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Author Topic: Dr. Robert Rozbruch, Hospital for Special Surgery (NYC, USA) - 2013 Update.  (Read 43194 times)
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« on: February 09, 2013, 11:37:31 PM »

Here are the responses from Dr. Rozbruch, updating his information with 2013 pricing and details.

1. How many patients have you treated for elective bilateral leg lengthening?
50

2. Which techniques do you use?
PRECICE Internal Lengtening Nail, LATN, LON.

3. How much do you currently charge for bilateral leg lengthening on one bone section?
$30,000 for the surgery, hospital fees and accommodation are additional.

4. What are the lengthening limits for your procedures?
2.5 to 3 inches for each limb segment

5. Do your patients need to do any preparation before for their treatment?
No

6. Is accommodation included in your pricing?
No

7. Are there any medical conditions that would prevent a potential patient from being accepted?
poor health, joint contractures

8. In what percentage of cases do your patients experience complications?
Less than 10%. Complications are treated to avoid problems.

9. Are complications or unscheduled surgery covered in your costs?
Yes if there is medical insurance

10. Is there any insurance available to cover the patient's treatment?
yes

11. What is your official website?
www.LimbLengthening.com ; www.hss.edu/limblengthening

12. How much do you charge for a consultation?
$350

13. What is the best way for potential patients to contact you?
Email or phone

14. Do you limit your services to people of a certain height?
Males less than 5'5"
Females less than 5'0"

15. What is your policy for people who are suffering from depression or some other mental health issue,
or have suffered from it in the past?

Physcholigical evaluation and clearance needed

16. Is there any other information that you would like to have included?

Limb Lengthening and Complex Reconstruction Service
Hospital for Special Surgery
535 East 70th Street
New York, N.Y. 10021
S. Robert Rozbruch, M.D.
Chief of Service
Professor of Clinical Orthopedic Surgery


LENGTHENING FOR CONSTITUTIONAL SHORT STATURE
 
Lengthening for stature in normally proportioned individuals with short stature but without dysplasia (dwarfism) requires a different strategy for lengthening than in patients with disproportion and dysplasia.  Most patients with constitutional short stature (CSS) or low normal stature (LNS) require only modest increase in stature compared to the extreme amount of lengthening required by patients with dwarfism. In fact, the starting stature of patients with LNS is the final goal of lengthening in patients with dwarfism.

When assessing distribution of height in the population we consider the normal bell curve.  We divide people by distribution around the mean (average), and normal height is considered plus/minus 3 standard deviations from the mean.  Short stature below 3 standard deviations from the mean in individuals without a medical condition such as dwarfism, growth hormone deficiency etc., is considered constitutional short stature.  The lower limit of so called normal stature for Caucasian men is 5’5” tall and for woman is 5’0”.

While patients with dwarfism are often treated as children, patients with constitutional short stature or low normal stature are not treated until they have completed growing.  Patients with LNS and CSS also do not usually have deformities of the bones.  A new fully implanted lengthening nail is available. This approach does not require an external fixator at all. The Precice Nail manufactured by Ellipse inc. is FDA approved. My experience with this has been very positive. The lengthening nail is telescopic and lengthens the bone in a very controlled fashion. An external magnet actuates the device and results in 1mm of length per day. This translates into an inch per month.

The usual goal of lengthening for stature for most patients with LNS is 2.5 inches.   More than that amount cannot be achieved safely in one pair of bones during one lengthening. For more lengthening one needs to repeat the process in a second pair of bones.  The maximum lengthening possible with the Precice nail is 6.5 cm (2.5 inches).


Most patients are in the hospital between 2-4 days after the procedure. Physical therapy to stretch the ankles and knees begins in the hospital and continues after discharge as an outpatient.  Patients need to have physical therapy for one hour everyday during the 2-3 months of lengthening.  The patients who do best work diligently at stretching their ankle and knee joints both at home and at therapy. Therapy can be carried out at any therapy center.  The patients from out of town can do their therapy in their hometown.  Remember you cannot do too much stretching. Ankle range of motion is the limiting factor for lengthening.  As long as the patient can stretch the foot beyond 90 degrees, the lengthening can continue.
Patients are seen in follow up every two weeks during the lengthening phase.  Even out of town patients need to be seen every two weeks.  On these visits we check nerve function, measure joint range of motion, exam pin sites and obtain X-rays.  Problems are identified and treated and medication prescriptions for pain or antibiotics are written.
 
One can assume approximately one month of distraction for every inch (2.5 cm of lengthening).  Lengthening does not begin until approximately one week after surgery.  Therefore 2.5 inches of lengthening takes about 2.5 months.
 
Patients remain nonweightbearing until the X-rays show that the bone is healed enough to allow weightbearing. One or two intact cortices must be seen on X-ray.  This usually takes about 4 months after surgery.  Physical therapy continues mostly to regain full ankle motion and foot push-off strength.  This can take several more months.  Therapy is only 3 days a week after removal but daily home exercises are recommended.  Removal of rods is recommended in the future.  This is not critical and can be done at anytime once the bones are fully healed.  We generally perform this about one year after the lengthening is completed.  Again, this is an outpatient or one night stay surgery.

While there are many potential complications of lengthening, other than mild pin infections they are uncommon. Ankle stiffness is a concern but a rare complication if intense therapy and home exercises are carried out and if the lengthening does not continue, if the foot position drops below 90 degrees (equinus contracture).  Deep infection is rare.  It is resolved by removal of rod. Nerve injury is also rare. All patients with lengthening for stature must undergo a psychological evaluation prior to the lengthening.  This evaluation is needed before we will agree to offer the lengthening to a patient.    Lengthening for stature is considered cosmetic and will usually not be reimbursed by insurance carriers.

 Therefore, all fees must be self paid in advance of the services contracted for.  We will be happy to prepare a cost estimate for the evaluation, surgery, anesthesia, X-ray, hospital and physical therapy costs.  This estimate must be paid in advance prior to the surgery. The approximate current medical costs for bilateral lengthening is about $100,000. This includes surgeon’s fee, hospital and equipment fees.  Lengthening for stature may be reimbursable by insurance in some cases, especially if there is any evidence of a hormonal or hormone treated related basis for the short stature, or if there is associated deformity.  Insurance pre-approval is required prior to acceptance into the program.

Finally the most important issue to consider is that lengthening for stature in any individual over 5 foot tall is primarily for cosmetic reasons and does not improve function.  It does seem to improve body image in patients with what we call short person neurosis.  Nevertheless, the issue of function is of greatest concern to us. This procedure can damage nerves, muscles and joints.  If such damage were to occur it could become irreversible leading to long term problems such as arthritis, limitation of joint motion and pain. Rare cases can even develop reflex sympathetic dystrophy which is a chronic pain condition and which may not be resolvable.  Pulmonary embolism and deep vein thrombosis which are common with other forms of orthopedic surgery are rare with this surgery, but they can occur and could lead to sudden shortness of breath, chronic leg swelling and even death.  While loss of life and limb have never occurred to us with this procedure, one must still weigh the risks of undergoing a major surgical procedure versus the benefits of increasing ones stature by 2.5 inches.  Proceeding with the surgery is a very personal decision.  At the present time although the procedure is performed for cosmetic reasons, it is not in the same dimension as other cosmetic procedures such as facelifts, breast augmentation and nose jobs.
A psychological evaluation and clearance is needed before being accepted into the program. You will need to make an appointment and see Dr. Ellen Katz Westrich, Tel: 212-946-1739

If you are from out of town, you may want to schedule an appointment with her during the same trip to New York.

S. Robert Rozbruch, MD
Chief, Limb Lengthening and Complex Reconstruction Service (LLCRS)
Hospital for Special Surgery
Professor of Clinical Orthopaedic Surgery
Weill Medical College, Cornell University
Office Location: 519 East 72nd Street, Suite 204
Mailing address: 535 East 70th Street, New York, NY 10021
tel: 212-606-1415   fax: 212-774-2744
email: RozbruchSR@hss.edu
www.LimbLengthening.com ; www.hss.edu/limblengthening
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