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The LIBRARY => NOTES - Surgical Procedures => Topic started by: cindypruz on July 29, 2008, 04:04:56 PM

Title: 9 Year Old Daughter needing femoral osteotomy
Post by: cindypruz on July 29, 2008, 04:04:56 PM
My 9 year old daughter has been through 6 months of therapy for chronic patellar dislocation, but is still experiencing new injuries.  She has 44 degree anteversion & her OS is going to perform a femoral osteotomy at the hip to relieve the anteversion with hopes that it will correct the patellar dislocation problem.  I have done lots of research on this & have gone to several doctors, including a U of M OS & Dr. Teitge (Detroit Pistons OS), all recommending this surgery & of course more & more questions keep popping up.  Her surgery is scheduled for this Thursday, 7/31/08.  My most recent concern is how her leg will appear post-surgery.  She is very slightly knock-kneed & I'm just worried about how her legs will appear, since only one leg will be operated on.  I keep imagining a grotesque difference that will affect her gait & functionality.  Any thoughts or comments?  I would appreciate your quick responses, since her surgery is only 2 days away.  Thank you!
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: katmomx2 on July 29, 2008, 04:49:57 PM
Hello Cindy,

I had a distal femoral osteotomy 3 years ago. Mine was for a severe valgus in the left knee and stage IV bone on bone in the lateral side. Your daughters at the hip is a bit different than mine. I know there are some people here who have had that type of osteotomy. My post surgical leg was straight, I never realized how crooked it was before. I worked hard on my gait and am still quite conscious of it. My left leg is a tad bit shorter than the right. My gait is more off when I am tired. I am a surgical tech in a busy labor and delivery department. Some people make fun of the way I walk, I explain what I went thru and they are shocked at the fact I do what I do. There is never another comment  after that. I do need the other leg done, but at this point can not do the time off work.  It does not slow me down and I do not take much meds for it. She is young, I think that is one of the best things working for her, and sounds like you trust her OS. I hope I have helped. Good luck for her she will be in my thoughts.

Let me know how she is doing, and if I can be of help in any way.

Kat in Texas
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: cindypruz on July 30, 2008, 01:26:00 PM
Thanks for your reply, Kat.  I appreciate you sharing your experience.  You see, I can't really say my daughter is valgus . . . maybe slightly.  So the thought of the OS turning her femur a possible 30 degrees makes me nervous on how the result will be.  And what a hard decision to make for someone else's body.  Not only am I worried about the success of the surgery, but I'm also concerned about the cosmetics of it, because of her young age.  Not the scarring, mind you, but the positioning of her non-operated leg compared to her operated leg AND how she will be able to walk normal as a result.  Any thoughts?

Thanks again, Kat!  I will let you know how things turn out.
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: Lyndsey on July 30, 2008, 03:09:32 PM
Hi Cindy,

I had a derotational femoral osteotomy done by Dr. T in MI about 10 weeks ago on my right femur. I am going to have to get the left done, as it is just as bad, but as of right now I only have the right leg corrected. The antiversion in my right femur was at 65 degrees. My left is at 67. So now, my right leg is normal, and my left is still twisted. It really doesn't look too bad. The only way you can really tell they are different is if I stand with my feet together, and actually look at how bad my left still looks, while my right is straight. I am 18, and I wish I would have had this done sooner. The longer you wait the harder the rehab. So far, this surgery has been alot easier than I ever imagined. I am at 10 weeks post op, and I am back to riding my horse! It is unbelievable how fast I have healed. It still gets really sore at my hip and the hardware is uncomfortable, but that will come out in a year. My right leg they straightened is so stable, it doesn't feel like it is going to give on me all the time. I can't wait to have the left done, simply because the surgery aleviated just about all the pain in my knee that was present constantly before.

As far as walking and gait goes, I agree with Kat. I am working on my gait, right now at 10 weeks post op if I concentrate I can walk normal without a limp. Actually, my right leg that they operated on tracks alot better than the left that is still twisted. I think my right leg is a tiny bit longer than my left, but that just may be me. When I get tired or don't think about my gait, I limp pretty bad. I think that is due to my still weak muscles after being on crutches for 7 weeks.

Honestly, I don't think there is a grotesque difference at all. If you look for it, you will see a big difference, but if you don't, people don't notice. Also, if they are doing the surgery at the hip, that's where mine was done, then you can't even see the scar unless I am in a bathing suit.

Is the Dr. going to use a plate and screws? Who is going to do the op?

Here is the link to pics of my knees before and after that I took if you want to take a look.
http://s266.photobucket.com/albums/ii244/Lyndsey200/

Here is a link to my derotation diary:
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=42532.0

If you have any questions feel free to ask! This board is the right place to come for information! I hope this helped!

Lyndsey
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: cindypruz on July 30, 2008, 06:12:16 PM
Oh, Lyndsey!  Thank you so much for your reply!!  My daughter & I read it together & checked out your pics.  You & Kat have been SO helpful & really helping to put our minds at ease.  Dr. Mendelow is performing the surgery & will put in a plate, but I'm not sure if he will pin it or screw it in place.  Like you, Olivia (my daughter) will have to have the plate removed in about a year. 

I do have a few more questions for you, though.  I noticed your anteversion was at a greater angle than Olivia's, but were you experiencing injuries to your right leg prior to the surgery?  Which hospital was your surgery at?  Olivia's will be at Providence Hospital in Southfield, MI.  Dr. M talked about doing both legs at the same time, but she hasn't experienced any injuries to her left leg yet, so he thought it best to hold off for now. 

Cindy
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: Lyndsey on July 30, 2008, 08:08:22 PM
Hi Cindy!

No problem! I am glad I could help! Don't be afraid to ask me anything. It sure is nice to know the hardware is coming out! Right now, the hardware causes me the most discomfort. For the most part, all I am experiencing in my right leg is discomfort. There isn't much actual pain. The left leg that hasn't been operated on causes me alot of pain though. It never ends.

The antiversion is one of the worst cases that Dr. T has seen yet. Actually, I have never injured my knee, I just grew crooked. The pain in my knee was caused by the inward twist of my femur and the outward twist of my tibia. It has always been really weak, and felt like it would dislocate at any time. Now, after the surgery, it is really stable.

My surgery was at the Michigan Orthopedic Specialty Hospital in Warren MI, and it was done by Dr. Teitge. He did the most fantastic job. I live near Pittsburgh PA, and had to drive 7 and a half hours to get there. He is going to do my left leg too. I am really satisfied with the job. I can't believe how smoothly the recovery has been so far.

How did you like the pics? Does your daughter's leg twist like my crooked leg does? The one he operated on is pretty straight. Feel free to ask questions. I love this board. It is really nice to talk to other people who have experienced what you are going through.

Lyndsey ;D
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: cindypruz on July 30, 2008, 11:21:34 PM
Lyndsey,

First let me tell you . . .you have THE BEST attitude in the world!!  I think that's just great.  I can hear your excitement in your replies!!  I hope my daughter will have as positive an attitude as you, although her hormones are just about ready to rage & I have to deal with her moodiness on occasion.  What fun.   :o

I was at my parents house earlier & didn't have a chance to check out your diary until now.  Your pics are amazing!!  I cannot believe the difference!  It helps give me an idea of what will happen with Olivia.  Her legs aren't as twisty as yours, but I'm anxious to see the difference during her recovery.  Olivia & I read your emails together, so I think she feels better about the surgery, too. 

Dr. Teitge told us that most people with Olivia's condition tend to be inactive because of the worry that something will happen to their knees.  Well, I can attest to that, because my kneecaps popped out, too & I've had arthoscopic surgery for my left knee when I was 15.  I never played sports, although I'm tall, because I was always afraid something would happen to my knees.  I had surgery 3 years ago to repair a torn ACL in my right knee.  I sure wish I knew about this board then!! 

I'm hoping Olivia's recovery will go as smoothly as yours.  My husband & I are spoiling her rotten with all the stuff we've gotten her for her hospital stay & at-home recovery.  I feel bad that half of her summer will be spent recovering, but I told her we will do LOTS of craft projects & watch lots of movies & play the Wii alot.  I think that made her feel better!

Cindy


Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: Lyndsey on July 31, 2008, 12:18:55 AM
Cindy,

Thanks for the kind words! I try to keep my head up. I am lucky I found Dr. T first, I haven't had to go through surgeries that didn't work. There are alot of people on this board that are much worse off than me. I just try to remind myself that it could be alot worse. Pain, though, is never fun. Sometimes once in a great while I will allow myself to feel bad for myself for a day, and just mope around. BUT, the next day, I am back at it! I refuse to let my knees and legs get me down. As far as the moodiness, I have a sister that just turned 13, I know ALL about it! LOL!

The difference is really amazing! It was hard to believe. It is really crazy how I can feel the difference in strength and stability. I think the best thing I did during my recovery was rest, and not overdo it. My mom and dad didn't let me out of the house until I was 3 weeks post op. I didn't go ANYWHERE. I played guitar hero and played on the internet. It was really hard. I was really mad at mom and dad at the time because I wanted to go to grams and I wanted to go out. Now though, looking back, that was the best thing for my recovery. I think that is one of the reasons I am doing so well now. Tell Olivia not to worry, that it sounds alot scarier than it is. I was really scared for my first surgery, but I am not scared at all for the second. The doctors and nurses take great care of you!

I definitely agree with the inactive part. Once my knees started to give out I pretty much stopped doing alot of the sports I love, except riding. I did't let my knees stop me from riding, and now at 10 weeks post op I am back in the saddle again. I am aiming to go to my first horse show this season on August 12. This board is, in my opinion, the greatest board on the net. The people are friendly and support each other.

Like I said earlier, I think the best thing to help ensure a smooth recovery is lots of rest and not to overdo things. With a younger kid, I am sure it will be hard, but it will be worth it in the end. As far as things after surgery, a shower chair is a must. Crutch covers are a lifesaver! If you don't already have them you can find them on the net. Mine are called crutch buddies. They cover your handles and under your arms, and it makes things alot more comfortable. I actually never had any blisters or rubbing anywhere. It was not bad at all. For me, half the summer recovering is just a tiny dot in the rest of my life to make things go alot less painful from here on out. It will probably take me a couple of years to totally recover, because of having both legs done and then the hardware removal. After having one leg done though, it is definitely worth it!!!

I sent you an email as well.

Lyndsey
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: FormerlyActive on August 01, 2008, 04:58:40 AM
Dear Cindy
Not sure if by now your daughter is in surgery? In which state will she have it? I just wanted to tell you at Gillette Children's Hospital they do that surgery on children primarily if they have cerebral palsy.  They often do multiple surgeries.They said the children recover very quickly, and also its easier because the parents can lift them.
They evaluated me for the surgery but determined I was too old, and they don't think I'm severe enough (not sure if that was injury or rotation). I have femoral anteversion both legs and external tibial torsion one leg. However I have had limitations from my mal-alignment my whole life and have had 4 knee surgeries (2 per knee). There is an article out there which shows that the younger you have this de-rotation surgery, and also prior to having other knee surgeries the better the surgical outcome is.
If there is a concern re gait, PT can help with that, also as another poster mentioned she should get checked for leg length discrepancies, and orthotics can be helpful.
Let us know how it all goes. When I think of all the years with knee injuries and surgeries, as Lyndsey mentioned much better to get it fixed earlier, timewise (and cost and pain too) it all works out better. Very best wishes.     
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: cat on August 01, 2008, 05:04:17 PM
Hey Cindy,
I just saw your post. I imagine that you are probably at the hospital now. Best wishes for a speedy recovery from a fellow twistee. (Dr Teitge rotated my leg in Oct.)
 ;D cat  ;D

Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: cindypruz on August 02, 2008, 02:11:07 PM
Thank you all for your replies & encouragement.  I created a new post: Post-Op diary for Olivia. Please check it out & give me as much advice as you can on helping her!
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: *Tiffany on August 02, 2008, 02:40:17 PM
Hey Cindy,

I found this thread yesterday. I read the whole thread. Then realized that her surgery was just a few days ago.  I was hoping you would think to post and let us know how your daughter is doing. She has been in my thoughts and prayers.
My son had surgery on both knees at one time when he was twelve.  Very different surgery, he had lateral release on both knees and both patella's resurfaced.  I was a basketcase.  I have had plenty of surgery, but when it is your kids .. well, that breaks your heart.

I will look for the post op thread.
best wishes
Tiffany
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: JoJoWez on August 04, 2008, 05:16:59 PM
Cindy,

Hope all went well for Olivia!  I believe it to be best to take care of this problem while a child is young.  Recovery time seems shorter and it could prevent further problems later in life.

Lyndsey,

Your pics look similar to mine.  My problem lies with my right leg only.  Eight years ago I went to an OS who told me he would have to cut my knee out and straighten my leg (both top and bottom) and put my knee back into place, asked me if it hurt that bad, turned his back and walked out of the room before I had a chance to say anything.  I have a high tolerance for pain, so I figured I would wait until I absolutely had to have something done.  Well, it's now!  Went to a different OS who explained that my problem lies in my hip for sure but wasn't sure about the tibia.  He explained to me that neither he nor his colleagues would touch me.  Explained that there was nobody in the entire Upper Peninsula of Michigan who could do my surgery, but has now consulted with a Dr. Goulet at the University of Michigan.  On Wed. (8/6) I have to have a CT scan with my knees and ankles taped and I guess Dr. Goulet wants to see that before he agrees to operate.  I'm very nervous about this because my knees touch but my ankles don't and I'm worried this will be painful.  My OS said I have a deformity in my femoral neck which has twisted my femur inward.  My right knee is completely pointed toward my left leg and the pain while walking and standing is excruciating.  I'm 37 (almost 38) and am worried about the length of time it will take to recover.  I am a cook which requires me to be on my feet during my shift  :( .  What is the "usual" length of time to recover from this?  As I said, I'm in the beginning stage of having surgery and haven't even seen or spoken to the OS who will do the surgery as of yet, so I'm hoping someone can help me.
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: Lyndsey on August 04, 2008, 06:01:54 PM
JoJoWez,

It sounds like you have had a heck of a time too.  Have you had a CT rotational study done? Are they going to derotate your leg? That is what they did to me 12 weeks ago. I was on crutches for 7 weeks. I am at 12 weeks now, and still limp. It gets worse depending on the day, and what I did the day before. I can't imagine being on my feet to work yet. I went to an amusement park last week, and am still paying for it. I am really glad I had the surgery though. The pain in my knee was, like yours, excruciating before the surgery. My left leg is still twisted and I still have that pain in my left knee.

Who is the OS that will do your surgery?
Feel free to send me an email and I can answer any questions you have. My email is [email protected]

Lyndsey
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: JoJoWez on August 04, 2008, 06:28:10 PM
Lyndsey,

Who will do the surgery. . .that is the question  ;D ?  Some time after Wednesday's CT I will find out if Dr. Goulet will do it or if he will pawn me off on a different OS.  The OS I went to, who said he wouldn't do the surgery, went on vacation for a week, so I guess after the CT and after his vacation, he will let me know if Dr. Goulet agrees to it.  From how it sounds it will be a derotation of my femur and correction of the femoral neck deformity.  But as of now, I'm not sure.  I guess my right femoral neck is longer and thinner than the left which in turn (no pun intended) has twisted my femur.  My knee looks out of alignment but in fact is not.  My tibia looks as though it is bowed, but the OS was not sure if that is the case or if it is an illusion.  I guess the CT will show if it is or isn't.  I'm going to request a copy of the CT after I have it done so I can try to get a better understanding of what is going on.  I have always been knock-kneed (and look bow-legged below the knees) and clumsy, i.e. tripping, falling, etc.  But the rotational deformity has worsened in the past few years and is affecting my lower back and sacrum.  Aging has not been kind to me  ;D .  Unfortunately through the years my activity level has decreased to doing absolutely nothing but working.  After work I have to lay down to take the pressure off my leg, knee, ankle, hip, back. . .UGH!  I only have the memories of how I use to be, hiking, bike riding, running, canoeing, hunting. . .all seem such a distant past life.  Amazing how fast things can change  :'(
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: Lyndsey on August 04, 2008, 11:00:24 PM
JoJoWez,

I know exactly how you feel. Lately when I wake up I feel like I am 80 and I am only 18. These crooked legs will do that to a person I guess. lol.  Dr. Teitge did my derotation in MI and he did an excellent job. My knee looked out of alignment too, but that is just because my femur was so twisted. When you find out the degree of rotation of your femur and tibia you'll have to let me know. i am curious. My femur was 67 degrees and my tibia was 35. A normal persons is supposed to be around 10-13 degrees. I don't have a copy of my CT, but Dr. T did an EXCELLENT job of explaining things. He is an expert on rotational deformities. My knees pretty much faced each other, and my legs have always been bowed. Now, at least my right leg is straight. lol. As far as activities go, I still have another surgery to derotate my left femur, and then 2 more surgeries to take out the harware. I am not sure whether I am going to get my tibia's done or not yet. I will make that decision after I am back to walking and being semi active. If they hurt, then I may have to have them derotated as well. Humph, these knees!!! lol!

Take care,
Lyndsey
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: lucyloo on October 08, 2008, 04:43:24 PM
i was just reading all the post and its so nice to know that people are like me out there,
i just had a rotational osteotomy of the right femur 6weeks ago.......and its driving me mad.....im just so impatient ahhhhhhh!!!! as im normally so active!!!!! im down to 1 crutch and in the gym everyday!!!!!!! to try n get some muscle back lol!!!! although i am quite enjoying the kate moss look haha!!! but please email me on [email protected] as its good to talk and to see if we all are in the same place.......get well soon every1, and u cant let these twists beat us ,
lucy
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: musikxaddikt on May 23, 2009, 06:47:41 AM
im happy to know that there are actually some people out there with similar leg conditions as me. The only other person i know with crooked legs like mine is my sister.
Right now im thirteen and my legs are crooked. They are supposedly they are not as crooked as an X but in that shape. My knees bend in at the middle, and its looks different then everybody around me, so I never wear shorts to school. My parents have talked to their friends about my legs, and my parents friends recommend surgery. My parents don't really want me to do surgery because there is a chance that my legs could get worse, but right now, they don't allow me to participate in sports.
Is there really a large chance of the surgery failing?
I really want my legs fixed and straight, but i'm afraid of that percentage of failure and not being able to walk again. My parents always remind me of that. I don't know what to do.
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: abbaroodle on May 31, 2009, 11:52:14 PM
Did you guys get derotated at the proximal (upper part of the) femur?  Or closer to the knee? 

My doc thinks I have a lot of anteversion (though only about 32 degrees) and said if I continue to have trouble that would be his next step.  Obviously not one I would take quickly!!!!
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: cat on June 01, 2009, 04:15:49 AM
I had an intertrochanteric external rotational osteotomy of my femur. Translation, my leg was cut and spun around near the hip. ;D
What kind of knee problems have you been having? Have you had any surgeries?
 ;D cat  ;D
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: abbaroodle on June 01, 2009, 07:35:01 AM
Hi Cat,

Thanks for the super speedy reply!  That sounds exactly like what my surgeon described.

I confess.  I am a hip-gal in a knee forum.  I got here via a google search for femoral osteotomy.

I started having hip pain 2.5 yrs ago when I was diagnosed with a femoral neck stress fx.  I had surgery for that since it wasnt getting better on its own and am now the proud owner a big a$$ nail.  I had my hip scoped last Nov and just had it scoped again on Friday.  While I am trying to be optimistic about this most recent scope working, there wasnt that much to do during the scope (which is good and bad in my mind!) and the surgeon evidently told my mom if it doesnt help in 6 months the next step was to consider derotating my femur.  He had talked about this with me a couple times before so its not a shocker to hear it, but, as I am sure you can imagine, I am not so excited by the idea!

I know right now I need to focus on recovering and resting and all that, but its hard not to be several steps ahead!  Especially since I have a fair amount of time off now but will have very little time off, limited vacation and sick days starting in a few weeks. 

Glad to hear you are doing so well!  Again, thanks for the speedy reply!!!!
Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: cat on June 01, 2009, 11:33:02 PM
Abbaroodle,
What area of the country are you in? Is this your hip doc that suggested the femoral deroation? You are not alone on this board. I believe that Daisygirl also had hip problems. You might read some of her posts. http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=35793.msg276869#msg276869
 ;D ;D

Title: Re: 9 Year Old Daughter needing femoral osteotomy
Post by: abbaroodle on June 02, 2009, 01:39:02 AM
Hi Cat,

I am in the process of moving from Nashville, TN to Portland, ME. 

Yep, my hip doctor discussed how, due to my anteversion, he wasnt sure the surgery I just had on Friday would work.  And the derotation would be the next thing to consider.  Hasnt told me I need it for sure yet - nor have I agreed!!!  He would operate with a colleauge who is a ortho trauma guy.