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Author Topic: Tibial Derotational Osteotomy Post Op Diary  (Read 6517 times)

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Offline j_smi001

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Tibial Derotational Osteotomy Post Op Diary
« on: May 10, 2006, 12:51:28 AM »
History - Noticed I had knee pain, clicking and swelling back in 2000.  By 2002 I had bilateral knee arthoroscopies to assit in the tracking of the patella.  Both knees had supra-patella and medial plica's removed as they were thickened and cuasing tracking problems, chrondroplasty and the right knee had a lateral release.  Following surgery I had good improvement in pain but my surgeon said that  TTT may benecessary in the future.  The underlying problem was that both knees were internally rotated - genum vulgus.  July 2004 pain in right knee gets increasingly worse and impacts on daily activities.  Get to see a surgeon in Februay 2005 and a derotational osteotomy is recommended.  This took place on the 7th April 2006.

I stayed in hospital for 6 days and then transferred to a convalencence home for three and a half weeks.  I had a post op follow up appointment on Monday 8th May 2006.  So far all transport has been on a strether in an ambulance.

Pre-op assessment three weeks beforehand.  Blood tests x 5, BP, pulse, urine, medical history, ECG

Day 1 - The ward I was told to report to at 7am had been closed so was taken to the day ward. I was allowed to lay on the bed unlike the day patients.  I was visited by my surgeon, the registrar, a doctor on the team, the aneathatists assistant and the aneathatist pre-op.
I signed the consent form and taken to theatre at 11am.

I came round in the recovery room at 3.30.  I had a hot air blanket over me but remember shaking uncontrolably.  The nurse said it was the aneasthetic and gave me an injection of pethadine to help with the shakes. The next time I woke up I was on the ward.  The surgeon came to see me much later and said everything had gone well and the knee had a very positive J sign under aneasthisia.  He had rotated the leg (Tibia) between 20 - 30 degrees acutely. 

Day 2 - Very groggy.  Noticed I had a needle in my right groin attached to a drip with a push button if I needed more pain relief (I didn't use it).  Given antibiotics through the cannula in my left hand.  The alarm kept sounding on the BP/Pulse monitor as my resting pulse is 47.   I had a drain in my knee that had a tube hooked through my big toe to a bottle.  I was in a very heavy plaster of paris back slab plaster.

Day 3 - Was told I would be in for 2 to 3 days so expecting to be released today.  Still on dihydrocodiene, diclofenac, paracetomol, asprin and oramorph plus the drip in my leg but they were trying to turn that down (very painful).  I was told this was a painful procedure but I never expected to come round feeling like I had been hit by a bus.  I did get my hair washed by a ward care assistant though.  I was also now getting up to go to the toilet once someone assisted to get the leg off the bed and put me on the chair.

Day 4 - Physio came.  I was given a pair of crutches.  Stood up on them took four steps, felt faint and put back to bed.  I didn't know then but that was to have been the full extent of the physio input.  Told transport was being arranged for me for Wednesday.  Surgeon came round and was very pleased with the outcome of the op.

Day 5 - Still sleeping a great deal.  Starting to manage the pain better as I get taken off the drip and the drain is removed.  Walked a few steps on crutches.  Given a toffee by another patients visitor and a back filling is promptly lost.

Day 6 - Morning of the transfer.  Ambulance booked for 10am.  9am projectile vomit and transport delayed by an hour.  No bowel movement so two suppositories given (50 minutes before travelling for 2 and a half hours) - story for another day but suffice to say I didn't make it!!!).  Arrive at the rehab centre and get taken to bed.  Was excused physio that day!!

Day 7 and the next three and a half weeks - at the rehab centre being thoroughly spoilt and looked after.  In a wheel chair to get about.  Have blood pooling in my foot.  12 days in I am desperate for a shower and have one with a leg cover - it leaked and I get the plaster wet.  Suffer it over night but in excrutiating pain the next day and get taken to Aand E where a new full plaster is fitted.  Had to have entonox as the foot droppoed and was too painful to bear (even with entanox).  Afterwards I knew I was developing a heel sore and the ankle /foot was too painful.  I decided to wait until I see my surgeon.

See surgeon 4 and a half weeks post op.  Happy with x-ray and shows two large staples in the tibia and good bone healing.  Can now partial weight bear.  New plaster fitted as I have a heel sore and more entanox as the foot drops again.  Excrutiating pain from the foot but at least there is some sensation along the outside of the leg even if the outside of the foot and two toes are numb.  Not much said about the foot drop other than they can heal and to return in three weeks time.  The plaster sould be removed then also.

The good news is I have no knee pain - bad news is I have bad ankle pain!!!  Early days yet.


2002 plica removal, chrondoplasty both knees and LR right knee. Derotational tibial osteotomy rt leg 07/04/06.  Awaiting for left leg to be rotated and have no more knee pain!

Offline dmcronin

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #1 on: May 10, 2006, 02:43:11 AM »
Ouch, ouch, ouch. I don't even know the full description of what you had done but it hurts me just reading the word. Here I am complaining about my ACL reconstruction recovery and then I look at your case and realize I better reevaulate the words pain and recovery! The thing that bothers me most is the losing the filling and the ankel; you go through all the trouble and pain to work on the leg and then you end up with ankle and mouth trouble. It really makes me wonder sometimes about the sense of humor of the folks up above. Do they somehow get their kicks by watching us writhe in pain and then adding side bits of pain and distraction just to see what we will do?

Take care and God Bless.

Offline j_smi001

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #2 on: May 10, 2006, 07:48:08 PM »
Thanks dmcronin,
Ouch does sum it up but it is getting better.
2002 plica removal, chrondoplasty both knees and LR right knee. Derotational tibial osteotomy rt leg 07/04/06.  Awaiting for left leg to be rotated and have no more knee pain!

Offline dmcronin

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #3 on: May 11, 2006, 02:20:10 AM »
Do you at least get a CPM machine at home to keep the knee moving slowly? I have one and it is really the only way I have found to be pain free for a couple of hours at a time.

Offline j_smi001

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #4 on: May 11, 2006, 10:42:38 AM »
Oh I wish.  I would love to be able to bend my knee, which I have not done since 7th April.  I am still in a full leg plaster of paris cast and for at least another three weeks.  No one has mentioned a CPM.  I would be in a much better position if the foot/ankle was not so sore.  The operation site has healed brilliantly and is only resonably sore not painful.  I get cramp in the calf and there is absolutley nothing I can do about it other than wait for it to pass.  I don't know much about foot drop but I am sure it will be OK just need a bit more time for the stretched nerve to heal.  I am fit and strong so I have a positive attitude - just the pain gets me down and also the inability to get out and about.  I just don't seem to be making the progress I should be - clearly I am milking this for all it is worth! 
2002 plica removal, chrondoplasty both knees and LR right knee. Derotational tibial osteotomy rt leg 07/04/06.  Awaiting for left leg to be rotated and have no more knee pain!

Offline dmcronin

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #5 on: May 11, 2006, 08:19:27 PM »
You certainly have a tougher road than me. At least I can flex so I can  hobble around the house a bit and curse all the inanimate objects that get in my way (when no one else is home, of course.) They should get a video of me; maybe a combination of Fred Sanford, Archie Bunker, and a one legged drunk stumbling around fighting with tables, socks, kid's juice boxes, and cats that are foolish enough to get within crutch range.

Maybe get a coathanger and use it to slide down the cast and rub/scratch?

Offline j_smi001

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #6 on: May 12, 2006, 03:10:14 AM »
A coat hanger - yep that sounds like an idea - I'll pass it by my surgeon when I see him again on the 22nd May! (Lol).  The wheel chair arrived yesterday but it is a bit like a Christmas present with no batteries and the shops don't open for another three days - there is no leg extention and the ramps have arrived but not fitted.  The OT has been exceptional, particularly as she brought the wheel chair round on her day off!!  how is that for a service.  I am hoping the plaster cast will come off Monday week and the foot drop will have improved so I won't need it.  I have been told I can start to partially weight bear now although the sensation in my foot is wierd and the pain afterwards quite something else but I will do it if it will make the foot work properly.  No point having a non painful and fully functioning knee for the foot to take its place.  Still i was concerned that I was making too good progress and may be well enough to go back to work before the final of the world cup but fortunately it looks like i will be off for the duration (yipee).  How is your progress going?
2002 plica removal, chrondoplasty both knees and LR right knee. Derotational tibial osteotomy rt leg 07/04/06.  Awaiting for left leg to be rotated and have no more knee pain!

Offline dmcronin

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #7 on: May 12, 2006, 04:22:43 AM »
In my case I had three things done:   ACL reconstruction with allograft, partial menisectomy, and chondoplasty to smooth out a divot in the bone somewhere. So, not nearly as hard core as you!  I am keeping a blog about my recovery so feel free to visit and comment: I try to update it daily and have been good about it so far.  There is no www,   just     http: slash slash blog.nomans.us  (for some reason when I try to put in a slash this message board opens a search window so I had to spell them out).

Anyway, in mys case they wanted me weight bearing and flexing from day one. I went kind of overboard on day 3 and then on day 4 I thought I would die. By now, at day 9+, I am free of the constant pain and in the middle of ROM work and stretching. It looks and feels like there is a chunk of hardened cement just above the kneecap that is all swollen whatever and is killing my ROM!

I have had good service as well. The day before my surgery a company called Surgicare (I live near Boston, MA and I think they are a local business) came to my home to deliver the CPM machine (keeps the knee bending back and forth for hours at a time), the cryocuff with pump and ice cooler, crutches, and my leg immobilizer or brace. They spent about 45 minutes setting up, adjusting and fitting, and running me through everything. They have called since to ask how I am doing and will come to pick up the devices when I am done with them. My recovery room nurse has called to check in as has my surgeons office. I certainly do NOT feel like just a number. Even my insurance sent a letter letting me know up front what they will cover (almost everthing).

Hey, where are you at:  UK somewhere? I ask because I am going to Glasgow the first week of June (assuming I am ready!) and then driving or railing to London from there and then home. This is a business trip but I always  like to ask folks for tips of anything I should check out with any possible open slot.


Offline j_smi001

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #8 on: May 12, 2006, 05:42:49 AM »
Yes I am UK.  I live in the Midlands so nowhere near Glasgow or London.  Where I live it is very rural and so we don't tend to get too many overseas visitors.  You appear to be making good recovery and I will visit your blog site.  I am just starting to develop my site but it won't be about my dasterdly knee or ankle.  You take good care and don't overdo the exercise, everything in moderation.  I am awake in the early hours of the morning as there always appears to be at least one hour at the end of the pain meds - a bit like there is always one week left at the end of my pay packet !  BUT I have ad a twitch and movement in my toes so I am quite sure this is good.
2002 plica removal, chrondoplasty both knees and LR right knee. Derotational tibial osteotomy rt leg 07/04/06.  Awaiting for left leg to be rotated and have no more knee pain!

Offline dmcronin

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #9 on: May 13, 2006, 04:59:44 AM »
Twitching is good.  Twits are decidedly bad but twitching MUST be good so keep twitching.

Do you have someone to help you at home for the first few weeks?  I found that for the first week or so I wanted to be alone a  lot and just zone out but then I wanted to get reconnected back to start feeling normal again. My wife has been doing everything for the house including getting me my ice bags and helping to re stock my little zone; food/drink/medicine/radio/papers/clothes/etc.  My mother has helped out a lot by watching the kids (4th grade or "form" and kindergarten) a lot and having them for sleepovers like tonight. It has helped me a lot.

Offline j_smi001

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #10 on: May 13, 2006, 06:32:08 PM »
Yes your are right twitching is good.  I have a posie of very good neighbours and friends who have a done a sterling job of keeping me fed, watered and clean.  I would not have coped without them so very pleased they have been around.  I know what you mean about having your own space as sometimes I feel it is all too much for me.  This site has been of great support.  Hopefully just one more week to go in a full leg plaster and that being removed will make all the difference.  Keep smiling whilst rehabbing Take care Jak
2002 plica removal, chrondoplasty both knees and LR right knee. Derotational tibial osteotomy rt leg 07/04/06.  Awaiting for left leg to be rotated and have no more knee pain!

Offline j_smi001

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #11 on: May 19, 2006, 02:55:46 PM »


I don't know whether this will work but have tried to attach piccies of progress to date - you'll see I still have a problem with blood pooling in my foot so have to keep it elevated as much as poss.
2002 plica removal, chrondoplasty both knees and LR right knee. Derotational tibial osteotomy rt leg 07/04/06.  Awaiting for left leg to be rotated and have no more knee pain!

Offline dmcronin

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #12 on: May 19, 2006, 03:03:29 PM »
That looks painful. I wonder if you could wear some sort of foot pump; a balloon like thing that squeezed regularly to help pump blood back out of the foot.

Offline j_smi001

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #13 on: May 19, 2006, 03:07:41 PM »
Good idea.  Hopefully the plaster will come off Monday so I will not be so restricted and be able to mobilise the foot more.  Nicely painted toe nails though!!  The blood pooling has not helped in me getting up and about as it is painful but to get up and about would probably help - so a bit of a vicious circle really.  I try to flex my calf and I manually move my toes about as much as possible.  Doing it right now in fact and that must help.  How are you getting on with your recovery?
2002 plica removal, chrondoplasty both knees and LR right knee. Derotational tibial osteotomy rt leg 07/04/06.  Awaiting for left leg to be rotated and have no more knee pain!

Offline dmcronin

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Re: Tibial Derotational Osteotomy Post Op Diary
« Reply #14 on: May 19, 2006, 06:36:19 PM »
I have no cast so I am chugging along well. The toughest part is feeling like the main part of the surgery pain is over and being frustrated that I am not just back to normal like already. The knee is letting me know that it is now the master and will be for some time to come!