DIARIES => Post-op diaries (<50 posts) => Topic started by: jmkuphal on January 25, 2017, 10:00:50 PM

Title: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on January 25, 2017, 10:00:50 PM
My first post.  Have been lurking for a long time after my surgery. Finally felt like I needed to pass along my experience as well as ask some questions to see if others experienced during recovery. 

Here is my background.   I am a 40 year old highly active male (or I was). I am 5' 5" and weigh about 180 lbs.   I was a gymnast and wrestler growing up, in high school and college.   I have been a competitive power lifter for 10 years from 2005 to 2014 except for a brief period in 2007 to have a labrum tear in my shoulder repaired and during which I decided to lose 60 lbs. and run a marathonÖlol.  Gained about 30 lbs back and resumed powerlifting after that.   I have squatted over 700 lbs to full depth, deadlifted 550 lbs and benched over 500 lbs during competition.  I love to snow ski, water ski, hike, bike, run, etc.  In 2014 I suffered a medial meniscus tear from deadlifting and probably squatting.  I was lulled into thinking a menisectomy was the way to go.  They removed 40% of my medial meniscus.  I never recovered and had chronic knee pain on the medial side after that.  Any thought of continuing in powerlifting ground to a halt and now just living normally and enjoying recreational activities became a concern.  I spent 2-3 years trying various injections, etc. and toying with the idea of regenerative medicine (stem cells from hip injected into knee).  Late in 2016 I decided I was going to proceed with some regenerative medicine.  The Mayo clinic sports med doctor I was seeing in Rochester, MN convinced me to get another MRI prior just to make sure things hadnít changed.  They discovered another tear in my medial meniscus.  He then convinced me to see a surgeon and consult before spending the money (regenerative medicine not covered by insurance) on expensive stem cell therapy.  I think this was wise advice.  The surgeon took one look at my legs and told me we needed to do some full torso/leg x-rays and evaluate the loading of my knee.  The results of these indicated the medial compartment of my knee was taking 100% of the load during activities (normal and sports).  The lateral compartment was taking 0%.  This was all due to the bow legged maldeformity  in my legs.  The powerlifting probably exacerbated the problem.  I guess I knew I was bowlegged but never thought it was an issue outside appearance.  Regenerative medicine or alternative treatments now seemed like a bad option (like putting new tires on a poorly aligned automobile).  The surgeon said until the alignment issue was corrected it was highly likely the medial meniscus would continue to tear and eventually arthritis would limit future options (meniscus transplant, allograft, stem cells, etc.) 
I proceeded down the path of an open wedge High Tibial Osteotomy and medial meniscus repair.  No more cutting of the meniscus!  The procedure used was the Arthrex iBalance system which employs a PEEK material wedge (similar modulus to bone material).  Also uses a PEEK anchor system which sits flush to the bone.  The procedure also uses equipment to protect from many of the complications and errors that can occur in traditional osteotomy.  I can explain more if anyone is interested.  The bone heals around the wedge and there is no hardware to remove in a second surgery which appealed to me.  The safety and lower risk for error of the system also appealed to me.

I had the surgery December 7th, 2016.  Here is my journey.

Day 1-3
Surgery went well and my body tolerated well.  It took about 4 hours, I was observed for 4 or 5 hours after that and sent home same day.  Outpatient surgery.  My wife drove me home 90 minutes from Rochester to the Minneapolis/St. Paul area of Minnesota.  Day 2 and 3 I actually was up moving around on crutches (stupid).  The drugs seemed to be keeping the pain at bay.  I was on Oxycodone and Tylenol every 4 hours.  Interesting but they did not want me taking any Ibuprofen.  NSAIDS can apparently have the potential to hinder new bone growth.  I also even went to a Christmas party I hosted for my department at work three days after the surgery (stupid)ÖI think I moved around way too much and set myself up for a miserable next 8-10 days.

Day 4-13
Swelling and excruciating pain hit me hard the next 8-10 days.  I paid the price for not staying in bed with leg elevated and icing often enough.  The small ice packs provided by the clinic did nothing.  I highly recommend automated ice machine and/or investing in large gel packs you can rotate which we eventually bought.  I was basically bed-ridden for much of my next couple weeks.  Probably my own fault.  Getting up to go to the bathroom became impossible because of blood rushes into the leg that were so painful in my shin and calf area I would convulse and almost fall over.  I cried.  A lot.  Part of my issue was running out of pain medication and having to space out my meds till reinforcements arrived.  I thought they could call in a prescriptionÖthey canít and had to fed ex it to me.  Donít run out of pain medication!  I resorted to urinating in a male urinal in bed and my faithful, beautiful wife who I owe everything to took care of it as needed. The narcotics kept me from being regular.  I think I had my first bowel movement at day 10.  I made sure to have extra drugs in my system to be able to get to the bathroom for that.  I donít think everyone experiences the blood rushes when getting up, but they were the most painful thing I have ever felt.  My skin also became highly sensitized like a terrible sunburn.  I developed blood blisters at the steri-strips from the swelling and skin layers separating.  These were disturbing, but doctor assured me to leave them alone and they would heal.  They did/are healing. 

Day 14
I was admitted to Mayo clinic for DVT evaluation (blood clotting) due to the red appearance of the entire leg and extremely sensitive skin in the calf/tibial bone area.  I was thankfully negative for DVT.  My leg was just angry and the nerves in the skin were firing.  Again this felt like a horrible sun burn and no one could touch my leg without me shaking and/or in painÖeven the lightest of touch.  I was given more pain medication and told to continue elevating and icing.  I was also prescribed Ambien to improve my sleep and was told it can sometimes help with the redness and skin irritation.   Interestingly the redness would drain from the leg with elevation.  Stitches were removed at this time.  Wound was healing nicely. 

Week 3
Slow improvements and leg skin sensitivity improved.  The entire leg continued to have a red sunburned appearance especially while standing.  Again, resolved with elevation above heart.  Started lowering doses and frequency of pain medication.  Also went to gym a time or two to do some light upper body exercises.  Was good for the mind if anything and my leg color responded to getting the blood pumping which was encouraging.

Week 4
Continued weening pain medication.  Started PT at Mayo Sports Med in downtown Minneapolis.  My leg had been locked in extension for this whole time (except to shower) to allow the meniscus to heal.  With just an HTO I believe they start moving your leg right away.  At my first PT session, I think I freaked out my therapist.  She had to contact my surgeon to see what she was dealing with.   My leg was locked.  The knee cap was frozen.  I could bend 20 degrees.  I really felt I hadnít been given any type of defined protocol other than ankle pumps and knee flexion to fire the quads.  I should have started PT sooner maybe.  At any rate they spent a good hour massaging and breaking loose the knee cap.  The first session was very painful.  She tried my on an exercise bike at highest seat and took me several minutes to get a rotation.  She provided me with knee slide exercises and stretches and I worked my butt off at home until the next session.  My leg continued to sport a red/purple sunburn appearance and feel like one too!  This really caused sleep problems.  The leg gets so hot it causes me night sweats (could be from weening off pain meds too).   I average about 4 hours of sleep a night.  Pain medication seems to keep me awake now vs. help me sleep so I continued to ween off.  I was told to begin toe touch weight bearing as well.  I continue to do upper body exercises at the gym for my sanity.

Week 5
Off of all pain medication besides Tylenol.  My 2nd and 3rd PT sessions were much better.  All my work paid off.  In 5 days I had gone from 20 deg. bending to 110 degrees!  Day after PT I did 5 minutes on a bike.  Day 3 after PT was 10 minutes on a bike.  By my 2nd PT session I was doing 20 minutes a day on exercise bike.  I just needed someone to say go!  I was given the go ahead for partial weight bearing with crutches with leg in extension.  My leg continued to have a sunburn appearance and feeling.  The redness is throughout the whole leg and continues to be hot and bothersome particularly at night and causing night sweats.  My sleep was terrible all week.

Week 6
More PT and more improvement.  I was given the ok for NSAIDs so I began alternating Ibuprofen with Tylenol.  I think I really saw a noticeable difference with swelling after starting this.  By the final PT session of this week I had achieved 140 degree ROM bending!  Pretty much full!  My extension is still several degrees shy of my non-surgical leg.  I did not like doing leg extension stretches despite the therapist stating how important they were.  It seemed to aggravate the Osteotomy site.  I would get sharp shooting pains which worried me so I took time off of these particular exercises.  The leg continues to be very red throughout and hot at various times mostly while standing at night!  I have to wake up each night and exercise the leg, elevate and ice to resolve.  My therapist and surgeon became concerned I had developed Regional Pain Dystrophy or CPRS Complex Regional Pain syndrome which is a malfunction of the Central Nervous System / Nerves after trauma.  It can take a long time to go away and/or become permanent.  This was very discouraging to me and I struggled with depression that I may be dealing with a sunburnt leg the rest of my life.  The doctor is setting me up with appointment with a Pain Clinic through Mayo for treatment (I donít like the sound of this).    The good news this week is they are allowing me to drive again.  I practiced with my wife around the block a few times to get my bearings and also rigged my jeep with the grab handles to lift myself in and out.  I continued to exercise as much as possible.  The color of my leg continues to turn normal with blood pumping and I like this and it motivates me to do my exercises! I am praying hard for this skin color and sensitivity thing to resolve!

Week 7
I take before exercise and after exercise photos of my leg every day.  The red/purple color changes to white as I exercise and I like that.  I am hoping once I am walking and weight bearing, this issue will resolve and I wonít have to worry about CPRS.  My sleep has improved tremendously.  5 of the last 6 nights were 7 to 9 hours of sleep each.  My last two nights I have slept without getting up.  I still wake up frequently with leg stiffness and pain, but I pump my leg several times and it loosens up and I can generally fall back asleep.  I also switched sides of bed (not sure why I didnít sooner) so I can hang my hot surgical leg outside the covers.  I think this helps and I donít sweat so bad.  Today is Wednesday.  I am returning to work (sit down office only) tomorrow, Thursday.  Kind of nervous for this.  I have plenty of available time to be off work on short term disability, but feel going back will help time go quicker and give my mind something to do other than worry about CPRS.  I stopped wearing compression sleeves this week to see if my leg would do better color wise or not.  I donít perceive a difference yet.  I travel to Mayo clinic this Friday for X-rays and post op follow-up.  Looking forward to good news.  I will try to post more as I goÖthis is a long overdue post.  I am trying to have a positive attitude.  My goal is to snow ski in the mountains with my kids again!

I will post some photos on my next post.

If anyone is still reading this would really like to know if you have had similar experience with skin color, redness, hot leg, etc. for this long.  Anyone?  How long to resolve? 

Outlaw Josey Wales

Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on January 28, 2017, 06:57:34 PM
Had my 7.5 week post op visit.  Was able to meet with the surgeon and his team in his office at Mayo clinic which was rare and cool.  X-rays look excellent.  Wedge where it needs to be and bone graft is clear.  Doctor was vey pleased and excited about the alignment which required an 11 degree change (>10 is more rare and significant).  My ROM is excellent at about 140 deg.  He is allowing me to begin transition to full weight bearing over next 4 weeks and maybe ditch the crutches as tolerable.  Until we can see bone growth can't put any twisting or torque on the leg.  He also believes the CPRS will resolve since it is only prevalent when I am standing.  I was very encouraged by the visit and excited to progress my re-hab and recovery.  He added that they may use me as a testimonial presentation case in his presentations.  Therapy continues but now I am very optimistic on recovery.  Still curious if anyone else experiences the red leg while standing that resolves with elevation, sitting, and/or exercise. 
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on January 30, 2017, 02:57:05 AM
Well two days of putting some weight through my leg.  Definitely feeling some new aches in knee and what seems to be osteotomy site.  Hoping this resolves with more activity and as thing get stronger.  Can't wait to ditch the crutches!
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on February 09, 2017, 12:52:16 AM
I am 9 weeks post op today.  I am walking at home without crutches or the brace with leg in full extension (peg leg), but still using one crutch and brace locked at work. 

My red leg (CRPS) Complex Regional Pain Syndrom is kept at bay with a compression sleeve.  I perceive it to have lessened.  I saw a specialist at the Mayo Clinic pain clinic which was mostly consultation.  The doctor looked at my leg and progress and felt like we should wait another six weeks before pursuing any potential treatment.  I am hoping this resolves and I never have to worry about CRPS long term.  Very fearful of this condition.   The leg seems to be at its worst before bed and in the morning when I first get up.  It just wants to be angry.

I do therapy every day.  Combination of my therapy exercises, swimming, and exercise biking. 

The PT gave me some new exercises yesterday (mini squats and another stretch using a strap on my foot and pulling my leg to my butt. My knee was pretty sore today after these.  I am icing 2 to 3 times a day still.  Much of swelling has gone down and I can now see my weak quads and my knee cap.  I can't wait to get the quads built back up.

I go back for additional x-rays March 10th and am hoping to see bone healing. 

Mostly I am praying this CRPS goes away on its own.

Getting closer to my goal of skiing in the mountains again with the family one day at a time.  Trying to stay as positive as I can.
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on February 16, 2017, 02:10:34 AM
Today (Wednesday) marks 10 weeks post op.  I regressed a bit last Saturday and leg became so sore I went back to crutches and didn't put any weight though the leg all day Sunday.  Monday I used both crutches all day and little weight through leg.  On Tuesday I did partial day with no crutches and same today.  The leg feels better than it did.  I think I overdid it.  I am limping quite a bit with no crutches though I think most of it is mental, habit, and weak leg.  I seem to be able to navigate going up stairs without crutches or brace now, but there is not enough quad strength to come down normally without plopping quickly when weight is on the bent operated leg, so I come down weak leg first (peg) and strong leg next so I don't have to bend much. 

My therapist informed me I should only be doing my leg strengthening exercises 1 time per day.  I have been doing them 3 times which may be why I overdid it and regressed.  I am to continue ROM and stretching exercises 3 times per day though.  She also measured my legs and amazingly they measured the same length.  It feels when I walk though that my operated leg is longer, so maybe I am just becoming used to it being angled differently.

I am also taking Calcium, Magnesium, Vitamin D3, Vitamin C, protein, and a multivitamin.  While I am not sure if the supplementation helps, it helps me to know I am doing everything I can to heal the bone in my leg. 

I do still have pain in the leg when I walk and put weight through it.  Most of the pain is on the proximal tibia and more on the lateral side.  This makes me nervous, but hoping will continue to resolve with healing and time. 

CRPS is still my nemesis, though I perceive it to be lessening to a degree.

My shinbone on my operated leg is re-emerging so the swelling must be continuing to improve. 

Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on February 20, 2017, 07:56:52 AM
10.5 weeks post op.  Quick update, PT last Thursday introduced more functional strengthening exercises.  Using bands around knees (above) did side steps, big steps forwards and back, standing on one leg, etc.  Got some pain  in tibial plateau lateral side which took extra day to calm down.   Only going to do these every other day.   Did get out and walk a mile or pretty sore near end.   Ice ice ice...crps still red and hot...annoying.   Still praying it will go away.
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on March 01, 2017, 01:40:48 AM
12 weeks post op tomorrow.   The good is I made huge improvement over last weekend.   Normal walking without much discomfort or pain. Leg color seemed to be improving, compression sleeve shortened and amount reduced to just cover knee and surgery site. Was feeling really good.   Did therapy Sat, sun, and on Monday increased band resistance didid three sets of everything vs. One and finished with 40 min on exercise bike.   In hindsight way too much and was hobbling around with sore calves and pain in knee again.  Dumb.  :o. So today I test and ice and take ibuprofen, tomorrow same.  Thursday I see the therapist again and hoping to be feeling better by then.  Was really encouraged then shot myself in foot I doc appt. is March 10th!  Gonna see some bone growth I hope!  ;D
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on March 01, 2017, 01:52:05 AM
Before surgery x ray picture
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on March 01, 2017, 01:53:27 AM
After surgery...can only see bone graft...really white portion.

Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on March 01, 2017, 02:07:52 AM
2.5 weeks post op
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on March 01, 2017, 02:08:55 AM
4 weeks post op
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on March 01, 2017, 02:11:13 AM
6 weeks post op.  Can really see the crps redness in this pic.
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on March 01, 2017, 02:13:46 AM
12 weeks post op.  Color improving but note the hair thinning from crps or compression sleeves, etc.   Wonder if it will return?
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on March 09, 2017, 01:36:44 AM
13 weeks post op.  Walking continues to improve.  Therapy continues strengthening gluten, calves, hamstrings, and functional loading (bands around knees) side steps and forward/backward steps.  The osteotomy site gets sore afterwards and next day.  I am still seeing swelling mainly late afternoons and early evenings at ankle, shin, and knee.  Some minor redness and heat still as well.  Today was first day I have gone with no compression sleeve and it felt pretty good though.  It feels good to take a load off at night and ice and elevate though.  I still ice one to three times daily.  I am still numb at knee and about 6 inches down leg.  It is annoying to me.  I see the doctor for xrays Friday this week.  I am praying for evident bone growth and union.
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: Minkxy on May 30, 2018, 01:32:05 PM
Hi! Thanks for posting about your experience with the I-Balance. I found your post only because I was interested in the product. I tried to message you but don't know how. Not sure if you will see my post but I was wondering if your insurance covered most of it? I guess I was also wondering if you would be able to find out the original price of everything if insurance was not involved. I believe I would have to pay 20% of my surgery costs but not sure what the total is.
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: jmkuphal on June 14, 2018, 01:33:45 AM
I think the total before insurance was over $30,000 but included alot of my physical therapy....i had an out of pocket annual max that was hit basically 2 years in a row, the surgery and all the followup, rehab, and therapy.  I was probably out about $5000 per year.  I can honestly tell you now, it was worth it.  My knee feels great.  Not like original, but 1000 times better then it did.  I can walk, jog, hike, bike again without pain.  I also skied in the mountains this year.
 So grateful for technology but long grueling recovery.  Let me know what other questions you have!
Title: Re: Arthrex iBalance High Tibial Osteotomy and Medial Meniscus Repair
Post by: WonkeyDonkey on December 27, 2018, 09:47:26 PM
I had an iBalance in my left osteotomy in November 2011.