Banner - Hide this banner





Author Topic: Upcoming Fulkerson's Osteotomy  (Read 1866 times)

0 Members and 1 Guest are viewing this topic.

Offline troysteris

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
  • Preach Always and IF Necessary Use Words.
    • Your Moral Compass
Upcoming Fulkerson's Osteotomy
« on: July 19, 2006, 12:22:36 AM »
Hello everyone. I am new to this site, but I have been reading different posts with great interest. My problem started in 1999 in my right ankle. I was diagnosed with Osteochodritis Dissecans of the right talus.

I canít trace back the causation event, but it originated, they think, from some previous traumatic injury. I had an arthroscopic procedure in which they ground down any jagged edge and did a retrograde drilling in the bone to allow new healthy material to form.  Alas, this procedure did not help me at all; in fact, it made things worse. Then in April of 2002, after changing OS, I had an open arthrotomy of the medial dome of the right talus done.  I felt better after this procedure, but not completely pain free.

My family and I relocated to the greater Cincinnati area in December of 2004.  This provided us access to a major medical university and great specialists (after all Cincinnati is the birth place of EMS).  I was referred to an OS who was supposedly the best ankle doctor around.  In April of 2005, he did a Osteochondral bone graft (OATís) procedure and birthed the new and dramatically more painful knee pain that I experience now.

I did my prescribed therapy and continued to see this OS for several months (he did improve my ankle, but I am still not pain free). I complained often and regularly that I had more pain in my knee then I ever did in my ankle.  I remember explaining prior to the OATís procedure in his office that I was a paramedic and being able to bend at the knee and bear weight on my knee was crucial and asking him if this procedure would jeopardize that.  He assured me that the bone would come from a non-weight bearing section of the knee and I would be fine.  Anyway, he would never take my knee pain seriously and kept telling me that more therapy would improve the problem.

Finally, I got tired of his flippant and dismissive attitude towards my pain and asked my GP for a referral to an OS who could help with my knee.  He referred me to the doctor who puts the Cincinnati Bengalís players, among others, back together.  He explained to me that the previous OS, who had done the OATís procedure, had taken the bone from a place that they (OSís) used to take from.  They had a great deal of people who came back complaining of the pain that I had.  He thought a proximal realignment procedure or lateral release might help and December of 2005 I went under the knife again.

This procedure did not help me at all.  My knee cap floats very freely now, but I never paid attention to how much or little it did pre-op so I canít say to what degree this procedure had on that.  The pain that I have experienced since the OATís procedure has changed my gait enough that now my right hip hurts.

I am working on a degree that is requiring me to do clinicalís and I will not be completed with those until the end of the year which bars me from having any new procedure done until that time.  The OS this week put me in a new brace that is supposed to restrict the side to side motion of the knee cap.  This brace is meant to help with pain in my knee as well as my hip.  The doctor does not think, however, that this will fix anything and has only prescribed it to get me through the end of the year.

He has suggested what he calls a salvage procedure called a Fulkersonís Osteotomy.  He said they experience success with this procedure about 80-85% of the time.  He said if it works it is a great procedure, but if it doesnít work then there is potential for a huge set back and extensive therapy and recovery time.  I havenít been able to find much detailed information about what exactly is involved and/or takes place in the actual procedure itself.  This forum has provided me a great deal of information about successes and failures, but not about what actually takes place.

Iím nervous about the prospect of this procedure.  I havenít had a great deal of success with any procedure to date.  In fact, I am so atypical, that my current OS uses my case to teach with.  How about that?  Some new doctor is learning how to fix people at my expense.  

My OS asked me to what degree does the current pain restrict my daily activity.  I composed the below letter in an effort to answer that question.  I guess my question to you guys isÖafter hearing my history and from your own experience, would you gamble on this procedure?  Or, do you know of any other procedures that might benefit me??



Date: July 18, 2006
Re: Follow-up to office visit

Dear Dr. OS:

Today, during my examination, you asked me if my right knee pain restricted my normal activity. In the interest of providing clarity to the extent of pain and restriction, I have decided to pen this letter.

Prior to the OATís procedure in April of 2005 my only complaint was pain associated with my right ankle.  Although I do have days where the pain in my ankle is debilitating, I have experienced improvement in my ankle.  However, this improvement has come at great cost in the debilitating and potentially career ending cost of dramatic and marked knee pain (worse pain then I ever had in my ankle).

I have tried most every kind of anti-inflammatory drug, different braces, and orthotics and I have followed a strict regiment of physical therapy with little relief or improvement.  I have been forced to ingest, nearly everyday and sometimes multiple times a day, Hydrododone/Ibuprofen and a complete change of lifestyle restrictions.  I have reached a point of tolerance to the narcotic analgesic where I require more and more of the drug to reach a therapeutic level.  I am fearful of this, because I do not want to reach a stage of addiction or dependence upon this.

The extent of restrictions include an inability to walk long distances especially while carrying extra weight and/or walking on uneven terrain.  I am unable to stand for long periods.  It is difficult for me to achieve and maintain a squatting and/or kneeling position.  I start to experience discomfort if I maintain a sitting position for too long a period.  Steps, even just to the second floor of my home, are often like climbing Mt. Everest for me.  As a prehospital healthcare provider, this has potentially devastating career ramifications.  This also makes finding employment very difficult, because itís painful to stand, walk, and/or sit and if I do any of these, I require frequent breaks.  Sometimes it is too painful to even get out of bed to do any tasks.  Short of dreary, damp days of high humidity there is no clear rhythm to the pain making planning and predicting events very difficult to do.

Other restrictions include my inability to do most aerobic exercising.  I canít practice soccer or other sports with my son due to the running, kicking, and terrain.  I had to buy a riding tractor to cut my grass, because walking on the slight incline and uneven terrain was painfully difficult.  The pain often affects my sleep.  It has even modified my sex life, because I have trouble bearing weight on my knee it is difficult for me to have sex in a missionary and other positions.  I used to play racquetball and hike outdoors a great deal, but those are impossible activities now.  I even bought a special queen sized bed that the head and feet can elevate to try to reach positions of comfort.

Of course, this list is not exhaustive, but it gives you an idea.  I canít believe that this is the standard by which I will be forced to live the rest of my life.  I have to believe that there is something more that can be done to permanently repair my knee and, if warranted again, my ankle and now the associated pain in my hip that has begun.

I hope this letter serves to answer your question and provide you with any information you may need in the future to demonstrate medical necessity.
Troy

Offline sharon74

  • Forum Faithful
  • ****
  • Posts: 403
  • Liked: 0
Re: Upcoming Fulkerson's Osteotomy
« Reply #1 on: July 19, 2006, 05:12:52 AM »
I am recovering from the Fulkerson's procedure myself.  My pain started to limit my activites which is what led me back to the OS.  I am now almost 9 weeks out and I am recovering very well.  The pain I had prior to surgery - for 3 months I could barely walk - is pretty much gone.  I have minimal pain now and I am able to go up and down stairs fairly easily.  My recovery is not the most common, I believe I am farther ahead than many at the same point.  But what I am trying to say is the surgery seems to have been a success for me.  I plan to return to skiing this winter and martial arts in October.
1990 - left knee exploratory - removed scar tissue
1991 - left knee LR
1993 - right knee LR
2002 - left knee LR
2006 - left knee TTT/LR

Offline willaustin

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
Re: Upcoming Fulkerson's Osteotomy
« Reply #2 on: September 11, 2006, 07:41:43 PM »
I too just had a Fulkerson knee realignment on 8/1/06, and six weeks out I'm progressing nicely. At first there's a significant amount of pain and discomfort associated with just about everything you do, but that only lasts about a month or so. The biggest burden for me was getting comfortable while in bed; it seems no matter how you lay you cant get comfortable. My OS told me today that I could discontinue use of my post op brace. I've been in PT for about five weeks, and I'm starting to really notice a difference in my muscle mass, as I lost 22 pounds in leg muscle after my surgery. But you have to realize I'm a 30 yr old male, and I'm very active and I have large quads and calves from where I tried to correct my sublexations without surgery. My OS basically told me that I have abnormally  narrow trochlear grooves in both knees, resulting in mal-tracking of my patellas. I have two more weeks on crutches, then another month of rehabilitation. After that, I'll be undergoing the same procedure on my left knee  :'(. But there are people out there with a lot worse problems then me, and I count my blessings. The biggest piece of advice I can give you is to swim (when cleared to). I still have a good amount of swelling so the water feels good, and it's really helped my flexability. My OS's only instruction was to do a tradional kick, and NO BUTTERFLY kicks. This has worked wonders for me as the pliometrics alone were not restoring my muscle mass, I guess my body got so accustomed to weightlifting, and own-weight resistance just wasn't cutting it.   
« Last Edit: September 11, 2006, 07:43:47 PM by willaustin »

Offline emphatic

  • Forum Faithful
  • ****
  • Posts: 365
  • Liked: 0
Re: Upcoming Fulkerson's Osteotomy
« Reply #3 on: September 12, 2006, 01:49:55 AM »
This has worked wonders for me as the pliometrics alone were not restoring my muscle mass, I guess my body got so accustomed to weightlifting, and own-weight resistance just wasn't cutting it.† †

I seriously hope you mean "isometrics" because no one on crutches should even attempt any plyometrics!   :o  ;)

Meg

Offline Arnoldplum

  • Regular Poster
  • ***
  • Posts: 55
  • Liked: 0
  • Easy does it.. but do it!
Re: Upcoming Fulkerson's Osteotomy
« Reply #4 on: September 12, 2006, 10:18:47 PM »



           But you guys, what actually is the fulkersons procedure.. what do they do??
         

Offline shade

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 3161
  • Liked: 0
  • An obstacle is often a stepping stone.
Re: Upcoming Fulkerson's Osteotomy
« Reply #5 on: September 12, 2006, 10:36:06 PM »
Antero-medialization (AMZ/"Fulkerson osteotomy")

Purpose and description of the fulkerson procedure:† This operation is performed to improve stability of the knee cap (patella) reducing the sensation of dislocation or giving way of the knee. It is also sometimes used for treating various forms of anterior knee pain (patello-femoral pain) syndrome. It involves releasing the tight tissue on the outer side of the patella (lateral release) and moving the bony attachment point of the tendon controlling the knee cap (patella tendon) into a better position. The effect of this is to hold the patella within its normal grove or track on the thigh bone, reducing the tendency for it to slide out of position to the outer side (lateral side). The tendon attaches to the tibial tubercle, which is the bony prominence below the patella, and the operation moves this forwards (anteriorly) and to the inner side (medially). It is then held in place with two screws, which usually do not have to be removed.

« Last Edit: September 12, 2006, 10:43:35 PM by shade »
July '05†(RK) - LR/debridement
Mar '06†(RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07†(LK) - LR + Fulkerson TTT

Offline cat

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1575
  • Liked: 0
Re: Upcoming Fulkerson's Osteotomy
« Reply #6 on: September 13, 2006, 03:23:20 AM »
Check this animation out-
http://www.kneehippain.com/patient_animations.php

You need to click on Knee and then click on tibial tubercle osteotomy.

 ;D cat  ;D
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-† 3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline littleone

  • MICROgeek (<20 posts)
  • *
  • Posts: 5
  • Liked: 0
Re: Upcoming Fulkerson's Osteotomy
« Reply #7 on: September 13, 2006, 04:04:16 PM »
Hi,

I am also from Cincinnati and had this procedure performed in April.  I had experienced the same pain almost EXACTLY prior to the surgery.  I now have a much more stable and reliable knee.  I am comfortable balancing all my weight on one knee without instability. 

My surgery was performed by Dr. Burger and Beacon Orthopedic and feel like I received excellent care.  I did have a complication with scar tissue that is fairly common with this procedure after an immobilization due to the osteotomy which was corrected two months after the initial procedure.

The recovery is very difficult and good physical therapy is a must, though I think after just a few months you will likely see a significant improvement.  I still have stiffness and soreness but I can tell those are not the same types of pains I felt prior and feel that it is just part of the healing process. 

Let me know if you have specific questions or need some local recommendations for PT or anything else.

Offline sharon74

  • Forum Faithful
  • ****
  • Posts: 403
  • Liked: 0
Re: Upcoming Fulkerson's Osteotomy
« Reply #8 on: September 14, 2006, 02:26:35 AM »
I am 4 months post op and progressing better than expected.  I am now able to do most activities with little to no pain where before I could barely walk (I am scuba diving, playing in bounce houses, roller blading, jogging, going up and down stairs)
1990 - left knee exploratory - removed scar tissue
1991 - left knee LR
1993 - right knee LR
2002 - left knee LR
2006 - left knee TTT/LR

Offline qtkatie013

  • MINIgeek (20-50 posts)
  • **
  • Posts: 36
  • Liked: 0
Re: Upcoming Fulkerson's Osteotomy
« Reply #9 on: September 16, 2006, 02:01:29 AM »
fulkerson was the WORST thing ive ever had to go through in my life.   i would try putting it off if you REALLY dont need it... have second, third, fourth opinions... i was on crutches for 3 months, had to take a semester off school, was in EXTREME physical and emotional pain for months on end.  i could not be left alone AT ALL.  i needed constant waiting on at all times.  i couldnt even get up to use the bathroom by myself.  sometimes i look back to see if it was really worth it.  i had to have the screws taken out about 6 months after... still pain... just had another surgery... still pain.  i don't think it ever really ends. 
20 years old
March 2004-Plica Removal
September 2005-Plica Removed (again), Scar Tissue Removal
January 2006-Fulkerson Osteotomy
August 2006-Screw Removal
September 2006-Orthoscopic
October 2006-Diagnosed with RSD