DIARIES => Post-op diaries (<50 posts) => Topic started by: kczech on August 27, 2019, 07:20:46 AM

Title: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: kczech on August 27, 2019, 07:20:46 AM
Hello everyone, first post here but I've read the complete diaries of some that have undergone a similar procedure, which has been invaluable to me in preparing for my own surgery.

A little background before I get into the nitty-gritty. Skip the brackets if you're only interested in the relevant diagnosis and surgical plans.

I'm a 25 y/o male who has been extremely active over the past 7+ years. During that time, I've summited the tallest 10 peaks TX, 43 of 58 14ers in CO, a hand full of the highest peaks in NM, AZ, CA, and UT, Mt. Rainer in WA, have done numerous 50+ mile backpacking trips through the Grand Canyon, and did my best to maintain running 20 - 35 miles a week , all while finishing a degree in Physics and working part-time for the National Park Service.

In celebration of the completion of my degree and the end of my NPS job, (which was tied to my being a student) I set out to hike 150 miles across the Grand Canyon, the furthest one can go along the established east-west trails. I had been training and prepared both mentally and physically for this for almost 6 months, and I felt invincible as I looked over the edge of the canyon the day I began my trek. That couldn't have been further from the truth, unfortunately. After about 3 days (~40 miles) of feeling great, I started to feel a dull pain in the lateral part of my right knee, which quickly became unbearable. At that point, I had another ~25 miles to the closest exit point and panic begin to set it. The next 48 hours were the most excruciating of my life. I could not bend my knee without experiencing a sharp 10/10 pain, I had to make a 2 mile side trip to the river to get water as the drainages were dry, and it had snowed ~4 inches the night before I finally made it out of the canyon, which made the final push all the more miserable. But I made it out, and I was thankful to be alive.

Upon returning home, my orthopedic surgeon (OS) quickly diagnosed it has IT Band Syndrome (ITBS) and said I just overdid it. A few weeks rest, a bit of PT, and I should be good to go again. Great! Two months later, my PT instructed me to try an easy hike, during which time I experienced the same excruciating pain again, not only in my right leg, but in the left now too. Had an MRI done that  same day and it showing a great deal of inflammation between the IT Band and the lateral femoral condyle. More PT, a second & third opinion, a dedicated strength training regimen over the past 4 months, and it only seemed to get worse, as I started experiencing pain along the medial side too now (MRI showed contusion/degeneration of the meniscus in the L knee, but no tears). I finally found a physical therapist that was genuinely interested in getting to the cause of my pain, as conventional ITBS therapy was clearly not working, and he pointed out that I have external tibial torsion (ETT). Say what? But it was as clear as day once it was brought to my attention. I brought it to the attention of the most recent OS and they dismissed it and said I should just have IT band release surgery, as I was "too old" to undergo a derotational osteotomy. I had surgery scheduled and all of the sudden the surgeon's office called and said he wouldn't perform the surgery and provided no explanation as to why, only that he was "very busy". That was when I felt like I hit rock bottom. At the ripe old age of 25, I wasn't ready to give up the one thing that made my life feel like it was worth living, but I was starting to think I might have to.

Scouring the internet for anything or anyone that may be able to help, I came across an article about "Miserable Malalignment", which described a number of symptoms of ETT, including ITBS and medial meniscus pain. That sounded familiar. Further research led me to a blog post by Dr. Mark Sanders of the Sanders Clinic in Houston, TX, who seemed to have success in treating various types of "Miserable Malalignment". It seems a number of his patients are members of this site as well, and I am indebted to their willingness to share their stories and their confidence in Dr. Sanders. I called and set up an appointment and his office was more than willing to accommodate out-of-town patients. Luckily I have family in Houston, which makes it a lot easier, so I set off on the grueling 13-hour drive across TX the day before my appointment. I had an EOS X-ray done at TCH and met with him shortly after, where he quickly identified my ETT and that I apparently have a varus deformity as well. To get a more accurate assessment of the ETT angle, they set up an MRI rotational study the same day, and I met with him again the following day. The study showed the torsion angle to be >40 on both sides, which made me a candidate for surgery. I was in shock as to the extent of the deformities, but I composed myself long enough to get through the meeting and asked as many questions as I could come up with, eventually agreeing to go ahead with the surgery.

I'm scheduled for surgery on September 4th, which seemed like enough time to come to terms with it, but I find myself still struggling with the anxiety of it all. After reading through a number of diaries, I thought that it might be helpful to start one of my own as I prepare. I plan on updating this after my pre-op consultation with Dr Sanders on the 3rd, and as often as I can post-op. I don't think anyone can beat @crankerchick though! It was extremely reassuring to read such an in-depth account of the experiences of a past patient. Hopefully this helps someone else down the line too.

Thank you for taking the time to read this far. I look forward to updating this.

UPDATE: I ended up having to postpone the surgery because of a few family and personal issues that came up. I'm now scheduled for pre-op on October 21st, and surgery on October 23rd.