NOTES - Surgical Procedures :
High Tibial Ostotomey(sp) - - Posted by drive35 (drive35), 21 December 2004
I am 33 year old female and have had 4 surgeries in the last 20 months. I was told this surgery is just what I needed; it was to prevent TKR because of my age. I have been in unbearable pain. My first doctor has been my doctor for 11 years, and I trust him totally. He did the first 2 surgeries, and after having trouble getting the bone to grow he recommended me to David Seligson of Louisville Kentucky. He is to top guy in this field. I went for 18 months with a broken bone that would not heal. The surgery from the start requires that the tibia be surgically broken and cut at an angle in order to put the weight on the portion of the knee that is still good, a metal plate is placed on one side and it usually takes 2 months to heal completely. I just did not heal my first doctor thought it could be from the plate causing the bone not to fuse. So he went back in 9 months later, by this time the screw holding the bottom of the plate had broken. Causing an indescribable amount of pain. The 2nd surgery was to take out the bent plate and the unbroken screws and as much of the broken screw as possible. Then replace it with more bone from a cadaver and three screws going from bottom to top at an angle. After 4 short months the bone had dissolved and then my doctor said it was time to see the top guy in Louisville David Seligson. He was totally confident that he could fix this with NO problem. He took the three screws out and using MY bone he took from my other leg he packed the opening with MY bone, and put a brand new plate on the broken bones. It was GREAT I was feeling better and wanting to work and do things by my 14th day. I was off pain meds, and I felt wonderful!!! Then by the 2nd month I got up and felt tremendous pain in the front portion of the knee, went back to Dr. Seligson and he informed me the plate had broken. I cried and cried, he reassured me this is a rare thing and that I could not just leave it like that, but that the 4th surgery would be non-complicated and I would be back to work in 10 days. I smiled and said "Wow 10 days, yeah I can handle that." I went in the following week and he did the surgery, but when I came out I was really hurting. I just blew it off and remembered he said 10 days. I went to follow up with him twice before he actually x-rayed it, and was complaining of rather severe pain in the lower outer of the leg, just where there was a small incision. He said that was normal and he would see me next week. I went in the following week and he x-rayed the leg this time, and I started to cry again when I way the fibula was broken and I mean just broken and sitting there with no support, and not straight. He just said "Oh yeah you have to clip that bone so that it doesn't try to push the leg straight. With two plates one on the inner and one on the outer of the leg you MUST clip the fibula to insure the proper healing of the leg with the two plates. The main problem was he DID NOT TELL ME HE WAS GOING TO DO THIS AT ALL!!!!!!!!!!! I was unprepared, and the 10 days thing started fading before my eyes. I am now a month out and still HURTING especially where the bone is just left broken. I have pictures of this to anyone who is interested, and I would love to hear from someone who has had this done to them. Where you are located and who did the surgery. Please feel free to contact me!!
Posted by hmaxwell (Heather M.), 21 December 2004
It sounds like you've been through the wringer. I'm so sorry. I went through 7 procedures in 15 months, so I have a bit of an idea what you are going through. Your entire life revolves around the knee, and you develop every complication under the sun--stuff you didn't even know could happen happens, and the doctor says "I was afraid of that" and you want to scream at them for not warning you...I've been there.
What about another opinion to make sure nothing is being missed? My last surgeon doesn't do the osteotomy procedures anymore, but his partner does. I've read quite about about his thoughts on the topic, and he recommends an external fixator for an HTO to avoid problems like yours. It's not a sure thing--you can still get non-union--but it's easier to control the angle of the wedge and other factors. Instead of going in again and again surgically to replace hardware that doesn't stand up to your unique situation.
If I could make a few suggestions...having gone through an average of one surgery every two months, I know how it drags you down. The constant pain was not something that my surgeons could handle, as wonderful as they were. I finally had to see a pain management specialist, and she has literally saved my sanity and quality of life. She has a unique skill set, and not all pain management doctors are comparable--I've been very lucky. But my PM doctor is an MD with a specialty in Physical Medicine and Rehabilitation. Basically, they see the salvage cases that orthopedists can no longer help--or they work together with the surgeon to provide a more robust and well-rounded pain management program. They are skilled at working with patients who have long-term chronic pain: a lot of back patients, those with auto-immune disorders like Lupus and Fibromyalgia, and patients for whom surgery was not a solution. PM&R doctors are trained in the soft tissue, connective tissue, muscle problems and so forth. And mine is a trained medical acupuncturist! So it's one stop shopping for me.
I can't tell you what a difference it makes to get your pain under control--it literally changes your whole outlook on life. It makes it possible to get back some of yourself, because you're not focused on your leg every minute of every day anymore. If there is one single thing that you can do for yourself, it would be to look up a skilled PM&R doctor with a pain management background. They are complimentary skill sets, so it's often a simple matter to find both specialties under one roof, or even in the same person. There's a national association of Physiatrists--that's the older name for a Physical Medicine & Rehabilitation doctor. You can even do a doctor search by area on the Net, or just get out your phone book--it's listed as a specialty, along with pain management. Often there are cross-referenced entries.
After you get your pain under control, you will be able to take a deep breath and start looking around at what needs to be done: finding another doctor for a fully objective opinion and/or doing extensive research on your particular diagnosis/situation and seeing what the options are for you. I've found http://www.findarticles.com to be incredibly helpful--you go there and enter in keywords like 'osteotomy and non-union' and pull up medical journal articles. I went one step further and looked up the authors who had done extensive studies/articles on my diagnosis--then I saw them and was able to get significant improvement from specialized treatment.
Also, you will want to go to the patello-femoral joint section just above this one. That is where the people who have had osteotomies post their stories and advice. There are a few who have dealt with non-union issues. Holly just had a series of bone stimulator treatments to try to deal with a fracture around her hardware.
I had a significant problem with healing abnormalities--my body just didn't respond like other peoples' did. I finally ended up having a very thorough workup at the Mayo Clinic. They didn't find anything, but after four weeks of tests and seeing a bunch of different departments there, we were all confident that I didn't have a signficant underlying condition that was negatively impacting my knee and healing progress. That information was useful, at least, since we ruled out diabetes and other issues that impact healing. Have you had an internal medicine review of your bone healing problems? Was a bone stimulator used? Fossamax or one of the other horse-sized pills that help prevent osteoporosis and bone problems?
You've got a lot going on, and I just wanted to say this site is full of people who really understand what you're going through. Lean on us a little bit, learn from our experiences and share your own. It helps a lot, believe me. I would think the Patello-femoral joint section would be the place for you, as well as the 'struggling with rehab and pain issues.' Have a look at a sample of the posts in those sections. You might even want to copy your first post here into that other section, because it gets more traffic. Also, the 'bone breaks around the knee' section is full of people who have had bone healing issues--most of them didn't have osteotomies, they fell off ladders and slipped on ice and such. But a broken bone is a broken bone, and you can probably learn a lot there, too.
Heather
Posted by hmaxwell (Heather M.), 21 December 2004
PS How far are you from Cincinnati/N. Kentucky? There is a fantastic knee clinic at Cincinnati Sports Medicine, and I believe they have offices in N. Kentucky as well. Dr. Noyes and Dr. Lindenfeld in particular work on issues facing women with patello-femoral syndrome and early wear and tear on their joints--I assume that's why you had your TTT/HTO? They both do these procedures, and several others to help restore function to knees that have basically been trashed.
I'm seeing Dr. Noyes on January 6th....
Heather
Here's their main web page:
http://www.cincinnatisportsmed.com
and the office locations, with one in KY:
http://www.cincinnatisportsmed.com/locationsa.htm
Posted by missmyknee (missmyknee), 6 January 2005
I had something similar to this. I had a tib fib derotational osteotomy to correct my malalighned fractured tibia. It had an IM nail in it and the fibula was plated. When the OS did the derotation, he removed the tibial nail and the fibula plate. He cut both bones in half, correctly alighning the tibia. It was then plated with 2 plates and screws. The lower( distal) fibula was left "broken apart" I was just as astonished as you to see my first postop xrays and seeing the broken fibula with quite a distance between the ends. The doc explained that it would grow a bone bridge as it healed. It took 4 mos. The ends would rub together for about the first month....not a good feeling. I was in a CAM walker NWB for 3 mos and the 4th month went thru percentages of weight to get to full WB. For a month after that I wore a custom made fracture brace. It was painful for several months. The fibula is healed but it looks like a crooked branch. It isn't as concerning as the tibia as the fibula is not the weight bearing bone in the leg.
Pam
Posted by kwood (kwood), 11 January 2005
I could really use some more info from you. My husband is 31 and is about to undergo the high tibial osteotomy. We live in Indiana about 10 minutes from Louisville. He will be having the procedure in Louisville. He has seen three diff MDs. I am very scared for him and he is nervous. He has no other options beside a total knee replacement or live in pain. I look foward to hearing from you.
Kwood
Posted by missmyknee (missmyknee), 12 January 2005
Kwood
Look down below in the Arthritis section, go to the thread titled : Changing forces thru the joint.
You should find some info there. Also try googling high tibial osteotomy.
Pam
Updated Sat Nov 21 2009
