Osteotomy - Which one ?

[skippybangkok]

Having issues with knee, and need to have an Osteotomy to re-distribute weight from medial more to lateral part of knee.

Basically 2 options

1. Cut tiba, realign, and then a plate and screws to keep it all in place - no weight for 8 weeks, metal stays in unless another operation

2. cut tibia , and put pins through bone which stick out. Upside, can put weight on it within 2 week if can bear the pain. also take pins out in 8 weeks. Recon can re-adust later if angle not right. a bit frankestein-ish

Anyone have experience what is the best ?

[thepool]

Interesting

Tibial osteotomy is an unusual procedure nowadays .

You do not give an indication of why this procedure is being recommended.

Have you sought more than one orthopaedic opinion about the knee?

I will be very surprised if you receive responses from people who have undergone this procedure in recent times.

Edited March 25, 2014 by thepool

[skippybangkok]

Interesting

Tibial osteotomy is an unusual procedure nowadays .

You do not give an indication of why this procedure is being recommended.

Have you sought more than one orthopaedic opinion about the knee?

I will be very surprised if you receive responses from people who have undergone this procedure in recent times.

Thanks - look forward to hearing from you more.

Basically consulted 8 doctors - just to be sure !

- 3 in Thailand - a lot of research / asking around for the best

- 3 in Australia - 2 of which i am sure are in the higher ranks

- 1 in the US who is quite high profile

- 1 in Germany

6 out of 8 looking at the X-ray said " HTO ".... High Tibial Osteotomy.

1 felt total knee replacement

1 (german) said the could do what i originally wanted (Autologous chondrocyte implantation, Meniscus Transplant and maybe ACL )

The german i am worried about, i felt from the start they were "we can do all", and just makes me suspicious that they can do it when others all say HTO.

basically - Medial Meniscus removed 30 years ago, sports injury. As you can imagine now, the knee is painful, and because no meniscus, there is some bow leg

Happy to hear your views ... thx

[thepool]

The more usual advice these days would be to have a Unicompartmental Knee Replacement which would correct any deformity and ensure a pain free knee.

However as I know nothing of your clinical condition or age, bar what you have kindly shared, I would urge that you not take my observation as constituting advice to be acted upon !

There are some excellent knee surgeons in Aus !

As you know it is vital to select a surgeon who has a specific interest (in your case knees) but who also has a demonstrable record of successful outcomes .

[skippybangkok]

Cheers.... Not sure which dr is right, but the one from US said that with loose tendons, the only option would be complete knee replacement. His words were Uni contraindicated if ACL issues. As such he recommended HTO

Other doctors said uni compartmental can always do later when HTO fails. If do uni now, will need to go in for servicing out in another 10-15 years

I am hoping to buy non - metal time in the hope better tech available in the years to come

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Edited March 25, 2014 by skippybangkok

[skippybangkok]

So going back to metal sticking out and being able to walk in 2weeks, or metal out of view but not being able to walk for 8 weeks..... What would be best ?

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[thepool]

As they say in Thailand " up to you"

Me ? ---------I would opt for early mobility

That is not a recommendation !

[FBN]

Excellent comments above and I think is as good as the forum can offer. Age plays a major part in the final decision as well as the general condition of the bone itself. Osteoporotic bones has a high risk of non- or delayed union so there are a number of factors to be considered in the final decision. External fixating devices also carries an increased risk of infection, especially in the older person so it has to be considered as well.

The final decision should be made by you and an orthopedic surgeon you have full confidence in.

Major surgery always carries a risk of complications and these need to be carefully considered as well; you don't want to be worse off after the surgery than you are currently!

[Evilbaz]

I've had a total knee replacement (TKR) at 65 - mainly medial compartment wear but lax cruciate ligaments - hence not uni compartment procedure.

You are partial weight-bearing the next day (and it fkn hurts! as does any procedure where weight-bearing bone is cut) - the end result is excellent - functional and no pain.

As I have balance problems (separate neuro condition) and was subject to falls, it was essential to have "one good leg to stand on".

As an Australian physio specializing in orthopaedic /sports conditions it must be several decades since I last saw a high tibial osteotomy (most of which finished up with an additional TKR.)

Edited March 26, 2014 by Evilbaz

[skippybangkok]

The final decision should be made by you and an orthopedic surgeon you have full confidence in.

Thanks for everyones good input, and of course will be my and dr decision (mine , as if i don't like dr decision - change doctors ).

The Doctor said both ok, but he recommended external as can walk on it quicker, and also can take the steel out. I have done lots of reading, medical journals and blogs.... summary.

Internal

Pro - less chance for infection

Con- Cant adjust later if angle not right, metal still in leg which for small % might be problematic later requiring 2nd op

Con - Cant start putting weight for 8 weeks or more - rehab longer / recovery but within 24 months no difference from External

External

Pro- can "walk in 2 weeks" (not sure how try)

Con- Possible infection a skin (entry point) with possibility of infection getting to bone in rare cases which would impact a future TKR.

Summary - internal sounds safer, but risk of mis alignment. External less safe, but can adjust alignment.

Generally asked about TKR, they don't recommend as i am still quite a way off being 60.... General consensus is to wear downs what i have now, and then go for TKR later. (hoping by that time will have better solutions ).

[skippybangkok]

Conclusion - going for High Tibial Osteotomy with external fixator so I can look scary. Guess will be having some bitch pain for a while

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[skippybangkok]

Frankenstein option was chosen.

That little cut near knee is where they did the dome cut, boggles my mind how they cut the whole tibia at the top through such a small hole,

One more cut about 1cm long and about 10 cm above the ankle to cut the fibula too.

Very painful foot, like the worst sprain you could imagine. It's because the foot tendons get jerked around when putting leg at different angle.

Strangely the cut of Tibia and pins are not painful

FYI for other who have sore knees and don't want to worry if they can handle the walking

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Edited April 9, 2014 by skippybangkok

[Sheryl]

Thanks for the update. Here's wishing a speedy recovery (or as speedy as possible)!

[thepool]

Many thanks for the update.

Hope the recovery goes well for you .

[skippybangkok]

Cheers..... Strangely the ops / pins so far are pretty painless. Just the contorted foot as a result of the new angle.... Very painful - the mother of all sprains

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Edited April 9, 2014 by skippybangkok

[Evilbaz]

Cheers..... Strangely the ops / pins so far are pretty painless. Just the contorted foot as a result of the new angle.... Very painful - the mother of all sprains

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You need some physio rehab and possibly orthotics.

Orthopods are often great carpenters (as was Jesus one told me 555!) but know little about consequent soft tissue damage and subsequent peripheral joint re- alignment.

Complain and ask for a referral.

If you don't solve this early you will be slow in your progress through to full weight-bearing.

[thepool]

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Cheers..... Strangely the ops / pins so far are pretty painless. Just the contorted foot as a result of the new angle.... Very painful - the mother of all sprains


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You need some physio rehab and possibly orthotics.

Orthopods are often great carpenters (as was Jesus one told me 555!) but know little about consequent soft tissue damage and subsequent peripheral joint re- alignment.

Complain and ask for a referral.

If you don't solve this early you will be slow in your progress through to full weight-bearing.

Nonsense

Best to post nothing if nothing is known

[Evilbaz]

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Cheers..... Strangely the ops / pins so far are pretty painless. Just the contorted foot as a result of the new angle.... Very painful - the mother of all sprains

Sent from my iPad using ThaiVisa app

You need some physio rehab and possibly orthotics.

Orthopods are often great carpenters (as was Jesus one told me 555!) but know little about consequent soft tissue damage and subsequent peripheral joint re- alignment.

Complain and ask for a referral.

If you don't solve this early you will be slow in your progress through to full weight-bearing.

Nonsense

Best to post nothing if nothing is known

HaH a - So 40+ years of treating orthopaedic patients doesn't count?

I suggest you heed your own advice.

[skippybangkok]

No fights pls

On another topic I had a great experience w rehab dr.

Had Bells Palsy yonks back an a senior level neurologist said "no hope " and and had no solutions . But the internet is great and I found out rehab drs could help.

When I met one in Bumrungrad she did a nerve test aka the dr mengele procedure

Her comment - neurologist knows squat and u will get better.... And she was right.

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[Sheryl]

No fights pls

+1

[skippybangkok]

24 days in and still fun fun fun - never in my life have I laid flat for so many days grumble grumble

Heavy nerve pain in toe subsiding, but still wake up early morning w heavy pain at knee where pins are

Enjoy HTO ( not similar to HBO )

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[Sheryl]

Hang in there!

[skippybangkok]

Thanks for the above guys.... generally i fell in the small percentage with some complications, most likely as a result of overly large correction ( or "young" ankles ). Been like hell on the toe nerve for 5 weeks now, and its like having a hiking boots one and having to hike 30 miles with a blister on your toe - day and night. Extensor hallicus longus muscle is still on holiday. Dr. says will see improvement when pins come out.

Reason i did not want TKR, i know a guy from US who has one, had a bacterial infection, almost killed him, and they need to remove the TKR for ie. 6 weeks to get rid of infection, and then cut bone back for next TKR. There are only so many bone cut backs you can endure before replacing TKR is a non option. The above friend also has to be careful - i.e. before going to see dentist , needs to take antibiotics to make sure TKR does not get infected again.

Full aware i might need TKR in 5 or 10 years, but prefer to delay as much as possible to see if new more natural techniques are available.

Hospital gives X-ray, and got OsiriX (to view orig X-rays )..... cool to see space has gone from 0 to 3.6mm already. But not sure if cause cartilage growth, or just because muscles and everything more loose cause not using leg for 5 weeks.

Next week pins come out.... I hope

Edited May 11, 2014 by skippybangkok

[Sheryl]

Good to hear.

BTW which hospital/doctor did you end up with?

[skippybangkok]

Have some improvement, but need hyaluronic acid injections as get pain at night when sleep. Making progress but worried, cause if this don't work, then it's a TKR

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[skippybangkok]

Good news - surgery starting to show results. On holiday and walking a lot - no knee pain

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[Sheryl]

Glad to hear it!!

[skippybangkok]

Final Result - after 9 months recovery, can say it has worked. I am not jogging, but can walk long distances now with no issue

Just record for others who have knee issues

[Sheryl]

Wonderful news, thanks for updating us.

[skippybangkok]

Buy the way... They remove the pins without and sedative..... Actually. It was not as bad as I thought. Removal of the one near knee join did not hurt, the one mid shin was like banging your shin on a coffee table...

Edited January 19, 2015 by skippybangkok