By now, the physiotherapist will have started guiding you through basic exercises, focusing on early mobility. These exercises are not just for regaining movement but are also vital for reducing the risk of blood clots, as movement helps prevent them. At this stage, your risk of fat embolism has significantly dropped, almost to zero. If your oxygen levels are stable, we’re confident that most of the immediate risks are behind you, which is why we proceed with the transfer to the general ward.

In the normal ward, you’ll have your own private room, complete with a bathroom, essentially a small apartment within the hospital. This will be your space for the next 10 to 14 days, where you’ll focus on recovery, but more importantly, you’ll begin learning how to adapt to your new reality following the surgery.

This involves mastering everyday tasks like using the bathroom, showering, eating, and getting dressed. Our multidisciplinary team will be with you daily, helping you regain your independence, and it’s incredible to see how quickly patients make progress even after such a significant surgery. I refer to it as “massive” because it involves both legs and has a considerable impact on your immediate post-operative function. However, thanks to our team’s support, patients usually recover quickly.

During this recovery phase, I will visit you at least once a day, often twice, to monitor your progress and ensure everything is proceeding safely. We’ll also perform x-rays to verify the results of the surgery, and I’ll share this with you so you can see the work we’ve done.

The exciting part begins between days 10 and 14 when we start the distraction process, which marks the beginning of your lengthening journey. Once you’re comfortable with the lengthening process, we’ll transfer you to our rehabilitation facility outside the hospital, where the next phase of your journey will unfold.

#Orthopaedics #OrthoInnovation #HealthcareExcellence #orthopaedicspecialist #OrthopaedicSurgery #OrthopaedicSpecialist #OrthopaedicSurgeons #OrthopedicSurgeon #OrthopaedicDoctor #OrthopaedicTherapy #OrthopaedicCare

These are serious conditions, and yes, the medical terms are long and intimidating. We use big words in medicine that can sometimes confuse patients! But at their core, these are the complications that concern us most, largely because they can be unpredictable and, at times, related to genetic predispositions.

Let’s break it down. Fat embolism syndrome happens when fat droplets from the bone marrow enter the bloodstream and travel to the lungs. This can impair the lungs’ ability to oxygenate the blood, much like what we saw during the COVID pandemic, where patients needed ventilation to maintain oxygen levels.

If this occurs, we can detect it quickly by monitoring a drop in the oxygen levels in your blood. That’s why we keep patients in a high-care unit post-surgery, to closely monitor oxygen levels and respond swiftly. If needed, we can provide oxygen through nasal prongs, which is a non-invasive method of delivering oxygen.

Thankfully, while about 4% of patients may experience some degree of fat embolism, not all of these cases are life-threatening. In fact, most are mild and respond well to treatment, becoming transient issues. Severe cases requiring more aggressive interventions are rare, and by choosing a well-structured, specialized system, you can be confident that every precaution is taken to minimize risk.

The second risk is related to blood clots, commonly referred to as DVT or thromboembolism. This occurs when a blood clot forms in the lower limbs after major surgery and can potentially travel through the bloodstream and lodge in the lungs, cutting off the lungs’ ability to oxygenate blood. In many ways, this is similar to fat embolism, but it arises from different causes.

We know from surgeries like hip and knee replacements that the risk of DVT is real, and the same concern applies to limb lengthening procedures. Reputable surgeons, like our team, use a range of strategies to lower this risk. One of the most effective methods is administering low molecular weight heparin injections for the first few days after surgery, followed by oral blood thinners once the patient is discharged. We routinely implement this protocol for an extended period post-surgery to ensure the risk of blood clots forming and traveling to the lungs is minimized.

#Orthopaedics #OrthoInnovation #HealthcareExcellence #orthopaedicspecialist #OrthopaedicSurgery #OrthopaedicSpecialist #OrthopaedicSurgeons #OrthopedicSurgeon #OrthopaedicDoctor #OrthopaedicTherapy #OrthopaedicCare

After about 10 to 14 days, I’ll teach you how to lengthen the nail. Although you can’t see them, the nail contains rare earth magnets attached to a small gearbox. By spinning these magnets, we activate the gearbox and gradually elongate the nail, allowing the bone to lengthen in a controlled manner.

This process begins while you’re still in the hospital under my care, ensuring you learn how to use the machine correctly. The device we use for this is called the ERC (External Remote Controller), and while it might look bulky, almost like something from the Cold War era—it’s simple and effective. The ERC generates a magnetic field that alternates polarity, spinning the magnet inside the nail, which, in turn, lengthens it.

Though the ERC may seem intimidating at first, it’s actually very user-friendly. I take great pride in personally teaching you how to use it, as I believe I’m one of the few surgeons who does this directly. It’s important to me that you feel confident in the process.

The nail will elongate at a precise rate, typically between 0.75 to 1 mm per day, which we’ve found to be the ideal pace for producing strong, healthy bone. Throughout the lengthening process, I’ll see you every two weeks for x-rays and clinical check-ups to monitor the bone’s progress and ensure everything is on track. We’ll also ensure that the surrounding soft tissues, blood vessels, nerves, and joints are keeping pace with the bone growth.

This method ensures that we perform the lengthening safely, combining advanced technology with meticulous clinical care and follow-up.

#Orthopaedics #OrthoInnovation #HealthcareExcellence #orthopaedicspecialist #OrthopaedicSurgery #OrthopaedicSpecialist #OrthopaedicSurgeons #OrthopedicSurgeon #OrthopaedicDoctor #OrthopaedicTherapy #OrthopaedicCare

Let’s break it down. Fat embolism syndrome happens when fat droplets from the bone marrow enter the bloodstream and travel to the lungs. This can impair the lungs’ ability to oxygenate the blood, much like what we saw during the COVID pandemic, where patients needed ventilation to maintain oxygen levels.

If this occurs, we can detect it quickly by monitoring a drop in the oxygen levels in your blood. That’s why we keep patients in a high-care unit post-surgery, to closely monitor oxygen levels and respond swiftly. If needed, we can provide oxygen through nasal prongs, which is a non-invasive method of delivering oxygen.

Thankfully, while about 4% of patients may experience some degree of fat embolism, not all of these cases are life-threatening. In fact, most are mild and respond well to treatment, becoming transient issues. Severe cases requiring more aggressive interventions are rare, and by choosing a well-structured, specialized system, you can be confident that every precaution is taken to minimize risk.

The second risk is related to blood clots, commonly referred to as DVT or thromboembolism. This occurs when a blood clot forms in the lower limbs after major surgery and can potentially travel through the bloodstream and lodge in the lungs, cutting off the lungs’ ability to oxygenate blood. In many ways, this is similar to fat embolism, but it arises from different causes.

We know from surgeries like hip and knee replacements that the risk of DVT is real, and the same concern applies to limb lengthening procedures. Reputable surgeons, like our team, use a range of strategies to lower this risk. One of the most effective methods is administering low molecular weight heparin injections for the first few days after surgery, followed by oral blood thinners once the patient is discharged. We routinely implement this protocol for an extended period post-surgery to ensure the risk of blood clots forming and traveling to the lungs is minimized.

It’s common to see world-class athletes walk through the doors of our hospital. You might even be treated by a physical therapist who was a professional rugby player and remains active in the high-performance sports world.

We have assembled an expert team dedicated to delivering exceptional care, utilizing the latest innovations and technology to provide our patients with the highest level of care possible.

#Orthopaedics #OrthoInnovation #HealthcareExcellence #orthopaedicspecialist #OrthopaedicSurgery #OrthopaedicSpecialist #OrthopaedicSurgeons #OrthopedicSurgeon #OrthopaedicDoctor #OrthopaedicTherapy #OrthopaedicCare

Day Zero: The surgery itself takes about three hours. Patients will spend approximately two weeks in the hospital, focusing on pain management, restoring normal function, and performing daily activities like showering, using the bathroom, and eating. During this period, we also establish the rehabilitation routine.

Rehabilitation Facility: After the hospital stay, patients are transferred to a rehabilitation facility.

Lengthening Process: We typically begin the lengthening process between days 10 and 14 post-surgery, at a rate of 0.75 mm per day. For a target length of 65 mm (6.5 cm), the distraction phase usually takes around 80 to 90 days.

Post-Lengthening: Once lengthening is complete, the focus shifts to consolidation and restoring function, which takes several additional months. At the 100-day mark, when lengthening stops, patients typically transition to crutches within about 6 weeks.

Weaning Off Crutches: After achieving safe crutch walking, we gradually wean patients off crutches over the next 6 to 8 weeks.

In summary, this timeline covers the major stages of femoral lengthening surgery for achieving approximately 65 mm of length.

Follow me to learn about frequently asked questions and myth busters.

Secondly, the devices we use are either electro-mechanical or magnetically actuated, meaning you cannot undergo MRI scans while the nails are in place. Understanding this is crucial, as MRI scans are not possible with these nails inside your body. Typically, the nails are removed after about 18 months, after which you can safely have an MRI scan.

Patients often ask if they can engage in high-impact activities such as running and jumping while the nail is still in place.

The short answer is yes, provided the bone has sufficiently healed. You can generally continue with normal activities until the nail is removed. However, during the initial healing phase, the bone is weaker and it’s advisable to limit activities to those deemed safe by your care team. Your doctor and physiotherapist will provide guidance on what activities are appropriate at different stages of your recovery. Typically, patients transition to crutches around four months post-surgery and can resume light running and exercise between 9 to 12 months after the procedure.

These are general guidelines and can vary based on individual factors such as anatomy, the amount of length achieved, and the intensity of physiotherapy.

We have integrated these elements into our limb lengthening package and care pathway. We’ve developed a pathway that outlines the minimum standard of care necessary to ensure limb lengthening is performed safely. Each component of this pathway is mandatory and forms part of the minimum safety requirements needed for a patient to navigate this journey securely. This includes comprehensive support from our psychologists, occupational therapists, specialized nurses, and physical therapy team, all of which are complemented by my expertise and that of my practice staff.

All of this is provided in the unique setting of Stellenbosch, specifically at the Institute of Orthopedics and Rheumatology (IOR), a specialist center dedicated to advanced musculoskeletal medicine, where I serve as CEO.

In addition to patient care, we are committed to research, innovation, and education in this highly specialized field. Our approach to patient care is holistic—addressing every aspect of the journey is crucial. While the technical aspect of lengthening a limb may be straightforward, delivering the complex care needed to do it safely and consistently is where our expertise truly shines. This is achieved through a collaborative team effort because, ultimately, this is a team sport.

Our team embodies these values, focusing on safety, innovation, and humanity to deliver the best possible care to our patients.

We have developed care pathways that outline the essential level of care required for patients throughout their entire limb lengthening journey. These pathways incorporate a multidisciplinary team, including psychologists, occupational therapists, nutritionists, physiotherapists, myself as the surgeon, additional team members, nursing staff, and administrative support.

The support network we build around our patients is crucial and non-negotiable; it’s a standard part of our approach. It is integrated into the surgery process and represents the safety standards I require you to uphold to continue this journey with me.

This standard of care we provide to our patients is rare and done by experts which includes high-level sports people.

#Orthopaedics #OrthoInnovation #HealthcareExcellence #orthopaedicspecialist #OrthopaedicSurgery #OrthopaedicSpecialist #OrthopaedicSurgeons #OrthopedicSurgeon #OrthopaedicDoctor #OrthopaedicTherapy #OrthopaedicCare