Mis-aligned, mal-tracking, and looking for answers...

[mountainknees]

If murder were legal, I would shoot the doctor who said to me "your questions are not important, just do what I say"
While I am not aware of the treatment for your specific issues, I would let your sister guide you away from this "fool" who call's himself a doctor.  Any physician who could simply brush off a patient like your doctor did, does not deserve to be in the healing professions.

Good luck but get your records and hop away from this guy as fast as you can.

God Speed, Mountain knees

[ElSquinto]

I'm at a loss for why anyone is trying to quantify femoral anteversion with an AP hip x-ray when the authority on this subject strongly recommends CT scan. I understand that CT is expensive. I just think it's pointless to keep spending time and and smaller amounts of money to quantify it any other way.

As far as age is concerned, I would defer to the experts on that.

The radiologist told me that a properly-taken standing AP hip x-ray is still the "gold standard" as far as providing a qualitative estimate (e.g. "too much anteversion" vs "normal anteversion" vs "too little anteversion") for femoral neck anteversion.  I guess the surgeon looks at the AP hip x-ray and - if he sees something of concern - then decides whether or not the CT scan is necessary.

But if the radiologist was correct - and that no orthopedic surgeon would think to treat this at aged 38 - then I guess that explains why Orthopedic Surgeon #2 didn't order up a CT scan for me - why order up a test that's going to quantify a rotational abnormality if "best practices" suggest you shouldn't do anything anyhow?

But then there's no real indication of how he intends to treat me if the pain returns apart from a "I'd give him an MRI if he comes back again complaining of continued pain" in the written write-up.

Might be time to book a plane trip to talk to a Dr. Sanders, Teitge, or Paley...

[ElSquinto]

If murder were legal, I would shoot the doctor who said to me "your questions are not important, just do what I say"
While I am not aware of the treatment for your specific issues, I would let your sister guide you away from this "fool" who call's himself a doctor.  Any physician who could simply brush off a patient like your doctor did, does not deserve to be in the healing professions.

Good luck but get your records and hop away from this guy as fast as you can.

God Speed, Mountain knees

It was Orthopedic Surgeon #1 who gave me the "brush off" with that comment.  There isn't a chance I'd go back to him...

Orthopedic Surgeon #2 definitely was willing to give me some explanations.  Unfortunately, it appears that he was working with a bad set of X-rays and his characterization of my rotational abnormalities seemed somewhat more severe in the write-up than what he told me at the time of the appointment.

Time to go see Orthopedic Surgeon #3 I guess...3rd try a charm?

[ElSquinto]

Well, I'll be visting ortho surgeon #3 next month.

This particular surgeon is, primarily, a hip specialist - but is very aware of "squinting patellae" and the combination of femoral neck anteversion and external tibial torsion deformities that cause it.  In any case, I've got hip pain now, too, so I was probably going to land in his office sooner or later...  

The encouraging part is that he's very much a "deformity correction" doc, understands that my knees are my primary concern, and is considered a leader at knowing what you can & can't reliably infer from using various imaging technologies.  Or at the very least he's authored a whole lot of papers on the topic

One thing that continues to suprise me - at least a little bit - is that there really don't seem to be many ortho surgeons who specialize in deformity correction of both the hips & knees because it really does seem that it's not too uncommon to find that deformities in the one type of joint are accompanied (maybe even caused by) deformities in the other.

[ElSquinto]

Well...it looks like I may have to wait longer than I thought to start getting real answers...
 

I was contacted by the office of ortho surgeon #3 and was told that the surgeon had a medical emergency and will not be seeing patients for at least 6 months.  The surgeon covering for him only just completed her fellowship in the last year.  So I need to think long and hard as to whether to cancel this appointment or not.

It's disappointing - but I guess the surgeon's own medical problem is a good reminder to me that others have worse problems than I do.

[NeverGiveUp]

As hard as it is, try not to get incredibly discouraged! Just remember that timing is everything! When the time is right for everything to be fixed, whether surgery be the answer or not, everything will simply fall into place.

Hope all is well! Good luck on everything!! Hang in there!

[ElSquinto]

Thanks!

I did contact the Surgeon's Office and I now have an appointment for late July.

I'm not as bad off as most folks on the board, so I should be okay.

[NeverGiveUp]

Congrats on getting a surgery date! Time will surely fly by as you are waiting! My surgery date is March 27, only a few weeks away!

Hope all is well! 

[captainruss]

Nevergiveup,

If I may ask, why did you have the LR on both knees?  Was it effective?  Can you explain to me why you had each procedure?  My daughter currently has a misaligned patella with pain.  My OS suggested a LR, but others are telling me this is wrong.  We are going for other appointments.

Russ

[ElSquinto]

Well, I met with the hip surgeon a few weeks ago.  The meeting was useful.  In fact I got far more useful information concerning my knees from a 15 minute visit to this hip surgeon than the three prior visits to actual knee specialists.  Mind you, this hip surgeon is not a knee & hip surgeon; he's strictly a hip surgeon.

From a hip standpoint I'm pretty messed up - bilateral dysplasia, cam-type FAI, a torn labrum in my right hip, etc...but this site isn't called "hipguru"...so enough of that.

But as it turns out this particular surgeon uses specialized MRI images to analyze deformities of the hip joints, femoral head and femoral necks.  In my particular case he only imaged my right side because that side had the symptomatic hip.  But the findings in those MRI were interesting.

I have femoral neck anteversion of "slightly more than 30 degrees" and tibial torsion of "probably 50 degrees" in my right leg .  And that's the straighter of my two legs.  The surgeon performed a TPAT (trochanteric prominence angle test) on my left leg and he told me that it "suggested FNA approaching 50 degrees" - though he was quick to add that TPATs aren't always reliable.

It's official, folks, I'm twisted.   

At the recommendation of this hip surgeon, I'm visiting another knee surgeon in September.  I already strongly suspect he's "not the right guy" because he's not a deformity-correction doc and he's renowned for prescribing PT or LRs for everything.  I sure as heck will not be letting him perform an LR on me...

[tumba]

Ehm, wouldnt you get twisted by all the compensations your having because of your kneepain?

[Lottiefox]

Ehm, wouldnt you get twisted by all the compensations your having because of your kneepain?

You can't physically twist your bone alignment due to knee pain. You might start off further pain issues because of the twists and the pain in your knees but these will not actually "twist" things more. Bone deformities tend to happen as we grow.

[tumba]

Alright, but you understand what I mean with pronation being caused by glutes medius shutting down etc?

[Lottiefox]

I do but that won't be evident on any rotational scans only in functional (or non functional if you're compensating for something) movement if your gait is "off".

[ElSquinto]

I do but that won't be evident on any rotational scans only in functional (or non functional if you're compensating for something) movement if your gait is "off".

The patella squint is usually the result of some sort of growth disturbance but, as far as I know, doctors have not yet explained why excess femoral anteversion results in pigeon-toeing (i.e. excess FNA but normal tibial torsion) in some folks and patella squinting (i.e. excess FNA with excess lateral tibial torsion) in others.

And I'd say a lot of the clinical tests (e.g. gait tests, TPAT/Craig's tests) that are administered - even by trained knee/hip specialists - are pretty unreliable.

...I never presented with an abnormal gait as a child/ young adolescent.  I've got a stack of patient visits notes from examinations by my pediatricians attesting to that.

...In 2010, I had a TPAT test administered by a very well-regarded knee surgeon who estimated that my FNA did not exceed 15 degrees.

...And just 8 weeks ago I had another TPAT test by a very well-regarded hip surgeon who estimated my FNA to be much, much higher.  This is supported by the images he took.

I've been skeletally mature for more than 20 years; there's no way my FNA changed significantly in 2 years.