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Author Topic: Distal Femoral Osteotomy & Osteochondral Fracture Allograft  (Read 607 times)

Offline Dogdragon

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Hey all.

I dislocated my kneecap when I was 13 playing sports. Crutches for a month and some physical therapy, but I was told it would never be great and completely stable again.

Fast forward to this year, 12 years later. I've spent 12 years with an achy, unstable knee. It prevented me from some things, and has some days worse than others. But, mostly I did everything I wanted to do, even in pain. But, enough people convinced me this year that I shouldn't be in chronic pain at 25 years old, so I went to see a specialist to see what's up.

I never got an MRI on it when I was younger. So, surprisingly, my first MRI comes back with a huge list of problems. Including a lovely fracture that I've been walking around with for many many years. Not to mention the osteoarthritis and other fun stuff. So, that specialist referred me to another specialist.

The second specialist told me I have an osteochondral fracture that needed an allograft (cadaver bone) to fill my fracture. But, on top of that, I have a 12 degree valgus deformity in both legs and there was no point fixing the fracture without realigning the leg, or I would just wear it out agaib.

So, a few weeks later, on June 23rd, 2017, I had both procedures done.


The morning of the surgery, I was very exhausted. I had worked hard all month to get a bit of extra income to help out during recovery, so I had only had a few hours of sleep the night before due to working long and late. The pain guys came in to insert 2 nerve blocker catheters into my leg. One into my femur, the other into my sciatic nerve. I kept panicking during the first catheter insert, and so the nurse gave me something to relax me.... next thing I know, I'm waking up in the recovery room and ask "are we going into surgery soon?" To which I'm told "...its done?"

I had 2 doctors doing my surgery. One for each procedure. I never met the 2nd doctor or his team prior to surgery.. On my first follow up appointment, a bunch of residents were like "look who it is!!" I awkwardly had no clue who they were.. Only to find out that I, in fact, never passed out during the nerve blockers, only blacked out, so I had been conscious and meeting people for a good hour or so before surgery?!?

Anyways, when I awoke in recovery, I practically demanded going to the bathroom. I couldn't do the bed pan. I just have bugged them enough to take me, because they put me in a wheelchair, with no brace, and wheeled me to the bathroom, to also use on my own! I remember sitting on the toilet, leg bent, thinking, "hey look, it bends like normal. This will be an easy recovery!" Wrong.

First 24 hours after surgery was just fine. I was also sent home with the nerve blockers still in my leg, in 2 balls, kept in little bags I had to carry around for 3-4 days. All the strong stuff from the hospital made it all a lie though. Roughly at the 25 hour mark, I started to get a lot of pain.. like a 9 on pain scale. It sucked. My nerve blocker from my sciatic nerve also leaked quite a bit, lovely puddles of it on the couch, so I'm unsure if that was preventing the pain relief I needed. We called the hospital and they said to add ibuprofen to my pain mix and hope for the best. Eventually the pain knocked me out and I semi-slept it off.

The next night, I had burning pain. I needed more ice but I didn't want to wake anyone. I buckled up my brace, put the ball bags around my neck, and tried to get myself ice. When I got back to my spot on the couch, I noticed I was in a puddle of wetness, again. Upon inspecting the catheters, I disxovered the one into my femur had detatched somehow. I had to call the hospital, they had to page and wake my nerve pain guy, and he had to walk me through removing it due to possibility of infection from being open. So, took that out. Such a weird sensation, and, no more nerve blocker to my femur... ouch!

The next day went okay. Kept up on pain killers, barely moved. Cool.

The following day was time for my sciatic nerve blocker catheter to come out... So the pain guys called me and walked me through it. Now, the femur catheter was only a few inches long... But the sciatic nerve one... holy crap. It was close to the length of my leg. It was an absolutely horrible feeling to remove it. I could feel it moving through my vein thing, and could feel it moving under my skin. It gave me chills and aches. In fact, 3 weeks post surgery, I still have a lot of sensitivity and weird feeling in my inner thigh where the catheter went in.. ugh. They say it should go away eventually..

Anyways, got that out, and kept up on meds.

Maybe a day later, or even that day, I slipped while lowering myself onto the toilet seat. Took a pretty hard hit on the seat. My bad. Called docs to let them know, they suggested I come in and check but I already had an appt a few days later so we waited.

First check up was on the Friday with the doc who did the DFO part. Had xrays done. He said it all looked well and good. Cool.

My next check up was on the following Wednesday with the doc who did the allograft part. Again, all good. He called it text book. Sweet.

Made it through the rest of that week great. Leg was no longer in much pain from movement, instead just had become a huge awkward dead weight. Just annoying more than anything. I made small outings with people, just to walmart kinda thing. Rode around in the wheelchairs.

Then Sunday came around. In my attempts to get back to normality, friend and I went to another friends huge dinner thing she does weekly. I'd missed 3 weeks, so we went. All was great until on my way out the door, one of my crutches slipped on some cupcake icing a kid had dropped. Yep. Slipped on a cupcake. Just my luck! I caught myself, all my weight, on my bad leg. Whoops. It hurt. It really, really hurt.

The pain was such a different kind of feeling to the entire recovery so far, so I called first thing Monday morning, and they said come in. We made the trek there, got another set of xrays. I didn't damage anything really, but there appeared to be a very very faint black line coming from the DFO fracture wedge thing, to the other side of the femur. They basically said I didn't damage anything... But don't fall Again. Don't want to risk extending the wedge fracture.

So, I spent the rest of this week not doing much. Don't want to risk anything again now. Banished to the wheelchair for the most part.. just to be safe.

I had my first PT session a few days ago. Just mostly an eval. I start that properly next Tuesday. I'm excited. My leg is getting stiffer and more and more atrophied. I don't know why it took almost 3 weeks to get a prescription for PT.. I haven't known what to do for it. Scar tissue build up is getting thicker. I'm not looking forward to breaking that.

I'm still on the couch here. I live in a travel trailer and haven't been back home since morning of surgery. Got people taking care of me. I was originally gonna be stubborn and make it work on my own, in the trailer... But it's probably good that I didn't. Maybe another week, the 4-5 week mark, and I'll attempt going home. We'll see.

Offline slightfield

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Re: Distal Femoral Osteotomy & Osteochondral Fracture Allograft
« Reply #1 on: July 18, 2017, 06:33:33 PM »
Hi Dogdragon,

Happy to see you are well on your way to a successful recovery given the unfortunate slip on the cupcake. I too am recovering from a DFO. I am 11 weeks post op and I can assure you, everything, I mean EVERYTHING becomes easier one day at a time. It really does seem like you are missing out on a lot of normalcy in your life, which you are. Don't get me wrong. When you signed up for this crazy mess of a surgery you probably knew that going into it and if not, well then, there ya go. Boom! Life altering for about a year or so is the reality that I have come to accept. Anyway, I miss doing the activities in my life that brought me lots of joy as I am sure you do too. What date was your surgery? Are you still non weight bearing? That was by far the most challenging phase for me. Hope you are well and looking forward to keeping up with your recovery!

Offline Dogdragon

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Re: Distal Femoral Osteotomy & Osteochondral Fracture Allograft
« Reply #2 on: July 18, 2017, 11:42:35 PM »
Life altering for a year or so?! Uh oh. I feel I was not given quite enough information prior to surgery, unfortunately. So, why a year? :/

My surgery date was the 23rd of June. So I'm about 3.5 weeks post-surgery. Still no weight bearing. How are you doing 11 weeks out? Weight bearing?

I had my second PT session today and they seem at a loss for giving me things to do. Given the DFO and the allograft, I can't do weight bearing or much resistance... besides heel slides and foot pumps from the bed, there's not much to do. That's irritating me a bit. I'm not getting much bend out of my knee. The allograft area is very, very tight. My bend stops due to the tight pressure from it. I don't quite know what's DFO related and what's allograft related. Tough.

So far I'm just bored more than anything. Hoping to be walking soon and get back to work. Though my work is often quite physically demanding as far as walking and carrying things. I hope that's not too far away.

Offline slightfield

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Re: Distal Femoral Osteotomy & Osteochondral Fracture Allograft
« Reply #3 on: July 19, 2017, 05:23:49 PM »
Right, it sounds like it. Yeah, I am weight bearing now.  Where did you have the surgery?  I am sorry if you had misinformation from your OS. My OS told me I can bet on forfeiting about a year of my normal activities which were hiking, skiing and MTBing. But once fully recovered, I would be able to have fun again. This time with significantly less pain than before. It sounded like a good gamble...

I have been doing PT since 2 weeks after my surgery. I wasn't happy with the first place I was going so I found somewhere that was much better. It helped my PT when they learned to treat me as a femur fracture. This surgery is not all that common, come to find out so any little bit helps. I was non weight bearing for about 6 weeks. Longest 6 weeks ever. My arms are in awesome shape though! At that point, once my xrays and ROM eval from OS showed sufficient progress, I was given "weight bearing as tolerated" status. After that, my PT had me walking with one crutch for about a week and then said i was ready to ditch the crutches all together, about 8 weeks post op! There is light at the end of the tunnel for you, even if it's hard to see right now.

What I can tell you from experience, is do the exercises you shared in your last post EVERYDAY, 3 times a day. Stick with it. I can share some other exercises (if you want) that I think helped me get to 90 degrees flexion and 2 degrees extension at 2 weeks post op and kept steady progress and my spirits high. Not to say it was easy by any stretch of the imagination. Keep in mind that every little accomplishment, and I mean EVERY TINE LITTLE accomplishment (no matter how insignificant) is HUGE. It is a victory for you. The hurdle of bending or extending that leg a bit more, being in less pain than the previous day, getting up out of bed for longer, defeating the horrible constipation from the pain meds, I mean ANYTHING, is a HUGH VICTORY. Don't lose sight of that. You can look up my diary here if you want more insight.

What is your current range of motion? Do you have the nerve blocks out? What is your biggest challenge? What is your biggest accomplishment in the last week? By the way, the first 2 weeks are the most difficult. Smile!

Offline Dogdragon

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Re: Distal Femoral Osteotomy & Osteochondral Fracture Allograft
« Reply #4 on: July 23, 2017, 06:18:57 PM »
I had the surgery at USC in Los Angeles.

It's definitely a long 6 weeks! Yesterday was 4 weeks post op. Less than 2 weeks until next op and xrays and hopefully approval for some weight bearing! I'm over it all already haha. My PT has me doing leg slides and ankle pumps. I can't raise my leg, feels like my ankle stays glued to the bed. I'd gladly welcome some more workout things! They don't want me doing any resistance either due to the allograft. Its a tough catch 22 kind of thing until I get weight bearing approval.

My current range of motion seems to be around 70-80 degrees. Last week was more like 50-60. Hoping for 90 by next doc visit. Nerve block catheter things I had to take out a few days after surgery, then got off pain killers around 2.5-3 week mark. My biggest challenge is lifting my ankle. I've got no calf muscle happening it seems. Or whatever controls lifting ankle haha. When I try, I just seem to raise my knee. Biggest accomplishment, I did laundry in my own? Haha. I can't carry anything with the crutches so that sucks. I want to get back to driving, and working!

Offline slightfield

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Re: Distal Femoral Osteotomy & Osteochondral Fracture Allograft
« Reply #5 on: July 29, 2017, 05:40:45 PM »
USC is a good start. Before I moved to Utah for the awesome skiing, i lived in Whittier then moved to Fullerton. It is a long road, but be happy to get through the day. Straight leg raises are important and something I had to work at multiple times per day, everyday. At first, my leg wasn't wanting to move either, it seemed way too heavy with that brace on. I had my mom help me getting started, so at first I would lay flat on my back on my bed. Then she would put her hand under my ankle and lift up VERY slowly and gently to get me started, before I knew it I could lift my leg on my own. WOW did it work my abs!! Oh, and crunches are great to do while you are bored. Some other exercises that helped me progress were side straight leg raises. So laying on your side (both sides if you can stand the feeling of weight at the allograft side), then raising your leg as a "scissor" motion up and down. My PT says that strengthening the glutes are key as this will align your leg and help with walking when you get to that point. With that said, I would roll up a towel and place it under my knee, then would press my knee down (flexing my quad) sending it into the towel as far as it will go. I do this exercises sitting up in bed with a pillow or two propped behind me. If you squeeze your butt during this exercise it will make progress much faster.  This really helped with my leg extension, which you will want to be as close to 0 for walking.  The calf muscle thing is a given, you likely won't start getting that back until you start walking.

I laughed when you put the biggest accomplishment was doing your laundry because I know exactly how that feels. Carrying things was a challenge for me as well until I started using a small bag/backpack to help me do little things around the house. LOL!  Good luck at your upcoming appointment! My next appointment is Aug. 1 to find out whether the bone has knitted together. I am excited for my next set of xrays!! Cheers to going off your pain pills too, that is a big accomplishment!   

Offline slightfield

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Re: Distal Femoral Osteotomy & Osteochondral Fracture Allograft
« Reply #6 on: August 08, 2017, 03:36:53 PM »
How are you?

I had my 12 week post op appointment and xrays came back better than expected. The osteotomy site is almost completely healed! Doc gave me no restrictions other than running and jumping. Says that at my next appointment, at 24 weeks, we can discussing the removal of the hardware.

Hope you are doing well! Send an update!

Offline Dogdragon

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Re: Distal Femoral Osteotomy & Osteochondral Fracture Allograft
« Reply #7 on: August 25, 2017, 03:37:57 PM »
Hi!

Congrats on your 12 week progress! I am jealous... I'm doing pretty terribly.

I had my 6 week visit 3 weeks ago, and he gave me nothing more than" toe touching 20-30lbs", and said walking at 8 weeks, see you at 9 weeks. But then backtracked and said no walking until the next visit... So, yesterday was the 9 week visit. I was over the moon ecstatic to be given some kind of walking approval... He saw me before xrays and said "go get xrays, if you're lucky, I'll give you toe touching 20-30lbs!" I'm like ".... no, that's what you granted me 3 weeks ago..."

So, here we are. He said it wasn't completely healed over yet (duh) and wouldn't allow me anything. I fought him and he agreed on 50lbs toe touching..... I've been putting probably 60-70lbs pressure on the leg the whole past week.

I am not at all happy with him. I just want partial walking... one crutch less would make everything SO much easier. I'm not gonna be running, jumping, walking far distances.. obviously. I'm just very unhappy.

2 surgeons did my surgery. One on DFO, and one on allograft. The guy I keep going back to is who did the allograft. I am going to track down the DFO guy and ask his opinion at this point. Even my therapists are bummed because it's a struggle to build my muscle back up without any walking or more weight bearing.

Offline Dogdragon

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Re: Distal Femoral Osteotomy & Osteochondral Fracture Allograft
« Reply #8 on: September 13, 2017, 07:35:25 PM »
So, update time.

I tracked down the 2nd OS on my leg, for a second opinion, or at least someone to answer my questions and concerns.

It was night and day going to see the 2nd OS. He actually looked at my leg, felt it, and made proper evaluations. He said I could have been walking weeks ago. So, time to wean off the crutches.

Now, here's the kicker. In asking questions and addressing concerns, I mentioned that my kneecap (main reason I'd gone to see specialists in the first place) was feeling looser than usual, and popping and clicking more.

Straight away, he was not pleased. He gave me the whole "are you serious?" I'm like, yeah? "Ugh. That's your MPFL. That should have been repaired during the first surgery". Well, poop. This 2nd OS was not part of anything before my surgery, and even after he was only to be a silent partner... the first OS didn't have a license to do the DFO himself. Brought 2nd OS in.

Anyways, he took a look at my MPFL and said "it looks partially if not completely torn". So, there's that.

He would rather I recover from my first surgery before talking MPFL reconstruction. I no longer have insurance afterr this month.. nor will I ever have the level of insurance i currently have. I'm really, really frustrated with my first OS. Like, oh my gosh. I just can't. I'm so angry. I don't know what to do. I can't spare more money or time off work to do this one now too.

Offline slightfield

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Re: Distal Femoral Osteotomy & Osteochondral Fracture Allograft
« Reply #9 on: October 08, 2017, 02:27:20 PM »
Hey! How's it going? I was totally bummed to read your last entry. So sorry to hear that you will be having another surgery soon. On the bright side on things, I hope you are walking now and you can get back to doing some activities in your life. I was given " no restrictions" at my last post-op appointment and have been able to do some mountain biking and hiking this season. At the next appointment which will be 6 months since the surgery the OS wants to evaluate if I am ready to have the hardware removed.

How are you??

 















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