Distal Femoral Osteotomy - Pre & Post-Op Diary

[aturpin]

Hi Tailwind,

Deep breaths, its still early in your post-op.  Truth is, I remember very clearly having more pain associated with arthritis than I did with the osteotomy, particularly after the first month or so and the site had healed up. The catch 22 about this procedure is that its goal is to help alleviate arthritis by displacing the weight evenly on the joint, blah , blah, we know.  But, the procedure itself results in significant muscle atrophy.  Without the quad muscles available to absorb impact and stabilize the knee, the joint takes the brunt of the work.  As you build your quad muscles back, less pressure will be on the knee joint and the pain will diminish. Also, I remember talking to my doctor about my "arthritis" pain and he told me that a lot of the pain I was describing was from the joint realignment and adjustment.  Its an interesting ride over many months, maybe even a year, where you will get different pains in different places just randomly for a day or a week or so and then they go away.... as was explained to me, all part of the joint adjusting to the new angle and what you may think is arthritis, may actually be from the joint adjustment.

To be clear about the pain I was having, it was all in the joint (after the initial month or so of course)... no pain at the surgery site.  Sometimes it was medial pain, sometimes patella, sometimes lateral. My defect is in my lateral compartment so I naturally associated the lateral pain with the defect/arthritis. Also, I had an opening wedge (I think you did too but cant remember) so the type of osteotomy will also impact where you have your pain. Right now my arthritis really doesnt bother me much.  And, when it does flare up I usually did something to provoke it and it usually subsides the next day or two...much improved from pre surgery.  Keep working to build you quad, hamstring, hip and glute and the pain should improve.  Hang in there....

[aturpin]

Well folks, it has been one year since surgery.  I only regret that I didn't notice it 3 days ago on the actual date of my anniversary and posted what I am about to post.  I suppose that is a testament to how I am reminded of my knee less and less as time progresses.  9 months ago I could tell you how many weeks, days and hours had passed since surgery.  So, my big news.....

I met with my OS regarding the possibility of having another surgery to repair my cartilage defect and he suggested that I have another MRI with contrast to check in on my defect.... is it bigger, smaller, healing, worsening?  He said that some patients experience a regrowth of cartilage, allbeit fibrocartilage (similar to the cartilage microfracture produces) not hyaline cartilage (what we are born with which is best), after unloading the impacted compartment.  He said that if I was one of those patients, we wouldn't need to fix the cartilage just yet and will continue to monitor it over the coming years and consider surgery if my symptoms worsen or the defect changes for the worse.

SO, I had the MRI and sure enough, my defect is improved.  He said it appears to be shrinking slightly and there appears to be some cartilage regrowth, erego, no surgery for me this year.  I dont know if I am more excited about not having surgery or that my knee is trying to heal itself... probably the latter (and, I cant help but wonder if taking glucosamine and chondrotin has been helping, who knows?). I can expect continued improvement over time as well (assuming I dont do anything stupid...big assumption).

I suppose this is the punchline of my ordeal:  I had a DFO and as a result have seen improved function, less pain and improved health of my knee. If I never made another post, this is all you would need to know about my experience. It worked.

Only time will tell if this will stave off a knee replacement or ultimately change the path of my knee (I may very well end up with a knee replacement at 50 regardless and we'll never know how long my knee wouldve taken me without the DFO), but, I can look back today and say that I am glad I did the surgery and I think I am in a better position now because of it. I will continue to post periodically because I am as curious as the next person about real long term results - 5 years, 10 years, 20 years. Although 20 years from now they will probably just rebuild a new knee with stem cells, it may provide someone somewhere some insight.

Good luck to all of you post-op DFO'ers out there and thank you to all of you who have shared your experiences for my beneft. To all of you considering this procedure, I hope that my experience eases and informs your decision making process.  It is a big surgery and big decision but, in my opinion and experience, worthwhile.

[Tailwind]

Bravo! Bravo!

SO happy for you to hear this news. I had not heard about this phenomenon until you described it here. And I thought I new everything about DFOs.

I wish you and your knee many many years of health and I hope you do follow up from time to time to let us know how you are doing. I am reminded, however that for many people, once your knee feels better you tend to ignore this forum and focus on the other things life has to offer. So I will cut you some slack if don't come around as much.

Thanks again for sharing your experiences here. You got me through many anxious moments.

[aturpin]

Thanks Tailwind.

I promise  not to disappear and will give periodic updates.  One thing is for sure is that I will be monitoring this knee annually and I also have a ton of hardware in my knee... these will be topics of note in addition to my overall well being. Will also check in to see how you and others are doing and answer any questions if they arise... dont hesitate to ask, of course. Till then....

[boysmum]

Great news, Pleased to hear you have done so well!

Hope things carry on the same for you

 

[KCuman]

Aturpin that is great news on the ‘cartilage’ re-growth.  I had not heard of that either and did not know that was a possibility for us DFO patients.  I am just over 9 months post-op DFO by your OS and have days I don’t have a reminder that I’ve had the surgery.  And, there are days that my knee does ‘talk back’ after an activity.  After reading Tailwinds recent posts I thought more about my current knee discomfort and I’d say it is in the lateral compartment not the surgery area.  I have damage to the articular cartilage in the tibia plateau and not much if any arthritis.   The discomfort now is much less than prior to surgery but still there.  I did go downhill skiing and my surgery knee handled itself fine other than a couple twinges getting off the chairlift again in the cartilage area not surgery.  I see the OS in March, I too will ask for an MRI to see if my cartilage damage area has improved.  Other than that, just continue to go through with the ‘adjustments’ of the new alignment. 
Does anyone use a foam roll to keep the IT band loose? 
Keep up the good work everyone

[hannah17]

Hi Im Hannah
        Im 17 years old and i will be having a distal femoral osteotomy on march 2nd. I've torn my meniscus twice playing soccer and i guess i have no lateral meniscus left. I guess Im just wondering what to expect. I live out by Chicago my surgeon says ill be over night and ill have a plate and 6 srews in my femor but other then that i really dont know much about what to expect. I'm really wondering mostly how long my scar will be and how long you think i would be out of school. I'm just really nervous.

thanks
    Hannah

[mmrocker13]

Hey hannah...I responded to your post on the other board, if you want more info. But my incision is about 7 inches, I have 8 screws. I don't know much about your case, but do know that this procedure is an end-stage procedure.

[hannah17]

Thank you soo much

[aturpin]

Well, it has been another five months since my last post which kind of summed up my experience.  In keeping with my promise to not disappear, I thought I would make a quick update post.  Also, as some of you might remember having followed my posts, last August (about 9 months post op) I attempted to summit the highest peak in Orange County California, Santiago Peak, (4,000 feet (1,200 m) in elevation and is about 16 miles (26 km) round trip) and didn't quite make it.  I was pretty achy about 6 miles in a decided to turn back early to make sure I could get down.  Well, yesterday I went back for revenge and conquered.  My knee didn't bother me one bit and I was so excited and surprised by how much difference another nine months made.  Rest assured all of you post-opers out there, you continue to progress over a long period of time.  This isn't a light surgery and the recovery takes a while. I am much stronger now than I was when I last attempted this hiike and I think that strength took a lot of pressure off the joint. I have to say that I still noticed some differences between my two legs, especially on the decent where that eccentric movement really highlights a weak point in the leg (like going down a ton of steps).

Also, I have been seeing a massage therapist periodically over the past few months to help with my IT band and scar tissue.  With all of the trauma done to the knee, I have some pretty solid knots/trigger points in the vastus lateralis that I can feel while Im working out.  Also, the weakness in my hamstring and adductors has caused other muscles to be recruited and everything is just a bit out of balance.  I feel like this has helped me regain a bit more functionality by breaking up some of the tightness. Granted I would have gone on fine without it, but, it may be worth considering for those of you out there who want to get back as close to normal as possible. Also, I should say that "massage therapy" is not the kind of spa-esque experience one thinks of when they hear massage.  This is a lot of digging, deep breathing and eye tearing up stuff.

Aside from that, I have no other news to report.  Things carry on as they have.  I continue to spend the majority of my exercise time on the bike while continuing to golf, swim, practice yoga, hike, do stairs, etc.  Still no running and no real plan to.  I tried to do a beach workout about a month ago that included some jogging on sand... while it went fine while I was doing it, my knee was sore for about a week afterwards... just not worth it. Keep on keepin on.....

[aturpin]

I stand corrected... the peak of the mountain I hiked was 5,689 feet.... i want all the credit i can get .

[crankerchick]

Woot! That's a great update. Very encouraging and inspirational. Congrats on the victory!

Rest assured all of you post-opers out there, you continue to progress over a long period of time.

This is something I really needed to hear today. I'm almost 7 months post-op from derotation osteotomies and sometimes it feels like strength is coming back so slow, like it may never happen! Very encouraging to know that gains are still made this late, and later, in the game.

[Tailwind]

Thanks for the update.

I am going to post a 9 month update soon that mirrors a lot of what you reported!

Glad to hear you are doing well.

TW

[aturpin]

Hello fellow DFO'ers (HTO's and all other variations too!)

It has been about 4 months since my last update and I am 2 months away from my 2 year anniversary.  2 years!!!! Thats crazy... time flies.  So I thought I give a quick update and I have a bit of good news to report. About two weeks ago I completed my first triathlon.  I am an ex sprinter/heptathlete so I figured the multi events in track might lend nicely to triathlon. Plus, I have always wanted to check it out and see what the fuss is about. The triathlon I did was a sprint (.5 mile swim, 12 mile bike, 3.2 mile run) and I swore before I allowed myself to signup that I would walk the run. I dont have anything to prove anymore and Im not in any rush to wear through what little cartilage I have left and jump on an OR table. I stayed true to that committment excepting the first 200 meters (cant walk out of the transition zone!) and the last 1/4 mile (cant walk across the finish line either!). The parts I did run felt great, so nice to be running again and no pain. I finished 4th in my age group and won the bike leg (kind of funny considering how much time I spend on the bike now vs. pre DFO, it certainly has positively impacted my ability there). I iced the knee that night and felt pretty good the next morning.  Hiking actually leaves me more sore than the sprint tri did. I really enjoyed myself and am aiming for an offroad/mountain sprint tri in November.

So, as you have probably gathered by now, things continue to go well.  Any knee pain I have is purely related to my cartilage deficiency and I dont believe any to be DFO related. I am looking to see my OS around my 2 year anniversary for another MRI with contrast to check in on how that cartilage is doing.  I still have a cartilage surgery in my future but the DFO has succeeded in buying me some more time.  Ill report back with news on the MRI. Hope all of you post opers out there are doing well and being diligent with the PT.  Good luck to all of the pre-opers considering the surgery... its not as bad as it seems.

[Tomas52]

I am new to this blog and hope this posts correctly.  First I would like to thank all of you for your input, especially Aturpin.

I am 58.  At 49 I had pretty much all of the meniscus taken out of my right knee, arthritis already present.  OS told me never to run again and that I would probably have a TKR within 5 years.  I ran for 8 more years, slower and shorter distances.  Still bike about 6000 mi per year, not nearly as fast as I used to.   Sigh. 

About a year ago I gave up running becasue ot the knee pain.  I still bike, but in the last few months the speed, distance and frequency have decreased.  I'm ok when I ride but get sharp pain afterward if the muscles get tired.  Then the short shots of pain started showing up if I did something like twisting  my knee.  MRI and x-rays show medial compartment of the knee is OK, but I have Grade III and IV chondomalacia in lateral compartment and that I have worn the lateral condyle flat.  My Tibia and Femur are at a 10 degree angle, knock kneed.   

Here's my issue. I can lead a life that a lot of people my age would consider normal and the pain is well within bearable limits.  The doctor has given me two choices, DFO now (the wear is so bad, I can't wait) or wait until the pain becomes unbearable and get a UKR, timing unknown, although I'm told pain associated with lateral compartment arthritis increases like "falling off a cliff".  I want to be as active as I can for as long as I can.   If I am to have a DFO I am pretty much have to decide now.  You folks have been through it.  Any advice?