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

[Lyndsey]

Beth,

Hope everything goes well with your appointment! Question-- Is the snapping of your hip on the derotated side? Did it happen at all before surgery? My left hip snaps, and I wouldn't mind it, but it's really painful. This is even a year after hardware removal. So Dr. T went back in in October and fixed a couple of problems. We thought that fixed the snapping, because for the first month or so after surgery it did stop. Now, I find it has started up again. It's like a popping feeling, that leads to stabbing pain. How about yours?

Good luck!
Lyndsey

[Teacher2Many]

Hi Lindsey,

Yes, the snapping is on the derotated side and it did not occur at all prior to surgery.  Prior to surgery, it would sublux and pop but not snap.  Although I don't even know if you would call it snapping.  It's more like a violent popping where it catches and then 'pops'-very palpable and visual (you can see and feel it pop).  The surgeon who's doing my follow-up care in Chicago sent me to a hip doc as we all thought the hip was subluxing/dislocating, that's how violent the pop is.  That's not the case, which is good.  Just need to figure out what the deal is and how to fix it!  I get sharp pains as it catches and then pops but nothing beyond that except lots of soreness and tenderness.

Will keep you posted on what the final word is...lots of issues to address tomorrow; just hope I don't fall asleep in the office due to being up so gosh darn early!

Beth

[crankerchick]

Best of luck at your appointment today!

Latise

[Teacher2Many]

Wow...haven't been on here in forever!  Such is life of working full time, grad school, and aggressive PT 3-5 days/week!

Good news is that at 9 months post-op, the tibia was about 90% healed...took long enough!  Nerve sensation from the EHL loss/damage hasn't fully returned but told it could take a few years to get back to normal re: that issue but that it SHOULD come back!

So here I am a mere 22 days away from undergoing my 'worst' surgery yet!     And by worst, I mean most involved, which probably will mean the one w/the most pain as well.  Hopefully this one will be the last (aside form possible hardware removal which isn't any major deal all things considering).  As of now, the plan for surgery on 6/16 is:

L derotational femoral osteotomy, L derotational tibial osteotomy, L LPFL reconstruction, L reversal of lateral release/repair of lateral retaniculum, R femoral hardware removal, R tibial hardware removal, R muscle contouring.

Possible options include L MPFL reconstruction, R MPFL reconstruction (and maybe redoing the LPFL reconstruction as well), R release of the IT band, and any other issues he finds that can be a factor re: the hip pain/snapping such as needed a bone/tendon shaved/trimmed, etc.

And all of this while continuing with grad classes over the summer!  Yikes!!  But am sure that, before I know it, it will be the end of August and I will be returning to start a new school year with my preschoolers with disabilities and surgery will be behind me with a road to recovery ahead of me!  Just hoping for a complication free surgery this time!   

Anyone else have this same procedure done (the osteotomy part that is) on both legs over a year or so and if so, how did things go?  Wondering if my R leg will hold up being the weight bearing leg since it's still not fully recovered and w/the issues with my shoulder, hope that holds up for the 6-8 weeks on crutches!

Hope all are doing well and enjoying the start to spring and summer!!!

[vl7007]

Hey teacher2many,

Glad to see some improvement there.  However the new surgery on both legs at once, I can tell you from Kat's prospective, the pain meds are good.  However Kat has only had both her tibias/fibulas deroatated at the same time.  Her ortho wouldn't do the femurs at the same time as he felt it was too risky.  At her last visit a few weeks ago his registrar suggested that after having done 4 tibial procedures on the left leg and 2 on the right, now might be the time that they do corrective derotational surgery on both legs again, and also looks at the femurs more closely, (I question their logic if the surgery hasn't worked yet).  Anyway back to the important stuff, your situation, I don't know what happens with muscle contouring,  I know that you are in great hands though under Dr.T. in USA,  he will do his best.  You know from experience it won't be fun, but you are so strong and have so much to look forward to post surgery, it con only get better.  Take each day one at a time, and believe in yourself.  I am proud of what you have achieved so far, to be able to work as well as cope with everything you have so far, just proves how remarkable you are and what stuff you are made of.   Take care we are thinking of you and praying for you whilst you go through the next round of procedures. 

Next year is going to be a great one for you.

Best of luck

kats mum.... vicki

[Teacher2Many]

Thanks Vicki!!!  Your kind words mean a lot to me and I wish only the best for Kat as well!

As for the muscle contouring...it was explained to me that when the femur was derotated, some of the muscles/tissues/etc. needed to be moved in order to get to the bone and correct the high rotational angle.  Most of the time, the muscles/tissues settle back down into their original place, sort of speak, but for me it's as if there is a constant pocket of swelling along the femoral incision.  I did think it was swelling until I met with Dr. T for my 6 week post-op visit and he explained what it was.  It looks like you cut a Nerf football in half and stuck it under my skin; makes wearing any kind of form fitting pants, skirts, etc. awful as you can clearly see the 'bulge' on the right side (operated leg) vs. the left.  So he said that when he goes in to remove the plate, he would contour them a bit and smooth them out so that the bulge isn't as obvious.  I joked w/him to even remove some of the extra fatty tissue too-why not, right?!   

I'm sure all will be fine!  I think it's just more along the lines of fear of the unknown, as well as not being there for my students' last 3 days of school (we used 3 snow days this year, which we haven't used in about 15 years, which totally screwed up my schedule), and trying to get through grad school over the summer while recovering, doing homework, PT sessions, and doctor visits.

20 more days to go and this will be behind me (woo-hoo) and I will be on my way to a successful and complication free recovery!

Thanks again for your warm thoughts and wishes,

Beth

[Teacher2Many]

Tried changing the title of the blog to reflect both rounds of derotational osteotomies (R in July 2010 and Left in June 2011) for better reference and accuracy.  However, not sure if it worked so this post is a test to see how it comes up!  Updated my 'signature' as well and had to cut out a lot of the more 'minor' surgeries due to space limitations; guess that just shows that I've been around the block a few times and then a few more!!!

Happy Memorial Day Weekend,

Beth

[Teacher2Many]

Two weeks from now, I'll be semi-awake, hopefully with motion and nerve sensation in my toes/foot, waiting for the scoop from my surgeon (providing it goes like it did last year)!  Getting nervous  but considering my leg has given out 3 times within the last 24 hrs. and one of those times almost resulted in a complete wipe-out on the sidewalk, I'm also looking forward to it as well.     I keep tweaking my 'packing' list as I am always forgetting one or two things.  Will dedicate more time to the final preparation (packing list, packing, getting my room ready for post-op fun, etc.) after this weekend when some of my work stuff starts winding down and family engagements are slowing down as well!

[Lyndsey]

Good luck with the surgery! I wish you all the best! You'll have to keep us updated with how everything goes for you!

[Teacher2Many]

Arrived in MI about 45 minutes ago.  Need to be at the hospital at 5:30 AM EST.  Not sure I'm ready but oh well!  Fingers crossed all goes well!  Will try to update when I'm coherent & lucid!  :-)

[crankerchick]

Best wishes. Hope you are doing well with all that work being done!

[Teacher2Many]

Figured I'd send a quick update while I'm coherent and not too drowsy...

Surgery took place on 6/16/2011 for a total of about 9.5 hrs. in the OR and was in the hospital for 6 days!  Procedures included:  left derotational femoral osteotomy, left derotational tibial osteotomy, right femoral hardware removal, right tibial hardware removal, repair of left lateral retaniculum, and the shaving/cutting of a bony step on the right hip (which I'm assuming was contributing to the clunking sensation, in combination with the plate).

Let me start by saying my hospital stay was amazing!!!  I was on the regular floor for the first 36 hours post-op with excellent care and then got transferred to the bone and joint unit!  Oh my goodness-that floor is amazing.  I went from a typical hospital room to what was a mini hotel suite with a bathroom larger than the one I have at home, a refrigerator and microwave (which was great for my parents who were staying with me), a pull out couch, multiple chairs, etc., etc., etc.  The room was probably 3 times larger than the regular rooms which added comfort while trying to move around and it definitely helped to have the nurses and aides familiar with orthopedic issues and needs (ie CPM use).  Wish I was down there from the beginning as those first two days were really rough but am glad I was done there when I was.  Totally amazed with the level of care received and the friendliness by all who worked there-from those who clean the room to those delivering your meal/picking up your food trays to the nurses, therapists, doctors, residents, etc.  Probably one of the friendliest places on earth and they did such a good job of taking care of mom and dad too (who were definitely worried with everything that was going on and all of the mini bumps along the road)!

Recovery has been rough...late on the day of surgery/early Friday morning (somewhere between 11 pm-1 am) I lost the ability to move my toes and ankle on the left foot.  I had this ability after surgery as I remember telling my mom "look my toes aren't dead this time" as the same thing happened to the right foot last year but that was immediate.  So I now have foot drop on top of everything else.

On Sunday, the 19th, my heart started racing for a heart rate of 133 bpm, which is about double what my normal is which is around 65 bpm.  They became concerned, especially because earlier that day I noticed some redness and increased swelling along the incisions.  They did some blood work and found that my hemoglobin dropped from 9.1 to 8.7 in about 12 hours.  The ortho resident came in around 1:30 am to check on me and was considered about a possible blood clot as all the symptoms were present (redness, tenderness, increased swelling, warmth, increased heart rate, and low grade temp) so he ordered an ultrasound to be done first thing in the am.  Ultrasound came back negative (thank goodness) and the lab work from that morning showed a hemoglobin of 8.0 so they figured that the increased heart rate was due to being anemic and my heart having to work harder to pump the blood.  They did 2 more transfusions (for a total of 6) and things were improved.  I was discharged that Tuesday, 6/21, in the afternoon and was sent home with antibiotics for the possibility of an infection starting to brew.

I had an appointment with my surgeon in Chicago on 6/27 to have the AFO casted for my foot due to the drop foot issue.  While I was there, he decided to do my 2 week follow-up visit 3 days early to save me a trip, as he could see how difficult it was to move around.  They too were concerned about the increased swelling, warmth, and redness in the leg so they ordered another ultrasound to be done.  This time the ultrasound confirmed 2 blood clots in my left calf so they put me on a protocol of twice daily Lovenox injections to help break up the clot and daily Coumadin therapy to prevent more from forming.  Luckily, my hospital that my primary practices out of is a fairly large and well known hospital and has a Coumadin/anticoagulation clinic that has been monitoring my every other day blood results, meds, etc.  I should be on the Coumadin for about 3-6 months with a list of extra precautions, dietary intake, etc.  I have a new found appreciation for all those who have to live each day on injectable medicine-giving myself shots in the abdomen twice a day is not comfortable-good thing I'm not wearing a bikini anytime soon (don't think anyone would appreciate all of the mini bruises)!   

So now here I am 2 weeks and 1 day post-op.  I went for my PT eval today and start official sessions on Tuesday 3 x a week for who knows how long.  I go get blood drawn about every other day to check various levels, have meds adjusted, etc. all related to the blood clots.  I am hoping to get back to grad school this week, even if only for two hrs. each night instead of the four-we only have two weeks left and although my advisor is super understanding of the situation, it would be nice to be in class ( and return to somewhat normal activities).  I've had a few friends stop by to visit and many cards and warm wishes from family and friends, which help.  Pain meds have been a life saver but for some reason, I can't take them w/out getting extremely drowsy.  I am going about 5-7 hrs. between doses depending on activity level and a lot of that is due to the pain associated with the clots versus the actual surgical pain.  My hip is hurting with sitting (as it did last year) so lots of cushions and ice packs are used at all times!  Sleeping is difficult due to getting up a lot at night but the semi stronger pain meds that my Chicago surgeon prescribed helped me get a much better night sleep last night so I think I will use those at bedtime only to see if it makes a difference.

But in the end, this is it!  Aside from the hardware removal (which I got to keep from the R leg-holy crap was it a lot; think I might try to make some sort of 'structure' when I get the hardware from the L leg) sometime in the next 9-12 months, I am done w/orthopedic surgery regarding the legs!  The R leg feels so much better now that the bones are straight and hardware is removed and am sure the left leg will get there in due time as well! 

I feel bad for my surgeon though-seems like all of these rare issues (ie foot drop, blood clots, etc.) all seem to be happening with me!  He is such a caring and loving doc who is truly dedicated to his patients (not to mention being a walking medical orthopedic dictionary)!

And that's it for me...dinner just arrived so I am off to enjoy a hamburger and yummy raspberry shake!  Stuck inside for 4th of July again (no parade or fireworks for me) but next year, I will be enjoying it all and without being on crutches, which will be the first time in 5 years!!!   

Happy 4th!!!

Beth

[Ruth M.]

Beth - glad to hear that you are doing well - even with the complications. We are all so fortunate to have Dr. T as our doc. This will be the first July in three years that I'm not "under the knife". I had my screws removed last March and all is good. We went to Europe - Paris and Madrid - a week ago. I went up and down so many stairs that I can't begin to count and outside of one "knee lock" on a step in the Paris subway, I was able to do all of the stair climbing. (I think the knee lock was because I was psyching myself out after three sets of stairs.) I would not want to be handicapped in either of those cities. Definitely not handicapped accessible. I don't know how someone would survive there - cobblestone streets with the bricks half up/ half down - good ankle twisting experiences).

Oakwood sounds so good. I didn't get to experience the bone/joint unit. I just know that I had my first surgery right before Dr. T took over the program and then the second surgery a year later and what a difference. He has made such a difference for so many people.

The best with your recovery. I'm a teacher also so I know how important it is to have mobility in our profession. I will be starting this year without pain, without pain killers (no more vicodin haze days). It was so worth it! Hope that you continue to get well and your foot issue improves (I have terrible arthritis in my feet and a foot doc who says nothing can be done - bummer).

Ruth

[jumpi5d]

Beth!! I haven't been on here in a while and didn't realize you had your other leg done! All said and done I'm glad to hear things are going okay. We do by far have the most caring and loving doctor ever!!! He's such a great guy and full of random and useful info.

Glad you got to enjoy the new ortho ward...and VIP Suite!!! LOL I was like the first person to ever stay in that room.  It's HUGE. Everyone there is awesome...the girl who cleaned my room was probably the funniest person I talked to while there! I still talk to some of the staff they're great.. (now Ruth and I both had the experience before the new Ortho area that was not so good.)

Isn't the metal crazy? I've had all mine out for almost 8 months and it's SO crazy still. I want to make something out of mine too but I'm not sure what?

-Paige

[Teacher2Many]

Ruth...glad to hear you were able to enjoy Europe without much trouble with your knees!  Amazing what this surgery can do once all heals!  And what a wonderful feeling it will be to start the school year without pain meds!  Hoping to be able to experience that as well!  :-)  What grade level do you teach?

Paige...I too experienced Oakwood prior to the bone/joint unit last year, as well as the first 2 days post-op this year, and what a difference in the understanding of the nurses and patient care techs from the ortho unit to the regular unit.  Sometimes you just need that extra level of care and understanding!  And yes, that suite is huge and was great for my parents, as it provided enough space for them to relax or sleep in, not to mention being big enough to move around in when on the crutches.

So, I saw my surgeon this past Monday for a follow-up visit and things are healing well.  The incisions are completely healed, aside from one or two small areas but even those are healing now (apparently the sutures weren't dissolving properly in those two spots).  The blood clots seem to be improving as well, although my INR dropped from 2.4 to 1.8 this past Tuesday without any reason so we need to keep an eye on that as well.  No improvement with the nerve damage and/or foot drop.  The AFO that was made 3 weeks ago needed to be trimmed, as it was way too big due to the swelling diminishing.  It doesn't provide as much support but it'll do for now.  I go back to see my surgeon in Chicago in 3 more weeks and if the foot drop hasn't resolved, I will have a new AFO casted (thank goodness to unlimited orthotic benefits with my insurance coverage) and am hoping it is a bit slimmer to accommodate work shoes (or at least shoes that are not as bulky).

The hip pain with sitting is improving slightly and the joint line pain in the knee can still get pretty intense, especially with sitting.  X-rays will be done at the next follow-up and we will see if the bone is healing; hopefully there won't be any issues in that regard like there was last year.  Am down to using one crutch when around the house (unless I'm in a small area, like my room or the kitchen to which I walk w/out the crutch) but still take two with me when out and about, especially with the foot drop as I tend to trip on my own feet since I can't pick the left one up to clear the ground all the way. 

The R knee is continuing to sublux and dislocate-Dr. T is hoping that building up the strength will help but am not sure.  All was fine last year after surgery until about 4 months post-op and then the subluxing and dislocating resumed.  Am hoping that doesn't occur with the left; only a few 'pops' with that one so far which I'm attributing to the swelling right now.

On another note, the issue with my R shoulder is getting worse, as I was afraid it would due to the use of the crutches.  Surgeon is waiting to see if things subside once I can wean off of the crutches and in the meantime, am using a TENS unit at home to help with the pain (which also doubles as a NMES unit for the quads).  Interested to see what becomes of this!

That's all for now!  Hopefully things will continue to improve and the foot drop issue will resolve before I return to work in 4 weeks!  Fingers and toes crossed!

Beth