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Author Topic: Tibial osteotomy - any experiences?  (Read 4695 times)

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Offline KJ

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Tibial osteotomy - any experiences?
« on: May 08, 2003, 09:27:43 PM »
I now have a date for a tibial osteotomy and possibly a combined posterolateral procedure at the same time. This is my 6th surgery along with my ACL reconstruction, PCL reconstruction, MUA and 2 arthroscopies to try and give some stability to a knee trashed with a simple fall whilst skiing 2yrs ago (nearly all ligaments ruptured)

I know there have been postings in the past but I wonder if anyone is currently facing similar surgery. I know that most people now have an opening wedge osteotomy and that most OSs prefer to delay a posterolateral procedure to a later date, whereas my new OS wants to do a closing wedge to access the lateral side of the knee and allow him to attack the posterolateral side.

Any thoughts on this and also how long you spend on crutches and need off work?
KJ
ACL/PCL/MCL/PLC rupture April 01
diagnostic arthroscopy June 01
PCL reconstuction Sept 01;  MUA  Oct 01
ACL reconstruction Nov 01; arthroscopy Jan 03
HTO,posterolateral recon + ACL/PCL revision recons Sept 03;
MUA Jan 04
arthroscopic debridement of scartissue May 04
metalwork removal April 05

Offline lam651

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Re:  Tibial osteotomy - any experiences?
« Reply #1 on: May 09, 2003, 07:47:13 PM »
Hi KJ,
I had a high tibial osteotomy in Oct. 01. It was to correct an arthritis problem I have causeing bowed legs and bone on bone contact on the inside of my knees. My surgery was just an osteotomy with no ligiment work or anything else done. So my surgery was different than what you have coming up. I'm having an osteotomy done on my other leg probably in June.
My first osteotomy didn't heal. I was told I was one of those 3% where the bones don't heal. So to correct that I currently have an external fixator on that leg. Typically I believe you can plan to be non-weight bearing on that leg for about 6 wks.
I would plan on a long time off for recovery. If you have a job where you sit all day, maybe you can go back on crutches.
The doctor that is doing my osteotomy in June says he does about 150-200 osteotomies per year. I think it's best to have someone experienced doing this surgery. I don't think I would have had so much trouble on my first osteotomy If I had gone with a better surgeon. Good luck, Larry
arthoscopy('99),HTO(tibia didn't heal 10/01),knee braces(7/02),HTO w/ex.fix. to repair tibial non-union(3/03), remove ex. fix.(9/03),HTO other leg(12/03)

Offline amazonia

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Re:  Tibial osteotomy - any experiences?
« Reply #2 on: May 11, 2003, 07:34:07 AM »
Hi KJ - as you know I had a HTO (opening wedge) in Dec. '02.  I was told no weight bearing for 8 weeks, although I started some weight bearing sooner than that.  However, I was only off work for 4 weeks, as I was able to go back with crutches, and joint mobility wasn't an issue since they didn't go into the joint.  If you're having both procedures at the same time then I'm sure the recovery part will be harder, since your surgeon will also be accessing the knee joint - not just the bone.  My PCL/PLC reconstruction is slated for May 22nd, but I re-injured my knee last week, so will find out on Monday if the surgery has to be delayed.  I was ready for the PCL/PLC reconstruction 3 months post HTO, but there was no way to get me in, so I've had to wait another 3 months.  I guess it's been such a long wait (since Jan '02) that it was only a matter of time before I re-injured my knee.  After the initial injury/surgery I was off work for 2 1/2 months, and then only went back part time to start, as I was doing physio 3X/week.  My surgeon felt that doing a HTO combined with any ligament reconstruction was too much surgery at one time, which is why he did the HTO first.  Don't know if any of this helps you in your situation - and I hope it all goes well!  When is it scheduled for?
Jan. '02 - complete tears of the ACL/PCL and PLC - emergency surgery to repair them;  high tibial osteotomy Dec 5 '02; May 22nd 2003 reconstructive PCL (allograft) and PLC (hamstring tendon).  No ACL reconstruction as I retore it 3 weeks prior to surgery.  No ACL/ loose knee but little pain!

Offline KJ

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Re:  Tibial osteotomy - any experiences?
« Reply #3 on: May 11, 2003, 03:28:45 PM »
Hi
I'm scheduled for September 12th. (I chose not to have it done over the summer when I ;ve got too much going on and its not convenient for work)
I've got a lot of questions to ask the surgeon next week - I've a lot of misgivings about so much surgery at once
KJ
ACL/PCL/MCL/PLC rupture April 01
diagnostic arthroscopy June 01
PCL reconstuction Sept 01;  MUA  Oct 01
ACL reconstruction Nov 01; arthroscopy Jan 03
HTO,posterolateral recon + ACL/PCL revision recons Sept 03;
MUA Jan 04
arthroscopic debridement of scartissue May 04
metalwork removal April 05

Offline Golfer

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Re:  Tibial osteotomy - any experiences?
« Reply #4 on: May 12, 2003, 11:21:12 AM »
Hi,

I had two high tibial osteotomies. My first was a complete failure because my first os was incompetant. This was about 15 years ago. My left leg was bowed more than my right and needed to be corrected. Unfortunately, I wasn't an advocate at the time and went to a surgeon who used an outdated procedure with a big staple.

As a result of the surgery, I had a major hematoma and the nurse at the hospital (which has since been closed down, thank God) decided that I should walk the day after surgery. As a result of her forcing me out of bed, my peroneal nerve was damaged causing foot drop palsy. I was lucky though in that the paralysis lasted for 11 months and function was restored to my leg.

Unfortunately, after going through all of this, the osteotomy was a botch. The bone was left at the original angle and still just as bowed.

I then had Dr. Russell Warren at Special Surgery in New York take over. He did my second high tibial osteotomy about a year and a half after the first one and the results were amazingly good. First, he didn't use archaic staples or old procedures. Second, there was no complications. Third, the healing was about 6 weeks--about twice as fast as my original botch job.

Dr. Warren's surgery was about 15 years ago and I never had a problem again.

However, as a result of wear and tear over the years (and a botched up meniscus surgery (by a doctor whose name I won't mention--I no longer had insurance to cover Dr. Warren or I would have continued with him), my patella no longer tracks properly and as this  last doctor removed cartilege that wasn't problematic from an area he wasn't supposed to operate on (I was awake though drugged throughthe procedure and watched him butcher my knee), presently my knee is a mess.

The point of all of this is: make sure you go to an OS who is reputable, has a great track record and operates from a top hospital. My second surgery was with a top surgeon in a top hospital and I got great results. Be careful to find recommendations from "top doctor" books because some of my medical colleagues have informed me that all you need to be listed in some of these is having another doctor offer your name as sponsor and pay the publisher $500. That's almost criminal in my book.

I am still trying to find a source that objectively rates doctors so that patients get a true opportunity to be advocates for themselves. I wish there was a public ratings book for surgeons like Zagat's is for restaurants in that I would trust the statements of patients a lot more than the old boy's network.

Regards,

Golfer