No lengthening is performed in the first week after surgery. This is called the Latency period.
One week after surgery, you will begin the lengthening (distraction) phase. During the lengthening phase, the STRYDE nail will lengthen the bone one millimeter per day (femurs) or three-quarter millimeters per day (tibias). Lengthening is performed by the ERC device and you will be instructed in its use by an Orthopedic Technologist after discharge. The turns are divided into equal quarter millimeter turns per day (four for femur, three for tibia). In patients over age 50 or those with osteoporosis, the lengthening rate may only be 0.75mm in the femur too. Patients undergoing tibia lengthening followed three weeks later by femur lengthening start at a rate of 0.75mm in the tibia until the femur starts lengthening a week after the femur surgery. At that point, the femur lengthening is 0.75mm per day and the tibia lengthening is reduced to 0.5mm per day.
The limits of lengthening are soft tissues. The risk of complications from lengthening increases with increased length. A lot of research on this has been done by Dr. Paley. Up to 5cm is a low-risk lengthening. Between 5-8cm is medium risk and over 8cm is high risk. For example to achieve 10cm of lengthening it is much safer to lengthen the femur and tibia each by 5cm than to lengthen either bone by 10cm.
Physical therapy is required daily during the lengthening phase. Physical therapy is performed at the Paley Institute’s Rehabilitation Department and is included in the cost estimate.
You are required to stay in the local of West Palm Beach for the entirety of the lengthening phase.
The duration of lengthening is dependent on the amount of lengthening performed plus the one week latency period. Femurs are lengthened at 1 mm/day so an 8 cm lengthening will take 80 days plus 7 days of latency. Tibias are lengthened at ¾ mm/day which equates to 1 cm every 2 weeks. A 5 cm tibial lengthening will take 10 weeks plus 7 days of latency.
Staying in West Palm Beach
In order to minimize complications and maximize a successful treatment, Drs. Paley & Robbins require all patients to stay in West Palm Beach for the duration of the lengthening phase.
It is very difficult to undergo stature lengthening by yourself, particularly in the first couple of weeks. You either need to come with someone who can help look after you or else you will need to hire a home health aide. We can help you arrange for this. Please contact Anglique for information on home health aides. The hourly cost for home health aide is approximately $18/hour. In the first week after discharge from the hospital, you will require more hours of help, and less as time goes on. You will need to budget for this if coming alone. At the very least, everyone needs help for the first two weeks after discharge from the hospital. If you do not have anyone with you, this will cost you at least 16 hours a day of help. At $18 an hour, the cost can be approximated to $4,000 for two weeks.
It is recommended to use a walking aid such as a crutch or cane to help with balance and uneven surfaces in the few weeks after surgery. Dr. Paley is the surgeon inventor of the STRYDE nail. He designed it specifically for stature lengthening patients to allow full weight-bearing during the lengthening process. Immediately after surgery, there is pain. Therefore most patients use crutches or a walker for two to three weeks after surgery. For longer distances, a wheelchair can be used during these first few weeks. We do a weight-bearing test in our physical therapy department and once the patient passes this test they can stop using crutches. We still recommend one cane when walking up or downstairs or on/off curbs.
Driving is allowed when you are no longer taking narcotics and have the strength, flexibility, and dexterity required to operate a vehicle safely. (most patients reach these criteria approximately two to three weeks after surgery)
Physical therapy is required daily, 5 days per week, throughout the entire lengthening phase. Physical therapy at the Paley Institute is included in the cost estimate for 5 days per week. Additional days are available at a discounted rate of $225 per session; please inquire into this availability if interested.
During the bone-healing (consolidation) phase, the patient needs to continue with physical therapy but less often (2–3 days per week). This is usually done closer to home since most patients depart from West Palm Beach once the lengthening is finished. If you plan to stay locally for some time during consolidation, we can arrange additional physical therapy at our center. Any additional therapy beyond the cost estimates is to be paid in advance. Daily home exercises are required by the patient throughout both the lengthening and healing phases. The physical therapists at the Paley Institute will instruct you on these home exercises. For more information on physical therapy at our center, please see Rehabilitation & Physical Therapy.
The lengthening performed by the patient with the External Remote Control (ERC) in 0.25 mm increments. Most isolated femur lengthenings are performed four times per day (1.0 mm/day) and most tibial lengthening three times per day (0.75 mm/day). Combined femur and tibia lengthening is performed at 0.75mm per day in the femurs and 0.5mm per day in the tibias. Our orthopedic technologist trains each patient how to use the ERC device until they are comfortable using it on their own. Each patient receives one to take with them and returns this device at the end of lengthening. The ERC must be returned at the end of the lengthening to avoid being billed by Nuvasive for this $10,000 device. There is no charge for the ERC device as long as it is returned after lengthening. This means you may not leave West Palm Beach with the ERC machine unless you ship it back.
Follow Up Appointments
Follow up appointments during lengthening are scheduled every two weeks. You will see Dr. Robbins and one of the Physician Assistants at each visit.
X-rays are taken every two weeks. One x-ray of each lengthening segment is taken.
Once the lengthening has concluded, Drs. Robbins & Paley will clear you to return home immediately.