Once the desired length has been achieved, you will enter the consolidation phase. No more alterations will be made to the PRECICE nail. The new bone (regenerate) is not strong enough and will need to consolidate before it can weight-bear fully. The PRECICE nail will remain in place throughout the consolidation phase to support the regenerate bone. Dr. Paley will allow you to return home for the consolidation phase. Continuation of physical therapy is important for strengthening and gait re-education.
Once you return home you will need to send weekly x-rays to Dr. Paley. The best way to do this is to email them directly to Dr. Paley at dpaley@paleyinstitute.org. If you are unable to email the x-rays, please mail the disc to:
Paley Institute
901 45th Street
Kimmel Building
West Palm Beach, FL 33407
Full Weight-Bearing
After reviewing the x-rays, Dr. Paley will email you about whether you can progress to full weight-bearing. This usually occurs one or two months after the end of distraction. Most patients can return to full weight bearing one month after a 5 cm femur lengthening and two months after a 5 cm tibial lengthening. Most patients can return to full weight bearing two months after an 8 cm femur lengthening.
Return to Sports
You have to regain your motion and then your muscle strength before returning to sports. If you work hard at this, you can go back as early as six months after surgery. This is an individual assessment from Dr. Paley for each patient.
Dr. Paley has performed implantable lengthening of the femur for 17 years, using a variety of devices (the Albizzia, the ISKD, and now the PRECICE). He has the world's largest experience with the ISKD and the PRECICE devices. To date, all of his patients have achieved the goals of treatment and have returned to full activities including sports. An article of our published results is available upon request.
Second Lengthening
If you choose to have a second lengthening done (on the opposite bone), an interval of six months is recommended between lengthenings. It is possible to overlap the femoral and tibial lengthenings and this option can be discussed with Dr. Paley.
Simultaneous Lengthening
Although femoral and tibial lengthening can be done simultaneously, we prefer to not insert the femoral and tibial rods at the same time due to the theoretical risk of fat embolism from reaming the medullar canal of more than two bones at a time. To insert four rods in the same surgery would increase the chance of fat embolism and death. We have done this successfully without complication but do not recommend it.
The main benefits are decreasing time to go through the procedure twice as well as decreasing costs by incurring only one hospital admission and one anesthesia cost. At present, we discourage patients from considering this option. The risks far outweigh the benefits. If you really would like to do both lengthenings together, we recommend staggering the two surgeries by two to four weeks.
