Derotational Femoral & Tibial Osteotomy (Right: 7/8/10 & Left: 6/16/11)

[jumpi5d]

Beth Welcome to side of un-twistedness ! LOL

I'm glad that you're home and doing okay, and glad that the pillows and blankets were helpful on the trip home! 7 hours isn't to bad for everything you had done. My first surgery was almost 6 for just one bone. (and I don't remember anything from the time they told me they were gonna do the epidural til I woke up in my room!!)  I never had any of the extras sent home either... I'm probably the only weird person who actually like the CPM. Dr. T told me I could bring my own ice machine if I wanted to use it. I took it with me but never did really. I still have random numb spots and its been 8 months. But most of my leg did come back for the most part...I still have one spot near the plate that bothers me a lot.

I hope all is as good as possible. It was good to hear from you

-Paige

[crankerchick]

Hi Beth! Glad to see you on the other side. You sound like you are doing very well considering. That is very encouraging.

My surgery took 6 hours for the derotations of the femur and tibia and a TTT to bring the patella down and correct the patella alta. It was scheduled for 3! No CPM here either. As for weight bearing, I was restricted to 25 lbs but I suspect I was putting more than that. Oh well LOL.

Hopefully the weird feelings and lack of sensation in the foot have improved or subsided. Cool to read that you already felt your appetite coming back too!

The pain in the hip is indeed so annoying for sitting, i know exactly what you mean. But it gets better of course.

Anyway so hopefully now that you are 5 days post-op you have started to turn the corner on the pain and the bulk of the discomfort. Best wishes for a speedy and uneventful recovery.

[Teacher2Many]

One week post-op today and things are starting to improve!  The swelling is decreasing, as my calf is no longer hard as a rock.  The pain in the hip is increasing but I think part of that is due to the bruises starting to surface.  As for the foot drop and peroneal nerve issues, no luck with that yet-medial side of the foot is still numb and no control over the big toe yet but hopefully as the swelling in the foot and ankle decreases, some of it may come back.  Hopefully!

Fatigue is still a major issue but am sure the majority of that was due to the major blood loss and super low hemoglobin.  Am hoping that the iron supplements start to take effect and get that increased so I get some energy back.  Simply walking down the hall from the kitchen to my bedroom is enough to make me want to lay down and take a rest.  Sleeping is still a bit uncomfortable and am up frequently during the night but did end up taking 1 Benadryl around 4 AM and propped my calf on a pillow and ended up sleeping until almost 9 AM.  Might try taking one tonight right at bedtime to see how that goes-definitely doesn't help with the energy level when you're not sleeping all night!

Am scheduled to get all of my op reports, labs, etc. in the mail by the end of the week (Monday at the latest) and am quite interested to read all that was done, particularly with the lateral patellofemoral ligament reconstruction.  I have a follow-up with my surgeon in Chicago on 7/26 and am set to start PT (again) on 7/27.  We definitely have our work cut out for us this time around!!!!     I follow up w/Dr. Teitge on 8/17 and will hopefully get the okay to start bearing full weight so that I can get back in my classroom and start getting things set up for my new group of kiddos!!!   

Hope all are enjoying their summer!  Temps have been quite uncomfortable in Chicago-high 80's and low 90's with lots of humidity, which doesn't feel too pleasant when you're still spiking fevers periodically throughout the day!

Until next time,

Beth

[Teacher2Many]

Two weeks post-op tomorrow and things are slowly improving!  Got about 6 hrs. of sleep last night which is a huge improvement over the last week, as I was averaging about 2-3 hrs. at night tops.  The numbness and such in the foot, ankle, and big toe is still there with no sign of improvement.  According to my surgeon, he thinks it involves the extensor hallucis longus muscle and that can take up to 6 months to fully recover.  Not looking forward to that and am hoping that once I get into PT next week, some of the strength and nerve function will start to return.

The pain is mostly muscular (not really feeling any discomfort in the tibia and just some slight discomfort in the hip area) and is located in my calf and upper thigh-very sensitive to the slightest pressure such as the water when taking a shower, rubbing of clothes, blankets, etc.  Icing regularly seems to help and when that fails, an occasional dose of pain meds does the trick when it's really rough.  Sitting in a chair w/the knees bent causes a lot of pain and discomfort in the hip but if I can long sit (such as w/my feet up on a chair, etc.) the pain is definitely not as bad.

Muscle strength is still non-existent-the slightest tweak, such as forgetting I can't move it and trying to shift it in while trying to sleep, causes a great uncomfortableness but luckily, it subsides after time.  Laying on my back isn't super comfortable due to the herniated discs in my lumbar spine but definitely can't lay on my right side and keep trying to lay on the left but the pull I feel in my right is enough to discourage me from trying to do this again.

With PROM, I can bend the knee to about 80 degrees or so (or at least that's what it looks like) but can't do anything actively yet.  It will come all in due time, esp. as the swelling continues to subside, and PT is initiated.

I received my operative report in the mail yesterday, along with copies of all my labs.  The amount of stuff that was done was quite extensive-the right patella was completely dislocated which is why he performed the LPFL reconstruction and repair of the lateral retinaculum.  He thought about replacing the tibia tubercle but didn't think it was safe or appropriate to do that while shifting the shaft of the tibia in the osteotomy.  Hopefully this will never need to be done, as I'm not looking forward to yet another surgery (at least not on the R leg-still need to go through all of this on the L leg).  He also ended up removing part of my bone and used a bone graft in the medial corner of the osteotomy site. 

Am having x-rays done on 7/26 when I follow-up my surgeon in Chicago and am interested to see all of the hardware in place!  Hmm, wonder if I will end up setting off metal detectors?!   

I am starting PT on 7/27 and was wondering if anyone out there who has had either the LPFL reconstruction or the derotational osteotomies done has a protocol that they were able to give to their PT re: what to do in therapy.  My surgeon does not have any protocols but I know my PT was looking for some guidance-let's face it, this type of surgery is not very common at all so they don't have any experience w/past patients having this procedure done.  Am sure we'll be fine but just wanted to see if anyone else had protocols used in the past.

Until next time...

Beth

[NickiAnn]

Beth,  Sounds like you're doing well, or as well as anyone could do after having two osteotomies.  It must feel very strange to lack so much muscle strength.  It must also feel very strange to have so much loss of feeling.  I guess when you think about how much trauma your body has undergone, six months for the muscle to heal sounds reasonable, but I sure hope that it comes back sooner for you!

Hearing that your right patella was totally dislocated has got to make you feel like you did the right thing.  That had to be fixed! 

I hope you have good luck with your physical therapist.  Do you see a difference in how your leg looks in terms of it being straight?  Maybe this is a silly question, but aside from all the pain, do you have any feeling that your aligment is right?  I always wonder what it would be like to look down and see a straight leg and if my joints would feel like they fit together more naturally, so I had to ask!

Keep resting and recovering!

Nicole

[Teacher2Many]

Hi Nicole,

Thanks for the words of encouragement!  Hearing my right patella was totally dislocated was some reassurance for me to say the least...I had been complaining of that sensation in both knees for the past 6 or 7 months, if not longer, and the docs never could find anything (it popped out as easily as it popped back in) or just thought it was par for the course based on past surgical history.  So in a way, it is nice to know I was right and not crazy!!!!!   

My PT is great...have been at the same clinic since 1/07 with a total of 4 different therapists, due to them leaving to go to different clinics.  The one I have now I've worked with since 11/09 and has been great w/follow-up with my docs, etc.  I'm just lucky my insurance covers unlimited PT visits w/out needing to pay copays!!!! 

There is a difference in the way the leg looks-not sure it would be as noticeable if it wasn't for the fact that the left leg is still super crooked and the right leg is straight-I saw the difference the 2nd or 3rd day I was home when I was up w/the crutches and you can see the difference between the two legs; even my mom was able to see the difference!  Can't feel much w/the alignment except for the fact that the dislocating is no longer occurring and that the popping in the hip is gone (at least on the R side).  But the true test will be when all the swelling goes down and activity level increases!  Hopefully all will work out well so that I won't be hesitant to get the L side done...nothing worse than going through these surgeries, find it's not as helpful as you thought, and then trying to convince yourself to do it again on the other side in hopes of better results!  Did that in the past...didn't work out so well!

Resting and recovering is top on my list...still super anemic so simply walking down the hall from my bedroom to the kitchen is tiring but things are improving and hopefully will continue to do so now that I'm sleeping a bit more at night.  It's kind of nice to be able to spend the day in pajamas though and catch up on old comedies, some movies, etc.  Not sure what's going to happen when I actually need to get dressed next week for doctor appts., PT visits, etc.!   

When is your appt. with Dr. Teitge?  How was your trip to MI?  Did you find the swimming to be helpful or did it cause more pain?

Thanks again,

Beth

[NickiAnn]

Beth,

My appointment with Dr.Teitge is August 17th, so we will see what he has to say.  I am also having an arthogram done on both knees the day before, along with the CT rotational.  So, I will have test results to take to Teitge's office.  That will be nice.

My trip to Northern Michigan was a pleasant distraction.  One good thing about my troubled knees is that it has led to me spending more time with my mom and dad (they have the cottage up north).  They have been very good to me and have tried to help me out.  Swimming was o.k.  It felt great to stretch out in the water, but I think the flutter kick aggravated my knees some.  However, it's hard to tell if the swimming made them cranky or the walk down to the dock and getting in and out upset them.

I am leaving for France and Norway Sunday.  My husband's sister is getting married in Norway and we have had the trip planned for months.  Since that will involve a lot of time staying at my in-laws' house, my husband and I had decided to take five days for ourselves in France.  Of course all this was planned before this big knee meltdown.  I'm pretty scared about going, particularly because my hips have decided to start aching, but I'm going to go for it and do my best.  I'm most nervous about the eight hour plane ride because my hips hurt the worst when I'm sitting.  The good thing is that being away from home will make the time pass more quickly until my appointment.  I just can't settle my mind until I see the results of that arthogram and get a plan together for how to deal with this.

So it's not quite the trip to France that I had planned on, but I think once I make it to my hotel, I'll be able to enjoy just being there, even if I can't do very much.


Beth, did all your knee trouble damage your cartilage much?  That's my biggest concern--that my cartilage is all thinned out.  I hope that pain doesn't necessarily equal bad damage...

Enjoy looking at that straight leg.  Soon it will be a strong, straight leg! 

[Teacher2Many]

Hi Nicole,

What a coincidence...I am in to see Dr. Teitge for my 6 week follow-up on 8/17 as well.  I believe my appt. is at 1:00 pm (EST) so perhaps I will see you there!!!  A note to caution though...not sure who is doing your CT (never had an arthrogram done so can't comment on that) but when I had my rotational study, it took several weeks to get the results as it's not a common thing for radiologists to measure and it took a while to find one in the Chicagoland area who knew what to measure and how to measure it.  But I guess if they're just doing the scan and giving you the images on a CD and not measuring them, it should be fine.  Just out of curiosity, what's the arthrogram and what does it look at?

Glad to hear your trip to MI was pleasant and I agree, moms and dads are great at helping in our time of need; couldn't have gotten through any of the 7 I've gone through without them, esp. during those first few weeks post-op.  It is great to be in the water (when I got to MI, I had about 20 minutes to enjoy the hot tub and pool in the hotel before it closed at 10 and I took advantage of those 20 minutes for sure) but I have found that swimming caused more pain and discomfort.  Of course, couldn't understand why as that was before I knew what was wrong and then upon doing some 'research', swimming is not the best when the bones aren't in line properly.  Guess that would account for why it hurt more than it helped.  When I did aquatic therapy, they told me to avoid the flutter kick as it was one of the worst for my knees!  But heck, for me, being in the water is far enjoyable and the pain is well worth it (to a certain extent that is)!

Have fun in France and Norway and at your sister's wedding...am sure that the pleasant time will be enough to distract you from the pain.  And if not, must make sure you pack some Tylenol or Ibuprofen or any pain meds you may have just in case...this way, you can be sure to enjoy yourself.  I know what you mean about the hips hurting when you sit-maybe bring a chair cushion or something to sit on (at least I've found that to be helpful-one of those thicker ones like for rocking chairs) but long sitting with your feet up seems to help get the pressure off the hips (at least for me).

Take lots of pictures while in France and then in a few years (or more) when your knee issues are resolved, you can go back and see all the things you missed!!!!!   

As for my cartilage, it was severely damaged!  It was slightly damaged when the first few operations were done and I had bilateral ACI surgery done last year on 6/17 which showed 70% of my articular cartilage was gone.  Grafts have filled in but have not yet hardened-the plan was to do osteochondral allografts but that was before the rotational issues were known.  Had my surgeon not recommended I go see a doc out of IN (to consult w/re: patellofemoral joint replacement vs. osteochondral allografts) who first noticed the rotational issues, I would have had yet another surgery that didn't fully correct the problem!  Am sure that down the road the allografts will be needed, it's just a matter of when!  Hopefully correcting the rotational issues and the LPFL reconstruction will alleviate the pain enough that the allograft procedure can wait.  But if not, we'll go ahead with that as well to ensure that there isn't anything else in my way to happy, healthy, pain-free, and limitless knees!!!!

But don't fret too much as for pain=cartilage damage.  The pain in my knees was awful and when my surgeon rescoped them in 12/09 to check on the ACI progress, the graft was filling in nicely but still wasn't hardened but there wasn't any more bone on bone contact.  Of course, hindsight is 20/20 and am sure that a lot of the pain is from the rotational issues with the cartilage damage being secondary.  But my rotation was off a lot (R femur at 62, R tibia at 55, L femur at 57, L tibia at 55-normal for femur is 13, tibia is about 20/25) which made the pressure on the cartilage a lot more than it should be and made the bones rub where they normally shouldn't!

Am sure you will have a blast on your vacation and will come back to a wonderful appt. w/Dr. Teitge!  He does take his time so be prepared to stay awhile (I think my visit w/him in May lasted a few hrs.) and maybe bring a laptop or something to keep you busy while he reviews your past history, images, etc. 

Hugs,

Beth

[NickiAnn]

Beth,

From the speediness of my reply, you can be assured that I am procrastinating on my real work!  I'm supposed to be getting curriculum ready for the fall--blech!

Well I'm afraid this is the summer of nothing working out quite right.  My rotational study and arthogram were all scheduled for this week, but I was scared the arthogram might aggravate my knees before the trip.  An arthogram is when the inject dye into the joint before doing the CAT scan, it's supposed to show even very minor wear to the cartilage or other knee structures.  Plus, my mom was calling me every day telling me only a fool would have dye put in her knees right before an overseas flight. Some people say it makes them sore for a few days. Anyhow, I rescheduled with the assurances of the radiologist's office staff that I can pick up my report the next day before my Teitge appt.  But we were specifically talking about the arthogram, so maybe the rotational study won't be ready in time.  Oh well...too late now.  I guess Dr. T will have to eyeball it!  It's pretty obvious to the naked eye, but I'm sure my angles aren't as bad as yours.  I think I remember numbers in the 30s for my femur when I had the rotational study done in 1997. Too bad those records aren't available anymore.  They only keep them for seven years, so I'm going in pretty empty handed.   

It would be great to meet you.  My appointment is at 11 in the morning.  Should I wear a black fedora and a carnation in my buttonhole?  Or should I just stumble into the waiting room yelling "Beth where are you?"


Nicole

[Teacher2Many]

Hi Nicole,

Procrastinating on doing school work over the summer-we would never do that, right?!  J/K  I have done that many times and am doing it again this summer, although I did get a bunch of stuff crossed off of my 'to do' list prior to surgery but that was only so I can get it up to my storage room and out of the house for the remainder of the summer!!!  :-)  Still have a bunch left to do, including finding some ways to modify our new curriculum for my kiddos w/severe disabilities, but am sure that now that I'm getting some energy back, I'll be working on that shortly as well!  When is your first official start day for the new school year?  Do you get to go in ahead of time and work in your classroom?  What grade level do you teach again?  Know you had mentioned it earlier, but can't remember (sorry)!

As for the tests, I don't blame you for delaying them until after your trip w/the off chance that the dye could aggravate your knees even more!  Would have done the same thing.  As for the CT rotational study, am sure that as long as you get the images on a CD the day you have the test done, that's all Dr. Teitge will care about, as he remeasures them himself anyway.  The radiologist who did mine, measured my femoral rotation at 50-after he measured, I gained 7 degrees on the L and 12 on the R.  He's very particular and scientific so am sure he'd remeasure them himself anyway.  (Word of wisdom though...if you end up having the surgery, bring an extra copy of the CT study w/the day of, just in case...they misplaced mine which delayed surgery for about 4 hrs. and ended up redoing the CT scan.  Of course they found it as my scan was being redone but when I do the L, I will be sure to pack those images in my bag...just to be on the safe side)!

It would be great to meet you on the 17th-you will probably be finishing up w/him just as I am arriving (providing he isn't running too far behind, which when I saw him in May, he was pretty on time w/his appts.).  Feel free to ask for me though if you don't see me yawning while hobbling around on crutches-having to leave the house around 6:30 AM just to get to an appt. on time is going to be ridiculous, esp. w/rush hour traffic in the morning!  Good thing I don't need to follow-up w/him in MI too often-I think just at 6 wks. and then at 6 months, unless something major comes up re: the surgery and/or rehab that my surgeon in Chicago can't handle!

When are you returning from your adventures overseas?

Have fun working on your curriculum!   

Beth

[crankerchick]

Beth, I'm sorry I haven't posted to wish you well in your recovery anymore! I just saw today that your thread had updates. I'm not sure why I didn't get an email notification.

In any event, I'm glad to see you are coming along in your recovery. Only a few more days and you start PT.

I hear you on the sleeping issues. Laying on the operative side was of course out of the question, but I too found it not fun to lay on the "good" side either. Every few days I would try to lay on the good side to build up a tolerance. Around 6 weeks I could actually sleep on that side for a bit and lay on the operative side for short periods of time. Now of course I can sleep on either side mostly fine as far as the hip goes, it's the tibia that hurts still for sleeping on the operative side.

As for PT, I had a protocol for PT from my doctor from day 0 that consisted of 3x a day of quad sets, straight leg raises, hamstring curls, leg extensions, and the cannonball stretch (every hour during waking hours!). I started on the stationary bike for 1 hour a day starting 6 days post op. I did the biking in 2 sessions to start until working my way up to 1 session a day. I did not "have" to do PT at that point. My doctor said I could if I wanted to. My mother-in-law was pretty insistent so I did it while I was in Atlanta for those 5 weeks (i stayed with my in-laws after my surgery). The PT liked my home plan (wouldn't have mattered if he didn't LOL) so for the most part he just supplemented the exercises with lots of exercises to get my quad and hip muscles to come around.

When I came home at 6 weeks, I started with PT at home. At that point, I had no real protocol for transitioning to weight bearing as far as PT goes. I think my physio was a bit at a loss too. Bless his heart, I liked him and thought he was good, but he just treated me on the same program as anybody else, which didn't really work for me because it wasn't paced face enough. I worked harder on my own in the gym. My doctor said I was allowed to anything, so I did the weight machines, elliptical, bike, treadmill, lunges, BOSU ball, and everything else I could think of on my own in the gym long before my PT was progressing me to them.

I started to get a bit frustrated around the 3 month mark because I was working hard outside of PT but felt kind of lost on if I was doing the right things. At 6 months I went back to my doctor for a follow up and to work with his trainer. His trainer spent a great deal of time (a week actually) assessing what I could do and coming up with a plan for working out and showing me how he wanted me to do all of the exercises. He said with my attitude I didn't need any PT, I just needed a clear plan of what to do in the gym and how to progress the exercises. I have been following his plan ever since and conferring with him every few weeks on my progress and what new things to add or change. I work with a personal trainer at home to supplement.

In hindsight, I should have went to Houston at the 3 month mark when I first started to get frustrated with the PT and the recovery. It's tough recovering from these surgeries as an out-of-town patient. Good physio makes a world of difference. I can't imagine where I would be if I hadn't been working as hard on my own as I was before going back to Houston. Houston was great for many reasons, one of which was that I got direction for my workouts which resulted in greater confidence that I was doing the right things and on the right track.

[Teacher2Many]

Thanks for the feedback!  I agree with you in finding it difficult to do these surgeries as an out-of-town patient; just makes it harder for follow-up care, questions, etc.  Will be interesting to see how PT goes-didn't get a protocol or list of things to do following surgery.  I know it was stressed about the non-weight bearing aspect and to be careful re: the LPFL reconstruction, so am not sure if that's why things were done.  But having been down this road many times before, quad sets, etc. were just something that was done anyway.  SLR and the like are impossible right now-part of which I'm sure is from the derotations and issue with one of the muscles and peroneal nerve but I feel a lot of the pain where the reconstruction was done so I figured it's best not to push that issue until I get into PT for sure.  Last thing I need is to have my leg come crashing down due to inability to control the muscles appropriately.  And knowing my luck, that's exactly what would happen!  Am sure my surgeon in Chicago will be able to provide my PT with some insight and a modified protocol re: what can and cannot be done in the beginning-they are great at always coming up with different exercises, routines, etc. as muscles improve or when they see that one particular routine isn't quite working.  And their follow-up w/the surgeons and doctors is remarkable!  Have been at the same clinic since I started PT in 1/07 and am quite confident in their abilities to get me up and going again!

I know my left leg is getting a bit more irritated as well, having to be the primary leg for everything which is simply stressing the fact I need to get leg fixed sooner rather than later.  Was hoping to wait until the summer of 2012 so that I can complete my grad school internship in the summer of 2011 but think I might have to postpone the grad school piece for a year and do the surgery in 2011 and finish up grad school the following year.  We'll see-maybe the R leg will recover enough to buy time in re: to pain, function, limitations, etc. but since I refuse to take time off during the school year (too hard on my students to have a sub due to their severe disabilities), I need to make sure my left leg will be able to wait that extra year and if not, back to MI I go next summer!

Thanks again for your input...will pass it along to my therapist when I start PT next week!

Beth

[jumpi5d]

Hey Beth. Glad to hear you're still doing ok. I've been reading everything just been super busy. My PT actually had to call and talk with Dr. T's office to find out more about a protocol which ended up being if it hurt stop? It wasn't to specific. SLR will come with time...sometimes a lot of time.  Getting in a pool was the best thing I did for PT and the transition from crutches to weight baring.

Nicki I had my rotational study done and read ready take with me the same day as my appt, from the same place. My CT was at 10 am the appointment was at 2 with Dr. T!  The place that does them still uses film.. no cd's coming from them. lol Dr. T remeasured them like 4 times again anyways.  I hope you have a good trip!

-Paige

[Teacher2Many]

Thanks Paige!  Need to look into the pool thing for sure-I think one of the PT clinics does hydrotherapy so when I start next week, I will check with them and see if I can head to that clinic once a week for the hydrotherapy and do land therapy twice a week.  We'll see how that goes!!

Enjoy your weekend-lots of heat and occassional storms in Chicago but Sunday is supposed to be cooler and sunny (perhaps I can actually get out and get some back to school shopping done for my students)!

Take care,

Beth

[crankerchick]

Hi Beth!

For me, the logistics of being out of town for follow-up care, questions, etc wasn't an issue. My doctor is tops! He's easily accessible via email and cell phone 24/7. I only went to a local doctor for staple removal and I did the x-rays and emailed them. It's amazing to have a doctor 1600 miles away be of more use then ones right in my backyard.

My out-of-town complaint is more to do with physio, simply because mine didn't have a clue what to do with me and I never felt like he knew how to treat me specifically as far as my surgery and my attitude went. Now, the trainer in my doctor's clinic, he's the bomb and I know had I have been able to work with him, things would have gone differently. There is something to be said for working with someone that you know understands your surgery and has worked with others that have had the same and is willing to push you as hard as you can be pushed (and as hard as the doctor allows).

It's funny how different doctors have different approaches. My doctor is an advocate of moving as soon as possible after surgery, with as much umph as is safely possible. Hence the ROM and exercising starting in the recovery room and the stationary bike at 6 days post-op. It hurts like a (#*@& but I felt very much in control and active in my own recovery which was huge for me.

I know how you feel regarding the other leg. Here's to hoping it cooperates for you so you can do your preferred path of grad school and then surgery. I know for me, I have fingers, toes, eyeballs, and anything else I can think to cross that the right leg will behave so I won't find myself on this path again.