NOTES - Surgical Procedures :
High tibial osteotomy - - Posted by admin (The KNEEguru), 25 April 2003
Placeholder - just to start the topic heading. Please help, everyone, to get this section going.
KNEEguru
Posted by Dale_Allard (daley), 14 October 2003
i have just been told that i need a high tib osteotomy. although i know the basics, i would really appreciate any info anyone could tell me (especially the pain post op!!). i had an acl recon 10 years ago, ruptured it again 3 months ago (it has now been removed) and live in a donjoy brace. have arthritis ++ to young for a knee replacement (34). am suffering at mo. any info would be great. am first time user so if i have posted this in the wrong place, whoops!!!! 
Daley[color=Purple][/color]
Posted by heronak (heronak), 15 October 2003
I was all set for a tibial osteotomy preop visit with my OS, but when he took one look at my xrays said there was no way the rest of my joint was in good enough shape for the procedure.
One side, lateral or medial, and the patella must be in good condition for this procedure to be successful. While I was terribly disappointed to hear my only option is a TKR, I'm glad I didn't waste a serious surgical procedure and a year of my life.
All said, I'd suggest asking lots of questions about your joint integrety and possibly getting a second opinion. Best of luck,
Heron
Posted by Thrill (Thrill), 21 October 2003
Daley,
When is your HTO scheduled? Mine is Dec. 9th. I ruptured my MCL the first of the year. Much to everyones surprise it never healed. So, the OS decided that since I am valgus it must put just enough strain on the mcl to NOT let it heal. So now I am going to have the HTO and MCL repair during the same surgery. I'm like you though I would also like to get some more info. The doc said I would be given an epiderril (sp) and then a pain pump for a few days after the surgery.
Posted by lam651 (lam651), 24 October 2003
I had a HTO with an external fixator attached on Mar. 14. I just had the fixator removed Sept. 29. This was done to repair a HTO that was done in Oct. 2001 that resulted in a tibial nonunion. I'm having a HTO done on my other leg Dec. 29.
The post op pain, for me, was the worst right after I woke up from general anasthesia. I'm thinking of having a spinal next time.
When I had the external fixator on I could weight bear very quickly which was great. My wife does daycare and has 5 kids in diapers so I don't have anyone to take care of me. Being on crutches, non weight bearing is so hard because you can't really carry much or do much. That was my biggest problem with my first HTO that didn't heal.
With the external fixator I could do dishes, clean house and be useful.
I would talk to your doctor about pain meds, get lots of pillows to get comfortable in bed, and be prepared for anxiety, depression, night sweats, fevers that are all normal reactions to major surgery, but only for a short week or two.
I've had great results from my recent HTO repair. Best wishes and I hope your OS has done alot of HTOs. My first OS hadn't done this often, I believe, and I think that was part of my non-union problem. My current OS does 150-200 HTOs a year. Good luck, Larry
Posted by KJ (KJ), 28 October 2003
I'm now 6 weeks post closing wedge HTO along with multiple ligament reconstruction.
So far, so good - I had major bony pain for the first 3 weeks but this has now completely settled. I was allowed to partial weight bear straight away (which wouldn't be the case with many OSs nor with an opening wedge osteotomy)
It all feels very good and I'm hoping that the next Xray will show good union.
Cosmetically my knee looks only slightly "knock kneed" compared to the other because I didn't need a huge correction. If it all helps my ligament grafts function properly then it seems worth having done
KJ
Posted by amazonia (amazonia), 17 November 2003
Hello - I am now nearly 1 year post HTO (opening wedge), and I found by far the worst pain was from the bone graft from my hip, rather than pain at the HTO site. I was completely non weight bearing for 6 weeks, which as mentioned, is a real pain as you are very limited as to what you can do. The scaring was pretty minimal, and I had no bruising or swelling at all. However, now nearly one year later, I still have pain and discomfort around the HTO site, and really don't like it to be touched at all. (hip is fine now) All things considered it wasn't TOO bad, since they don't go into the joint at all, and there wasn't any physio involved - but you have to be very careful after surgery, and just follow the Dr's orders! As you can see from the posts, there are a variety of HTO's with different post surgery instructions and results! Best wishes, hope it all goes well!
Posted by Mikesk (Mikesk), 18 November 2003
Hi
I live in the Northern California, and need a HTO (4 degree varus) and a meniscus transplant. Can anyone suggest a good doc who can do both at the same tiime. I am pretty young, who lost the entire medial meniscus. As soon as i lost it I started to wear out my cartilige and it is grade 3 now in a year.
Need help please.
I also read that somone's OS has been doing over 200 HTO a year. Can you tell me who the OS is
My email is alfarom02@yahoo.com
Thanks
Posted by lam651 (lam651), 18 November 2003
My OS does 150-200 a year. His name is Dr. Mark Dahl and works in Minneapolis, MN. Larry
Posted by squig2 (squig2), 3 December 2003
I to am going for a hi tibial osteotomy in a month..Kind of freaking out over the pain..From there I have to have a meniscal allograft transplantation done...Anyone ever here of Dr Frank Noyes in Cincinnati. I am trying to get a hold of the Noyes Rating system
Posted by todds (todds), 8 February 2004
I've been told after losing some medial meniscus that my next step is an HTO with a microfracture. I'm weary that the microfracture could wear away. Is this true? Does anyone know about Salubria, the synthetic cartilage development out of Georgia tech which seems to be accepted by the body. It's release was supposed to be 5-7 years past 1999 and I can't find any more recent news past the 1999 article. It sounds like a very promising advance. It can be dialed in to different strengths. I'm hoping to wait for something like that.
Posted by squig2 (squig2), 8 February 2004
Good luck with the HTO....I am 3 1/2 weeks post osteotomy...It is brutal....Sorry to tell you that but the pain is still unbelievable and I can not walk yet and will probably still be 3 more weeks...at the current moment, i am regretting doing the surgery but hope that once I feel better i will think otherwise..Please feel free to email questions to me if you want to squig2@aol.com
Good luck
Posted by JessToni (JessToni), 9 February 2004
hello,
I am scheduled for an HTO in a few months. What exactly is microfracture? I have heard this mentioned along with HTO, but haven't had the time to research what exactly it is.
I have a lot of medial damage due to an OCD lesion that never healed properly, a couple of meniscus tears and Rheumatoid Arthritis. The HTO seemed to be my only option since I am only 24, I was not ready to go with a TKR.
Squig, please keep us updated on your recovery..I have heard it is a brutal surgery, but hopefully it will be worth it in the end.
Jess
Posted by surgeryXseven (surgeryXseven), 25 February 2004
I had a meniscal allograft and high tibeal osteotomy at Rush Pres in Chicago. I drove six hours from home.
The Doc told me no one did it in my area (not true I later found out a doc had been doing it eight years).
The Doc removed all my remaining medical meniscus and then when the donor meniscus was thawed (during the same time I was on the table, to save his valuable time) it was discoved it was for the wrong leg (left versus right). I can still remember him telling them "Turn off the Video" (I was awake, then they put me fully under when the massive screw up was discovered). I ended up with no transplant and lost all my remaining meniscus. Except my knee, all the cuts, prep work, removing of my remaining meniscus, drilling for new menicus was all done. Lots of scars and now scar tissue. Had to do the whole eight weeks non-weight bearing and seven months of rehab for the HTO (high tibeal osteotomy). The doctor didn't even come in to visit me the next day in the hospital, untill I insisted. No nurses on the floor were even notified that the operation was screwed up, and questioned my being upset? Six hour drive back home also, in the back of a Suburban. Stay away from physicians with MBA's behing their name, for this guy could have referred me to someone he knew eight miles from my house, but he made me come to Chicago for the business. In it for the $$$$. Promised me soccer with my kids, some running, sport activities, etc., My next step, knee replacement. Also, in his pre op notes he wrote "informed patient and his wife of the possibility of receiving the wrong meniscus, even with this, they agreed to proceed" Be careful! I was on the table six hours.... Oh yes, the video of the surgery was lost too? 
Now in regard to the HTO, it did help my pain alot. I just take Glucoso/Chon everyday and some NSAID's, but then again my activity is very limted and it is a salvage operation.
Updated Sat Nov 21 2009
