KNEE ARTHRITIS - Changing the forces through the joint :
Remove plate and screws, or not? - - Posted by Mo_Saic (Mo_Saic), 13 November 2003
My compliments to all contributors to this bulletin board. Really useful information.
I have a specific question which is not quite answered in the "screw removal" threads. My HTO in Jan 03 was successful - the tibia healed quickly and without problems. The femur caused the initial problem: a small wedge dislodged itself from the surface. Apparently this is caused by bad circulation in this area of the bone. However, no-one can explain why this happens. It may be genetic. I scanned the web and could not find any significant explanation for this condition.
My surgeon informs me that I should have the plate and screws removed from the tibia in Jan 04. The main reason is to allow better and safer movement when playing sports or doing any kind of exercise. And there is also a risk of complications if the metal stays in for long periods. Another benefit is that he can remove scar tissue from the femur at the same time. This will alleviate the "click" when I bend my knee.
The idea of another operation is far from appealing. I became very sick and had to take myself off all food and medication for two days. I see that many other people have been through the same thing - crutches, learning to walk again, muscle atrophy, lack of sleep, re-opening the operation scar, pain, losing the nerve endings below the skin, gaining weight, and so on.
My question is, is there a winning argument for removing the metal and the screws, or is it better to live with them inside?
Many thanks for any feedback you can give me. I have to decide very quickly.
Posted by lam651 (lam651), 15 November 2003
Sorry I can't answer your question, but I just wanted to say that removing the hardware shouldn't be near the surgery your HTO was. I mean there shouldn't be cruthches involved would there?
I know that you already know this. Maybe you could get a second opinion from another OS who is experienced in HTOs to see what he/she says about having hardware removed. Good luck, Larry
Posted by gimp (gimp), 18 November 2003
It's probably not exactly the same, but I had surgery in June to remove the screw from my tibia that initially held my reconstructed ACL in place. Since I had a closing wedge HTO I only have two staples - but from what I have seen the plate and screws are on or close to the surface of the bone. This is good. For my metal removal the surgeon had to dig pretty deep into the bone and used a bone plug to fill the void. The surgery wasn't all that painful and I was back on my feet and walking comfortably in about 5 days. Assuming that's all you are in for I wouldn't be too concerned about the recovery. You will want to do your quad sets and straight leg raises right away to get the muscles going again but I am sure they will come right back. I didn't have nearly the disruption to the muscles with my metal removal as with the ACL or HTO.
You should definitely let the anesthesiologist know about your prior reactions. I have had trouble as well but they were able to manage it well for my last two surgeries.
Good luck with your decision.
Posted by Mo_Saic (Mo_Saic), 5 December 2003
Thanks John and Larry for the feedback and encouragement. Points noted for the anaesthesia and the exercises. No crutches would be a bonus.
I was away for two weeks and had time to adjust to the situation. My knee is some way from 100% usable, so the second op will probably be a relatively small dip on the road to recovery. We will schedule it sometime this winter.
My best good luck wishes to all those approaching surgery or dealing with knee problems.
Updated Thu Apr 29 2010