Distal Femoral Osteotomy - Pre & Post-Op Diary

[aturpin]

ooohhh, bitchin..... I'll bet it pretty gnarly to what huh? If you happen to have that digitally that would be cool to see.  It would be neat to see my Dr. in action.  I'm jealous your surgeon gave you that.

[Tailwind]

I find it fascinating. There are two in particular I have watched over a bunch. They are both combos of DFO and OAT and MAT. I watched them because I was a candidate for the DFO/OAT/MAT triple whammy, but now I'm just having the DFO. They don't show much of the DFO on the vids but reallt get into the OAT and MAT. Its sort of like watching someone take apart and rebuild a lawnmower engine. You can order a copy from Dr. Cole at www.cartilagedoc.com

[aturpin]

Thanks for that.  I have OAT procedure coming up in my tour of knee surgeries so I am glad they show a lot that.  Maybe I dont want to see it before the fact on second thought  ?

[Tailwind]

For me, knowledge and info is how I maintain some "control" in this process. The more info the better, even if its tough to watch.

[aturpin]

Post-Op Month 8 Day 12 (August 18, 2009) - I have another update of sorts.  Up until this point, the only activity I had really not attempted since my DFO was hiking.  And I don't mean walking, but really hiking.  I have been nervous about how my knee would handle it, esp. the descent as it is pretty much like going down a neverending set of stairs. Well, this last weekend I did a hike alright. My boyfriend has been suggesting we hike the Grand Canyon in the Fall but wanted to test his fitness/my knee by doing a test hike.  The hike he mapped out, which was misrepresented to me as "challenging but no big deal", was to the highest peak in Orange County, CA. Details of the hike are as follows:

17 miles roundtrip……8.5 up, 8.5 down
 
We parked at 1,716 elevation, the peak of the mountain is at 5,687 feet for a total gain of 3,973 feet in 8.5 miles.
 
I would love to say that I made it all the way to the top.  But, for fear that I might not be able to make it back down, or that I might completely thrash my recently altered knee, I turned back at about 4,650 making my elevation gain about 2,934 feet.  I cut about 2.5 miles off the distance as well making my hike about 14.5 miles.

In short, I was really proud of my knee!  In hindsight, it wasn't necessary that I turned around, my knee would've help up to the top and through the descent.  That said, I am glad I did turn around.  I don't think it is wise to have my first hike back be that intense, esp. if I would've gone the entire way. My knee got a little achy about 5 miles into the hike.  On the pain scale (1-10) the pain reached about a 6-ish around mile 5 and maybe hit 7 by the time I was done with it all.  I was nervous at mile 5 that if my pain was already a 6 then I was going to be in trouble.  I was pleased to discover that the pain leveled out. The pain I speak of had very little if anything to do with the DFO and was mostly arthritis related.  That said, I am getting some interesting pain around my medial compartment.  Given cherebs experience I will montor this closely. I also experienced a significant amount of muscle fatigue by the end of the hike.  Judging by my boyfriend's comments upon his return, I don't think my fatigue was any more or less than a normal person. 

The next day there was nothing more sore than my calves. Both of my knees are sore but the subject knee feels perhaps a little more sore simiilar to the soreness I get after overdoing it at the gym (maybe if I did lunges or too much stairs, things I really shouldn't be doing too much of in the first place). I don't know about the Grand Canyon at this point... whether I am fit enough or whether it is even prudent to do is TBD but I am glad I got back on the mountain and pleased my knee did alright. Before surgery I did a hike that was much much steeper and shorter and I really struggled on the descent.  I expect that if this hike had been steeper or the same elevation crammed in a shorter distance I probably wouldve had more pain and struggled mightily. I'll save that hike for a much later date.

In general update news, I feel I have hit a mini road block of sorts since my last update.  I am all around just a little more achy than I have been in the month or two preceeding my last update. I had been doing quite a lot of activity and I think it just added up. So, I have tried to scale back a little and it seems to be helping. As I said before, the hurdles are more subtle and fewer and further between, but they still exist for me at this point. As I mentioned before, I am having some soreness around my medial compartment and am also having interesting patellar tendon and patella pains.  Some of it feels like tendonitis and some of it feels like the pain is coming from the back of my patella.  I seem to remember my doctor telling me that I had some signs of wear there so that makes sense.  I wonder how much of the pain is from the joint adjusting to the new angle and how much is something I should be concerned about... only time will tell. Even in my more sore state, I was able to complete a challenging hike, do a 15 mile bike ride and play 14 holes of golf in a 3 day period. So I don't have a lot to complain about and am grateful to be tolerating as much activity as I have. Nevertheless, just wanted to let people know I still get sore and achy and I am still working out knee issues.
 

[chereb]

Good to see you still posting Aturpin. I hope your aches and pains are a bit better. You go girl!! Hiking!! I am impressed. I am getting worse by the day. Its a struggle to walk anywhere at all and have been relying on my crutches more and more. 3 weeks today i will undergo the surgery again. Fingers crossed i get a good result this time!

[KCuman]

Hello All
Tailwind, you have probably undergone your surgery by now.  I hope all went well and you are recovering well.  Chereb, good luck with your next surgery.  Aturpin, thank you for the updates.  I have been out of the picture for a bit and it is nice to get back to this and see how you are progressing.  You are about 3 months ahead of me, both having the same dr. and you being ~20 years younger I like to see what you are going through and activities you are doing.  Thank you

A little update for me, next week is 6 months.  I would say I'm about 80% or more.  For most of my day to day activities I can’t even tell I have gone through a DFO.  Going up stairs my quad seems to have to work a little more, going down I tend to hold the railing just to make sure I stay vertical, although I don’t really need it. 
I am back to road bike riding, using clip pedals without problems, I go about 40 miles riding some hills in so Cal.  Aturpin I did have some patella tendon pain at times during my ride, more earlier than now.  I have had to adjust the seat height up some and will try that next week to see if that helps some.  I did some mountain bike riding last weekend and the rough terrain did not bother my leg.  I’m doing kickbox classes 2x week at the gym, I don’t go all out with the high impact and I do still feel some pain, different than prior to my DFO.  It is along the outside of my shin, maybe old nerve damage in the knee box side affects.  Aturpin, do you feel anything like that?  I probably should ice after activities but most times do not.

My quad feels much stronger than it did 2 months ago.  I can walk downhill without limping or even favoring my surgery leg.  I do notice if there is a cross slope that bothers my kneebox which my PT said I should avoid. 

Dr. Bugbee told me at 4 months that he didn’t need to see me again until I hit my one year date.  Aturpin, he told me he would not remove the plate unless it caused me problems.  Is yours bothering you?  Mine doesn’t other than I have a bump on the side of my knee now.

I’m considering trying to run at 6 months.  Nothing major just try.  I haven’t yet.  Dr. said wait at least 6 months.
Thanks for listening
Karen

[aturpin]

Hi Karen,

Happy anniversary!  Six months is a great milestone.  Thanks for the tip on the seat height for patella pain.  Most of mine has gone away (at least recently) but I am with you, I think it is positioning on the bike. I am glad to hear you are doing kick box classes... I have been wondering how the impact of hitting a bag would feel on the leg.  Also the torque that could be on your leg in some of the kicks could also be pretty intense.... good for you to get back at it. 

To answer your question, I don't have any pain along my shin and haven't experienced that to date... sorry I can't provide insight on that one. As for the plate, mine really doesnt bother me.  On a scale of 1 to 10 (10 being completely bothered and in pain and 1 being I dont know its there) I am at a 2 or 3.  I get a little achy over the plate area after vigorous exercise (I assume from the muscle rubbing along the plate) and I feel tightness in the muscle over the plate when trying to sit on my heels (almost like the muscle is getting caught up on the plate but not painful). Also, I can kind of see the bump on the side of my knee too...its kind of annoying at times.  I am having another surgery for my cartilage and he is going to remove the plate then.. however, if i wasnt having another surgery, I probably wouldnt schedule one just to take the plate out, it certainly doesnt bother me that much.

I try running from time to time but only for 10-20meters max.  Just to see what it would feel like.  It is better now than it was say 3 or 4 months ago but absolutely does not feel like before surgery.  I think if I actually did it with any regularity or distance I might feel differently, I will be curious to hear how it works out for you. Be careful and have fun! Congrats again!

[KCuman]

Hi Aturpin,
I chickened out with my run yesterday because my knee has been a little sore after my weight lifting class at the gym a few days ago.  I use only 3-5 lb weights i think it is the motion more than the weight.  To many pleeaa (sp?) squats i think.  Anyway, a little sore in the medial side.

The kickbox class I do is at air, we don't use bags so I have not experienced kicking a bag.

That's it for me.  Take care all

[aturpin]

Hi Karen,

I hardly think you chickened out, I think it was wise and prudent.  If there is one thing this surgery teaches you is to know when to push, know when to lay back, and listen to your body.  If you are sore from plie squats think how sore you wouldve been after a run.  You'll be running again one day soon, when its right, till then happy kickboxing, cycling, and weightlifting.

[steveHa]

Hi

I had a DFO coming up for about a year ago now (end October 2008) and have really found it quite interesting reading what you've gone through.

I've been having some discomfort with my plate since it's been in there (and really can't wait to be rid of it), but have managed to run up to about a mile before may leg feels like it's really had enough. I started running after about 6 months and have taken it fairly steady, as it's very odd getting running again and feels completely unnatural now, but i used play rugby and really miss the running.

I was really surprised to hear your doing martial arts - kick boxing - does this cause you any pain? Did your doctor/physio suggest this as a good exercise? I've been looking for low impact types of sport that i can take up, and i'm really intrigued that your doing this!

I hoped you may tell me about your experiences with a few things that i've noticed about my own recovery and wondered whether it's just me or if you've experienced similar things,  as it's very difficult to know whats normal after this type of operation.

Firstly, when ever i get up in a morning and first stand up, my ankles are really sore for a few minutes. I'm not sure if it's to do with the re-alignment and my legs still getting used to things, but i'd have thought this would have all settled down after 11 months. I never had this soreness before my op.

Secondly, do you have much in the way of scar tissue? I get quite a fair bit of discomfort from around my plate which I think is caused by the scar tissue. It almost feels like there are ball barings beneath my skin rubbing over each other and doesn't quite feel right when ever i straighten my leg. Do you still have much in the way of scar tissue or anything like this?

I'd really appreciate any comments you have and good look with your continued recovery. I hope you get yourself running soon.

Thanks
Steve

[Tailwind]

I am constantly referring to this diary and Aturpin's experiences at a particular time post surgery. When I see that, for example, she was still limping while walking 11 weeks after surgery, I don't freak out that I am limping too. This is the best DFO diary ever!

[aturpin]

Hi Geeks!

I am sorry, I have been terribly remiss at my diary duties lately. Tailwind, thanks for the shout out.  It makes me feel great to hear such positive feedback. My initial intention when doing the diary was to accomplish exactly what you are getting out of it so I am just thrilled you are benefitting.

To steveHa:  I am sorry I have not replied to you and I hope you havent given up.  It seems we are only about a month apart in our recovery stage.  I am really surprised to hear you were running after 6 months.  I am still not running and, if you have read much of this diary you know, that I will likely not ever do much running.  Nevertheless, I have done some light jogging just to get a feel and I agree wholeheartedly with you about it feeling unnatural.  It feels like running with someone elses leg or even a prosthesis.  I have noticed not only in running but also in other activities that the subject leg lacks explosiveness in a big way. its like its sleepy or something. I continue to work on this and, to this day, focus extensively during exercise on making my subject leg work and do its part.  If I dont, my brain easily begins to compensate. As for the martial arts, I think you might have been reading a post someone else made to my diary.  I have only done one cardio kickbox class, no bags, and I only stayed for 40 mins because the movements were a bit awkward for my leg. I have considered doing this with punching bags and the whole thing, however.  And, I think that it would probably be ok on my knee so long as I took it slow in the begining and stayed away from jumping or high impact moves.

To your specific questions:
1) I have not experienced what you are experiencing with your ankles. That could be for many reasons including the number of degrees we had corrected.  If your correction was more dramatic, it would make sense that you may need longer to adjust.  I would really chalk this soreness up to your legs adjusting to the new angle as you said.

2) as for scar tissue, its hard to tell.  I can feel a bit of a speed bump over the top part of my plate that could very well be scar tissue. I think I have been fairly lucky with the whole plate discomfort thing. I really dont get too much agitation from mine.  I think different doctors use different sized plates. Perhaps if yours is larger it may be more of a nuisance.

Although I cannot really comiserate with your specific issues right now, I think we all have our little hangups that are unique to our biology especially as we get further along in recovery and introduce more activities. If you have other questions or issues I would be happy to comment given my experience.  I am usu. more diligent in keeping up with posts so fire away.  Good luck to you and best wishes for continued improvement in your recovery.

[aturpin]

Post-Op Month 11 (November 6, 2009) - Happy 11 month anniversary to me!  I can't believe I am coming up on a year now since surgery. I thought I would give an update since it has been a while but also because I saw my doctor last week.  I really went to go see him regarding the cartilage procedure I have in my future and to get his opinion on if and when that should be done.  More on that in a minute...

We took xrays and everything is still glued together.  You can see where the bone graft was placed and the wedge and he said that you will likely always be able to see it, kind of like a scar.  But, the bone has healed fully and the surgery was a success.  I have gotten feeback from family and firends who have commented that I am capable of doing more now than I was before surgery and that I also appear to be in less pain.  It has been such a long road for me personally that it is difficult for me to remember how I felt pre-op so hearing objective feedback from others is helpful to me. I continue to be active and aside from running, am doing everything I want to do. In fact, I am spending so much time on the bike now that I decided to get certified to be a spin instructor and just completed the certification last week. All in all, I am pain free....even the arthritis isnt acting up much lately, not for months now. I experience the most discomfort when hiking for long periods and that usually goes away by the next day. Stairs are fine, I can run up and down. Squats are good, lunges are fine...all in moderation.

As for my next surgery, I am scheduled for an arthogram (xray with contrast) and MRI for next week to see how my carilage is doing.  In some patients, when the pressure is taken off the defect via osteotomy, the knee grows fibrocartilage on its own.  If this is the case for me, no surgery this year.  If not, we are gonna go in and fix it via allograft. I feel good about deciding to have surgery this way rather than just going for it to get it over with.  I am trying not to form an opinion as to whether or want or dont want to have surgery. Obviously I dont WANT to have surgery, but I know I have a problem in there and I know I will eventually need to take care of it. Now its just a matter of timing. 

I hope you all are doing well and coming along nicely in your various stages of recovery.  Keep up the good work and stay positive. TTYS!

[Tailwind]

Aturpin

Thanks for the update. I recall that your timetable for the next procedure on your knee is approaching. I hope you get the answers you want in your upcoming exams. I am jealous that you have additional options for your cartilage issues.

I have a specific question. I clearly have arthritis pain when doing stairs and single leg, full weight exercises. Its not the most horrible arthritis pain I've ever had, but its annoying and, frankly kind of surprising considering I just had a major operation designed to eleviate this pain. But I also realize that this is a looong rehab and I'm only 12 weeks post op and that my leg is slowly getting stronger......

So my question is, did you have arthritis pain in your knee at this point in your recovery and did it get better as your rehab and recovery progressed and your strength returned to your leg? After re-reading your diary, I think the answers are yes and yes, but sometimes you were not so clear about exactly where you were having pain. Right now I would say I have no pain associated with the surgery site. All of my pain is lateral knee pain.

Talk me off the ledge......