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: 10-19 & 2-20
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.

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 in TX, 45 of 58 14ers in CO, Mt Rainer in WA, a hand full of the highest peaks in NM, AZ, CA, and UT, 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 Bachelors of Science degree and working part-time.

In celebration of the completion of my degree, 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). 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 ~45į on both sides, in addition to about 4į of varus, 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. During this delay, I consulted with a number of other doctors, many of whom agreed with the surgical plans proposed by Dr. Sanders. I'm now scheduled for pre-op on October 21st, and surgery on October 23rd.
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: kczech on October 24, 2019, 03:18:28 PM
First update post op:

According the Dr Sanders, the surgery went well. My left tibia was corrected internally by 20į, resulting in a torsion of about 24į, and my 4į varus was corrected to about -1į  (Valgus). The difference when compared to the uncorrected right leg is striking. He also performed an MPFL imbrication, which tightens this ligament by folding it over on itself and sewing together. I opted for this as opposed to a full reconstruction.

One thing I knew about but wasnít quite aware of the extent was the wearing down of the cartilage behind my kneecap, particularly on the medial side, which was due to repeated partial subluxation. Hopefully the tighter MPFL and new tibial alignment will prevent this from happening again and spare the remainder of my PF cartilage.

Pain was surprisingly minimal after waking up due to the nerve block. I was sent home about 3 hours after the surgery was over, which seemed crazy to me but itís nice to be in a familiar bed. This was until around 8pm when the nerve block started to wear off and the pain became much more intense. Post-op instructions from the hospital nurse we to stay in bed, and only take half an Oxy every 6 hours until tomorrow (today), which conflicted with the instructions given by Sandersí office. Right about the time we were reaching out to him, he calls to check on me and thatís the first thing I asked. He wasnít happy that the nurse gave us conflicting information and instructed me to get on the medication schedule immediately. Sure enough, little to no pain within 15 minutes of taking everything (OxyCodine, gabapentin, tramadol, Tylenol, and baby aspirin).

The most difficult thing so far has been getting up to pee. The residual effects of the anesthesia make it hard initiate flow and I have to constantly push and hold my breath to get anything out, even though I feel the urge to go more than I ever have before. Hopefully this getting easier over the coming days.

Another effect of the anesthesia has been numbness in my hands, particularly my first 3 fingers. Itís made it hard to hold onto things, especially the small pills and my phone. But itís finally a bit better today.

Iíve been laying with my left leg up at 90į since around 12pm yesterday (other than we I get up to pee) with constant ice and the Venapro cuffs on each leg to prevent blood clots. Iím supposed to straighten it out tomorrow with only a small support below my ankle. ďCannonballĒ exercises should start tomorrow too, which will likely be painful but Iím excited to start moving my leg again.

Iíll update tomorrow after I switch position.
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: kczech on October 26, 2019, 03:04:13 AM
Todayís been a rough day.

I started laying with my leg straight with a small support underneath my ankle so the knee isnít touching the bed. This is fairly painful so far and I find it difficult to get comfortable in this position. Iíve also started to develop pain below the incision along the anterior and lateral part of my ankle/lower calf. I think this is from the new position of my leg pulling on the muscles and nerves. I asked the doctor about it earlier and he said itís nothing to worry about, just gotta deal with it for now.

Also started doing the cannonball exercises (knees to the chest, keeping calves down), which arenít as bad as I expected. Just taking them slow and I can feel a bit of pain along the incision as I bend the knee, but not much pain within the leg/knee itself. I almost have full range of motion as compared to the other leg.

Numbness in my hands is completely gone thankfully. Peeing has also gotten easier, but itís still been almost 3 days since Iíve had a bowel movement. I know I need to keep eating, but I feel bloated. Popped a few stool softeners and a laxative earlier so hopefully those help. Riveting stuff here!
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: kczech on October 28, 2019, 03:13:52 AM
Yesterday sucked (day 4). I stopped taking the Oxy to help with the constipation and woke up feeling decent, but then started feeling achy everywhere (flu-like) and the laxatives kicked in full force. Was in pain most of the time resting and didnít eat very much either because my digestive system felt like it was in chaos. I also noticed a small amount a blood coming through the medial part of knee after doing cannonball stretches. Pulling back my stockings showed 5 needle-sized holes outside the bandages that were bleeding. No idea why they were there but will ask doc.

Today (day 5) started off the same too. But after eating and moving around a bit more, I feel a lot better. The primary source of pain now seems to be the in the lateral part of my ankle around the malleolus, especially in dorsiflexion. Not sure yet exactly whatís causing this. Hopefully Doc will have some answers tomorrow. Follow up appointment in the morning then flying back home tomorrow night. Looking forward to being back home but dreading the logistics of air travel in my current state.
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: Ron22 on October 30, 2019, 04:20:41 AM
Hope your appt. went well.  I posted here quite a bit a long time ago.  I've had just about everything done over the yrs.  Have to update my profile as I am now up to an even dozen surgeries.  Four yrs of college football and then 15 yrs or 30 seasons (Fall and Spring) of Division 1 Rugby.  They told me to stop playing all sports after my freshman yr of college.  I have no regrets but cannot get the knee and hip replaced due to the ancient vascular surgeries where they just yanked out the long pulmonary veins (2 of those bad boys).  I'm pretty familiar with your surgery and others.  I'd be happy to answer any questions you might have.  I had good surgeons who did like to explain in even further detail than usual and I have absorbed a lot of knowledge over the yrs and am always willing to share whatever I can if anyone needs any first hand experiences.

Best of luck and feel free to PM me or post.  Hang in there.
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: kczech on November 02, 2019, 02:07:25 AM
It's been a rough few days since my last post. Follow up appt on Oct. 28: removed my dressings, took X-rays, and started partial weight bearing per doc's orders. The wound is sickening to look at (although I was told it was healing well) and there are a number of black, blue, and yellow areas from my thigh down to my ankle. Most are not painful though and should disappear in the coming weeks. X-rays look pretty gnarly too. I knew it wouldn't be pretty, but I was surprised as to the amount of step-off. The back of the distal segment protrudes about 8mm from the proximal segment because of the irregular shape of the tibia when rotated flush with the tubercle. Doc says it's nothing to worry about functionally, so I'll take his word for it. I had been carrying the leg on crutches up to that point so it was frightening when we instructed me to start putting weight on it, but it wasn't as bad as I had expected. It was (and still is) just difficult to go through the ambulatory process with one foot pointing in a different direction. The lack of dorsiflexion is a big factor, as it was something I never fully developed with my feet pointing out for so long. Lastly, a scope of my patellofemoral compartment showed abrasions along the trochlear groove and significant deterioration of the cartilage on the medial facet. Nothing to be done about that for now, but hopefully the new alignment will help.

Airport and plane ride sucked, not much else to mention there. Iím also not a fan of being pushed around in a wheelchairÖ

First day home was good after moving things around and making other living accommodations. That night though, I had an accident and fell while getting out of bed. Combination of factors: I was lightheaded getting up, my crutches were further away than they should have been, and I really had to pee. I donít think it was that bad of a fall, as I landed on my good side and was only about half way bent over, but itís hard to remember exactly what happened as sheer terror took over. Called Doc the next day and he didnít think it was enough to knock anything loose, but I had xrays done just to be sure. Based on those, he still doesnít think I did any harm, which is a relief, but I still have new pains that developed after which makes me paranoid.

The most annoying new pain is a pulling sensation in the lateral part of my thigh, which seems to start on the lateral prominence of my patella (more of a stinging) and extends upwards through the area of the ilitotibial tract. Hard to say if itís the IT band, the vastus lateralis, or whatever else. Itís painful to the touch and pulls when walking (trailing in extension) and in full flexion. Iíve also developed pain around the proximal part of the plate when too much weight is put on it or sometimes when moving against gravity.

Despite all these new pains, Iím still keeping up with my exercises (cannonballs, working ROM, etc) and partial weight bearing as tolerated when walking. I know itís only been 9 days, but I was hoping to be past the point of developing new pains so I would only have to focus on managing existing ones. The long road to recovery continuesÖ

Ron22, thank you for your message and for the well wishes. I am sorry to hear about your situation and I hope you have found a solution that works for you. As I donít have the ability to send messages yet, Iíll post a few questions I have here. Do you have any experience with plate fixation or with this type of surgery yourself? And would you expect there to be any future issues/complications with bony step off, such as the kind that is presented when rotating the proximal tibia on itself?
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: kczech on November 05, 2019, 04:07:14 AM
Finally an entry that isnít all doom and gloom! Past 2 days have been what I would consider good days, in contrast to the recent string of bad ones. I started going on daily walks a few days ago and today I managed to make it all the way around the block! I can feel my pace quickening too. I was definitely in pain by the time I got home, but after some ice and a pain pill, I felt much better. Iíve also been doing a number of easy exercises given to me by my physical therapist, and theyíve been getting easier day by day. Above all, the pain is finally at a level where I can ďexistĒ in relative comfort without doping up.

Sleeping is still somewhat difficult though, even with sleeping pills. I often wake up 3 or 4 times and find it difficult to go back to sleep. I managed to sleep in later today and itís amazing how much better I feel. Hopefully this keeps getting better too.

Lateral thigh pain/tightness is still there but seems to be getting somewhat better. The more I look at it, it seems to correlate with surface discoloration. Biggest annoyance right now is the pain behind my knee that causes numbness in my foot when laying down, although I did manage to find a combination of foam supports that eliminates the pressure behind my knee. My right (nonsurgical) knee is starting to bother me again too, I imagine because Iíve been relying on it a lot recently. That pain in minimal compared to the other leg, but is annoying nonetheless.
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: kczech on November 09, 2019, 11:59:23 PM
Good days are never without bad ones it seems.

I think I overdid it with the walking and I may have been doing too much weight bearing. I feel like I need to push myself to keep making progress, especially on good days when my confidence is higher, but then I'm reminded by the pain that's it only been about 2 weeks since I had my tibia cut in half and reattached. I'm not a patient person by nature, but this whole ordeal seems to be a lesson in that.

The primary pain I'm experiencing now is around the plate. It's a dull ache most of the time, but increases as I do too much walking. I think it was the day after my last post that I stopped going on daily walks so as not to exacerbate the issue. As an alternative to walking over the past few days, I've been using a stationary bike with variable resistance, which I think will be my primary form of exercise for the time being, in addition to the leg raises, extensions, etc. I started doing more walking again yesterday, but stopped as soon as it became painful after a few minutes. Now that the swelling is mostly gone, I can easily feel the outline of the plate, and it is tender to the touch as well.

The pain/discomfort behind my leg at the osteotomy site is still there too. There is a slight, sharp pain in full extension and most lying positions seem to put too much pressure on the area of the bony step off, which causes pain at the site and the rest of my leg to go numb. The couch in my living room has cushions with a space right behind my knee when lying down, so that's where I spend most of my resting time. Otherwise I have to put together a number of foam cutouts we've made for support, which is a pain in the...

I hope this is something that will resolve with time, although I don't see how given that the prominence on the distal segment isn't going to go away. I had the opportunity to look at a few other X-rays from patients who had the same (or similar) thing done, and their distal step off is nowhere near as prominent as mine. This may be due to a number of factors, but the result in my case is unexpected nonetheless. This is the one outcome of the surgery I am disappointed in at this point, but I will do my best to be optimistic that it doesn't result in any functional deficiency later on. I've attached an image of a lateral xray that shows the step off I'm talking about. If anyone cares to provide an opinion and reasoning as to wether or not this is problematic, I would greatly appreciate it.

As far as things that have gotten better, the lateral pain/tightness is almost gone, along with the bruising that seemed to be causing it. Just a minor pain along the lateral part of my patella that remains. Bruising/discoloration overall has improved quite a bit, and ROM is now just about identical to the other leg.

The "views" count on this keeps going up quite a bit every time I check, which is somewhat unexpected given how inactive this site has been recently. If you've read this far, thank you for your interest and feel free to leave a comment if you'd like :)
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: crankerchick on November 11, 2019, 03:04:22 AM
Itís too early to be disappointed and worried about what will and wonít resolve. Some of the improvements Iíve had over time are measured in years. Most in months. Few in weeks. Week to week improvements, especially in the beginning, weíre more related to initial surgical pain and the deep bone pain (if that makes sense). Iím not saying this ďbony step offĒ will improve, Iím just saying try to stay focused on the small goals and ďwinsĒ rather than the big ones. Youíll go batty and stay depressed otherwise.

Iím curious Docís thoughts on walking versus cycling. Itís been a while for me but when I had my surgery, it was all about the cycling. I lived for the bike. It kept me from getting stiff and it always felt better afterward, even if during the ride if it was hard. Being stiff hurt so much more, especially when time came to move again.
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: crankerchick on November 11, 2019, 03:12:47 AM
Is it possible with healing over time there will be some bony build up to fill in the step somewhat?
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: kczech on November 11, 2019, 07:19:45 PM
Crankerchick, you are right. Looking back, there have been so many things that have gotten better or resolved completely since day 1, but I have been reluctant to acknowledge them in the face of current issues or pains. That's something I probably need to get better at for my own sanity!

Perhaps the word "disappointed" was a bit strong. It's just one of those things I remember having a small freak-out over the first time I saw it in an xray because it was something I was worried about beforehand and I was expecting it to be fairly minimal based on other xrays I had seen. It seems to me like sharp or larger bony prominences are generally problematic, especially when there wasn't one there before and in areas where there are nerves, tendons, etc. Doc did not think it would be an issue, but I was skeptical based on my own preconceptions. My skepticism may very well be unfounded though, and I hope it is. I'm just a worrywart and admittedly, I'm stubborn. It is likely there will be some fill-in around the step, but it will clearly remain prominent. Maybe once the sharp edge is gone it will become less of an issue though. In any case, I'll do my best not to dwell on this one issue. I appreciate your response and your viewpoint :) and glad to see your profile revived!

Doc had me start weight bearing during our post-op appointment only 5 days after surgery and said to stop "carrying" my leg, and to try to stay as active as I could tolerate. He didn't even mention the bike but it's something I asked about recently and he said it was a good alternative if I was unable to do much walking. The reason it became an issue for me is I was trying to put too much weight on it. Should've only been doing around 20-30 pounds, but I never bothered to check on a scale and I was probably doing 40-50+ at times. No wonder it hurt...
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: kczech on November 16, 2019, 10:56:25 PM
3Ĺ weeks post-op.

The pain I was experiencing when walking has mostly subsided and I'm down to one crutch! I still use the other when out in public, but for the most part I can get around fine with just one. It's so nice to be able to carry and move things around again, which has really increased my independence.

I don't feel much pain when I attempt to put full weight on the leg, but the issue is it feels extremely unstable due to a lack of strength. I'm on the bike (with increasing resistance) for probably 1 - 2 hours a day and doing my strength exercises twice a day now, so hopefully this will improve soon. I'm also back to going on daily walks and have made it around the block again two days ago. One crutch half way, but used both after it started to get sore.

I did a lot yesterday and was quite sore at the end of the day. Went out to dinner and wore "normal" clothes for the first time in a long time, but made the mistake of wearing one shoe and a sandal on the bad leg. The different sole sizes resulted in a leg length difference, which caused my IT band on my right "good" leg to flare up quite suddenly and severely after a moderate amount of walking. It was hell trying to get back to the car with 2 bum legs. But I made it with some help and that pain has mostly subsided today. Only reinforces the need to have the other leg done at some point...

Sleeping is still difficult, even with sleeping pills. Not sure if I'm building a tolerance or what but I have a hard time falling asleep most nights and I still wake up at least 2 or 3 times almost every night. The oxy helps to knock me out but makes me feel really groggy the next day so I'm trying not to use those. Part of it is difficulty getting comfortable. The pain/numbness that results from pressure behind my leg is still there and I have to get it "just right" for it not to be an issue. I would normally move around or change positions to get comfortable, but I'm basically stuck to one position now.

Overall things have gotten better since my last update. Walking with less pain and doing more, but just always tired.
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Oct. 23, '19
Post by: kczech on November 25, 2019, 11:17:16 PM
1 month

I can walk! Took my first few unaided steps out of curiosity last week and I was pleasantly surprised that I was able to do it, albeit with a fairly prominent limp. I still use the one crutch most of the time for stability, but I can now make smaller trips around the house like to get water, to the bathroom, etc. unaided. Itís surprising that there is relatively little pain when doing this too. The reason for the limp and instability is just a lack of strength, but Iím working on it daily. After the 6 weeks X-ray next week, I should be able to ramp up the strength training in PT a bit.

There have been some pretty dramatic weather changes in the western US the past few days, with more in the forecast, and Iíve felt a bit of increased discomfort around the hardware due to this I think. Not a big deal but interesting to experience this fabled phenomena.

The scar is starting to reveal itself as the surgical glue and scab are starting to flake off more in the shower. There are some areas it looks really good and some where it probably shouldíve remained covered a little longer. There have been a few pieces that catch when taking the stocking on and off too, which is painful and sometimes results in bleeding. I have a number of bandaids over the rough patches now to try to prevent this from happening, but Iím running out of bandaids as I have to change them every time I shower lol.

Some things that havenít changed: still not sleeping very well and the pain behind my leg is still there. Admittedly the latter has gotten a bit better, but I still find my foot going numb more often than not when my leg is positioned wrong.

The biggest issue Iím facing right now is withdrawal symptoms from the Tramadol. I was on 2 a day for almost 3 weeks, then down to one a day for another week. I tried a few times going a day without them and the symptoms were pretty intense (flu-like achiness, nausea, intense headaches, twitching, increased insomnia) so Iím down to half of one a day. I didnít take any yesterday and I donít feel too great today. I asked Doc and his recommendation was to just stop and ride out the withdrawals but I think thatís easier said than done. If still feel this bad tonight I may take another half and try to just do half every other day before attempting to stop again. Itís always been an out of sight, out of mind thing, but I finally understand the issue with the opioid epidemicÖ

Going into this, I honestly didnít think I would have made this much progress by this point, so I am pleasantly surprised. Looking forward to what the next few weeks have in store.

If youíre reading this in the US, Happy Thanksgiving!
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - October 2019
Post by: kczech on December 16, 2019, 01:01:36 AM
7Ĺ weeks

I'm walking completely independently now. The limp is mostly gone but I find myself reverting back to it if I've been sitting for a long time or if I've been walking for a while. Depending on where I go, I'll bring the cane just in case, but I can get by without it almost everywhere I need to go. I can even go up stairs with little difficulty, but going down is a different story. That requires the cane and/or handrails.

Still occasional pain behind the fibular head but it's manageable. It was a lot worse a few weeks ago when I first started walking unaided. As I continue to walk longer distances, there is some strain on the lateral part of my foot because I'm rolling through the center of my foot as opposed to obliquely through my big toe. It's manageable though. I'm continuing to work on strength, but it's taking a long time to see any progress in this. It's frustrating because I put a lot of effort into my exercises everyday, but I'll keep after it. Need to get this leg up to speed to get ready for the next one.

Had xrays done at 6 weeks and they show the bone is healing well. There's a "nick" on the fibula that looks completely healed and the main osteotomy gap is showing new bone growth. I've attached an image that shows a comparison. (Hard to see the full extent because I'd had to compress it multiple times to meet the absurd 700kb upload limit) It will be interesting to keep comparing these every so often as I get new X-rays done later.

The biggest issue I have right now is my right leg. IT band or whatever lateral pain I've been dealing with for the past year has come back full force. Before, it would take a lot more to irritate it, but now it seems to go off after walking down the block or a simple step down. I'm beginning to trust my left (surgical) leg more than the right now. I've gone on extended walks a few times and had to call my parents to come get me because I knew if I tried to keep going, it would get to the point where I couldn't walk at all. I've been locked to the couch the past two days in an effort to let the inflammation resolve but it still aches. I can't take the NSAIDs I would normally take (ibuprofen or naproxen) because I'm told they effect the bone healing in my other leg.

Waiting to hear back from Sanders' office on scheduling for the next one but I'm shooting for mid-February.

Update: Next surgery scheduled for February 12.
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - Feb 2020
Post by: kczech on April 15, 2020, 06:07:44 AM
9 weeks post-op #2

Wow, didn't realize how long it's been since I last updated this! A lot to update, some good, some bad, although I tend to fixate on the latter.

The second osteotomy went okay, although I'm not entirely happy with the new alignment. It was discovered during surgery that I have some articular surface damage on the medial femoral condyle, so coronal alignment fixed to be slightly more valgus than was planned. Only about 2 degrees past neutral so no big deal. The thing I am disappointed in is the torsional correction. Was supposed to have been corrected by 20 degrees, but my thigh-foot angle is still about 25 degrees (~33 degrees prior), which would indicate it was only corrected by about 10. It is very noticeably different than the other leg and I still have to think about pointing my foot out to get my knee to move straight forward. I asked the doc about this and he disregarded it. We'll see if itís an issue when or if I'm able to return to higher levels of activity. Other than that, recovery on this side is doing well but is noticeably slower than the previous one. Makes sense as there was a larger wedge opening made. I'm still using a cane but over the last week it's gotten a lot easier to go without it.

My main issue now is still the left knee (surgery #1). Prior to surgery #2, I still had complaints of crepitus with associated pain and swelling, so an arthroscopy was performed at the same time to further diagnose and debride some of the damaged patellar and trochlear cartilage. It feels like I'm much worse off now. There is a much more aggressive crepitus that is more painful accompanied by a burning sensation. Thereís also a bunch of scar tissue thatís formed underneath the portal incisions that are fairly painful. I stretch and massage them daily but it hasnít helped much. The difference in ROM compared to the other leg is about 5-10 degrees, depending on the day. And here's the kicker. We did new long-leg X-rays after #2 and it was discovered that this leg is back to about 5 degrees of varus. This was supposed to have been corrected to -1 last time, so either it wasn't, or the wedge collapsed and the bone healed in that position. Either way, extremely frustrating. Doc's response to this was ďWell we'll redo it if you're not happy with it." Again, weíll see if this is an issue down the road, but I currently have some medial joint line pain, so Iím not overly optimistic.

I'm now looking at finding a new surgeon to address the issue with my left leg. I've seen 2 different doctors closer to home and they suggested ACI. Neither have experience using it to address patellar lesions, so I am looking at traveling again. I've been in contact with Dr. Tom Minas' office at the Paley Institute and I was supposed to see him early in May, but this virus thing put that on hold. I sent him a punch of X-rays and paper work and I'm planning to get an MRI next week. We agreed to have a telehealth appointment once he gets the MRI to come up with a game plan, but it will likely be sometime in June or July until Iím able to make it to Florida.
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - October 2019
Post by: RGB on April 16, 2020, 11:08:10 AM
Hi Kczech. I speak from a position of no knowledge but considerable personal experience. I counsel careful thought before getting into the whole cartilage repair process, especially for the patella and trochlea, unless you're young and feeling lucky. I spent a 7 years of trying one thing and then another, strictly following rehab protocols, hoping for the best and having those hopes dashed. You can find my posts if you search. I've ended up with a PFJR and it's fantastic - not quite a natural knee but pretty good. For someone in their mid 50s and older with serious isolated patellofemoral issues that's what my evidence base of one indicates to be the best option. You have a lot of other stuff going on with your knees so this may not apply to you. I did a lot of research before trying various other procedures and they all looked promising at the time. However, in hindsight I don't believe any of the current cartilage repair options is sufficiently developed/successful to warrant the investment. I'm not talking about money but time, energy and hope. Feel free to ignore me - others have been luckier than I was, and I have no medical training. Good luck though - it's a tough problem to have.
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer - October 2019
Post by: kczech on April 16, 2020, 07:35:09 PM
Hi RGB, thank you for your message. Itís definitely not something I take lightly and Iím aware of the mixed results with cartilage repair on the patella. Thatís one of the reasons Iíve decided to go see someone who has arguably the best success rate for addressing these types of defects.

Iím definitely not planning to jump right into it. Iím still recovering from the last surgery and Iíd like to see what happens once Iíve had a chance to build my strength back up. For the time being, Iím just planning to talk to Dr Minas to get a sense of where my cartilage is at right now and what might become of it if I delayed treating it or tried to return to higher levels of activity. That is my ultimate goal and if itís not possible given where things sit right now, I donít really see another option. Iím not quite ready to call it quits and give up hope of returning to climbing at this point.

Iím sorry to hear that cartilage repair didnít work out for you. Youíre not the first Iíve heard from that has cautioned against it because of their experiences. Iím glad to hear youíre doing well with a PFJR though. I will see if I can find your posts about it. Best wishes!
Title: Re: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer: 10-19 & 2-20
Post by: kczech on May 21, 2020, 03:30:35 PM
14 weeks post-op 2

I had an MRI and a CT scan done on my left leg a few weeks ago. They showed significant scarring behind Hoffaís fat pad, medial compartment (thatís new) and PF chondromalacia, and damage to the lateral part of the quad tendon (likely from the arthroscopic incision from the last surgery). These all seem to mostly line up with the worsening issues Iím having. Since my last post, Iíve also lost the ability to actively extend my leg. It feels like it gets stuck around 45į of flexion due to pain and restriction underneath my patella. If I relax my quad, it can be moved manually though, albeit with a fairly prominent and uncomfortable ďclunkĒ. The lateral IT band pain is also back intermittently, so back to square one on that too it seems.

About 2 weeks ago, I started to notice a very dull pain in the lateral compartment of my right knee, which I assumed was just my knee getting used to the load distribution from my new 2į valgus alignment. A few days later, it suddenly became very sharp right beneath the anterior lateral joint line during a sort walk and I had to hobble back home. My physical therapist did a McMurrayís and Apleyís test and they were seemingly positive, which would indicate a lateral meniscus tear. I have an MRI next week to see if thatís the case. Before this happened, my right leg was actually doing pretty well.

Iím not going to physical therapy any more now because Iím still extremely limited on the types of things I can do, and what I can do Iíve been doing at home as often as the pain allows. Sometimes this means not getting off the couch for a day or two, and sometimes I can do straight leg raises, stretching, and other simple floor and balancing exercises for a few days in a row.

Iím at the point now where Iím beginning to regret going through with these surgeries. It seems like all the new issues coming up are direct and/or indirect results of them, the issue that started this whole ordeal is back, and Iím possibly looking at several more surgeries to get back to at least being able to walk comfortably again, let alone do any of the things I used to. One thingís for sure, I will never walk through the office doors of Dr Mark Sanders again.

Iíve had two virtual visits with Dr Minas so far and I am impressed by his thoroughness and general demeanor. Iím scheduled for arthroscopic surgery on both knees with him in mid-July to remove scar tissue, asses my cartilage (with a possibly biopsy for MACI), and fix anything else that might be amenable at the time. We also discussed the possible need to redo the osteotomy on my left leg at a later date because itís still at 5į of varus and now I have medial compartment damage.