

[RB]

There is also a worldwide shipping hold of precise products according to that article, so the US could also be affected.

[RealLostSoul]

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?

[V21]

Please inform if some other surgeon gives an update about Precice

[Serilium]

this guy did cross or quadri with full externals?

He did cross lengthening with LON externals (even on Femurs yes,) through two stages

[Medium Drink Of Water]

Ilizarov frames are full weight bearing, and I got zero pin infections.  It's not so bad.

[V21]

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.

[Serilium]

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

[V21]

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.

[Serilium]

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.

[RealLostSoul]

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.

[Serilium]

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:













7cm:

[V21]

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

[V21]

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

[RealLostSoul]

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.

[Serilium]

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".

[Stretch]

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?

[Serilium]

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

[V21]

Opinions from other surgeons would be useful in order to know if we can expect precice back soon

[Stretch]

Lon

ok, recon even for femur?

[Serilium]

Lon tibia only

No recommendation for femur