Tibial derotational osteotomy

It was back in March 2000 when I first saw a very well respected knee surgeon who carried out a thorough examination of my knees.  On examination he found that I had very obvious and severe external tibial torsion which was compensatory to excessive anteversion at my femoral neck.  This was bilateral and probably developmental in origin.  As a result  I had squinting patellae on standing and walked with markedly externally rotated foot progression angle.  I had slightly valgus heel with pronated flat feet.  On standing on tip toe I did not develop a significant medial arch.  There was a wide Q-angle.  Fortunately both my surgeon and physiotherapist spent time to explainn what all this meant.  Basically when I stood up my knees pointed inwards at eachother.  This in turn caused pain to my poor suffering knee caps. 

It was decided that a course of physiotherapy would help to get the knee caps to track properly and therefore reduce the pain.  I was diligent in attending my appointments and doing my exercises as prescribed by my physiotherapist.  At times I seemed to make good recovery and the pain would subside but without the taping and specific maintanence of the pain on the inside of my knee things degenerated again into pain and the knee caps slipping about. 

Initially I was offered a bilateral arthroscopy to have a look inside and proceed with anything that needs doing.  The arthroscopy took place in June 2002 where both knees had chondroplasty and excision of the medial and suprapatella plicas and the right knee had a lateral release.  I was on crutches for a couple of days and after seven weeks was back to all my intial activities, including aerobics and running.

I made good progress and recovered from the arthroscopy's quickly without complication. I was reveiwed by the surgeon who was happy with the operation but of course the underlying problem of the tibial torsion was still there.  Although some of the symptoms had gone from the arthroscopy I continued to have pain and poorly tracking knee caps.  I continued to keep up the strengthing of my muscles, particularly quadriceps and gluts to maintain as much a pain free knee as possible.  Unfortunately my knee pain, level of activity and ability to sit, walk etc in comfort all degenerated. 

I was referred to a regional orthopeadic hospital where I met a lovely consultant surgeon.  He listened carefully to my history and battle to maintain pain free knees.  He was aware that my previous private surgeon had considered a derotational osteotomy using an external fixator.  He was also aware of my reluctance to turn a screw everyday whilst in a fixator.

In April 2006 I had my first tibial derotaional osteotomy, which consisted of my tibia being broken and my leg rotated to a straight position.  This was internally fixed with staples.  I was in a plaster cast for 8 weeks.  Unfortunately I managed to get my plaster of paris cast wet and had to have it changed. This was the first indication that something was not quite right.  As the cast was removed I was in incredible pain even with entenox, and my foot flopped down and disappeared off the end of the trolly.  I had peroneal nerve palsy (foot drop).  I also developed type 1 CRPS which is a nerve disorder that causes pain, swelling and discolouration of the skin.  This did subside and eventually went through the diligence of my physiotherapists and hydrotherapists.  Despite these known complications, the operation was a complete success with the most noticable thing for me was no pain whatsoever in my knee and most noticable for everyone else was my foot no longer stuck out and pointed forward again.  Of couse this made the other foot look all the more rediculous!  People would ask whether it was worth it.... well,

In May 2007 I had the left leg derotated.  Despite being ill from being very impacted from the drugs I recovered from the operation quickly.  I do have weakness in my leg muscles and my core muscles and so the saga continues as to why this is the case.



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