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Offline whitey85

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osteotomy
« on: June 24, 2007, 02:17:30 AM »
hi all... I am new to this site but have already found it helpful to read some of the posts so here goes...
i am 44...have spent 30 yrs playing sports, running, soccer etc.  I have had my right knee scoped a little over a yr. ago...a small meniscus tear was removed, some bone chips etc.  apparently i had pretty extensive wear and tear..medial side. since then my pain in the medial area is insane.  After the procedure the medial area never felt any better, but has even become worse.  I cannot run 2 steps.  I have been through some injections(prior to the first surgery)...wearing a brace to overload the outside of the knee(slight relief)..but the pain is horrible...So....my choices seem to be TKR(too young), PKR, or osteotomy... I have recently decided to have the osteotomy procedure done at the end of august.  I am very nervous about it...I don't know what to expect for recovery...surgery..etc.  I am wondering if anyone has any experience with this surgery out there..I'm trying to be as prepared as possible.  This procedure is basically to 'buy time' until a total knee replacement ...  i would like to think i could return to some of my active lifestyle, but i don't know if that is realistic..

Offline trish85

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Re: osteotomy
« Reply #1 on: June 24, 2007, 05:29:08 AM »
Hi Whitey
what type of osteotomy would they be doing? There are many good threads on here about them.  Does your patella come out of place at all or any other symptums of giving out?
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Offline jathib

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Re: osteotomy
« Reply #2 on: June 24, 2007, 01:27:57 PM »
A few years ago my doctor told me I needed a femoral osteotomy (my lateral meniscus is gone, medial is intact). He said it would buy me 7-10 years before I would need a TKR. I did a lot of research and decided I didn't like the idea of having my leg realigned. I also read a lot of articles that said it's much harder to convert an osteotomy to a TKR then my doctor let on.

Anyway, five years later I went to another surgeon. By then I was almost 49. He told me I was what they called a "tweener". At that age they can do either an osteotomy or a PKR. Either has the potential to buy me up to 10 years before a revision or TKR. By then I had done enough research that I decided I wanted a PKR. There's no doubt I will need some kind of revision in my lifetime but my doctor said that 10 years from now there will be new advancements in knee replacements. It is much easier to convert a PKR to a TKR than it is an osteotomy.

I had the PKR last December and so far I'm happy with the results. I have very little pain and I'm back to swimming and mountain biking. A PKR is probably not a good idea if you're still wanting to run and play soccer. They really aren't meant to take that much pounding. In that case an osteotomy might be better. 

Offline whitey85

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Re: osteotomy
« Reply #3 on: June 24, 2007, 04:21:16 PM »
hi trish...
my damage is all in the medial compartment...so i know the 'wedge' would be from the lateral side...not sure of the exact type they are calling it.  I have another appt. 8/10... there are no patella issues etc., just 24/7 pain in the medial region.  i am leaning towards the ost. hoping I can get back some of my very active lifestyle.  I asked my surgeon if this procedure or the pkr was better as far as heading into a tkr later...and he felt confident that either procedure would set up the tkr without too many complications.   at this point it hurts to walk, stand, sleep  :-[     i am a bit concerned about the rehab... I was hoping to take a short trip 4 weeks post op...and it sounds like it might be tough.  I am a pro unfortunately on crutches...as long as the pain was ok by then...i think i could be ok...
thanks for your response!   :)

Offline whitey85

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Re: osteotomy
« Reply #4 on: June 24, 2007, 04:23:52 PM »
hi jathib... thank you for your response.... i'm glad to hear your pkr is doing well.   I guess wanting to get back some of my lifestlye is what is leaning me towards the osteotomy...  i don't know if that plan will work or not...time will tell :-\

Offline UK Girl !

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Re: osteotomy
« Reply #5 on: June 24, 2007, 04:33:49 PM »
Hi Whitey

years back my old old OS suggested that I have an High Tibia Osteotomy - which all was be planned for until he found that my arthritis was too far gone - he said he could do it but didn't know how long it would help me for and that he would NOT be able to follow it with a TKR- this was all 10 yrs before my TKR.  Obviously things have changed in the last 10 yrs as to procedures and 'parts' they use - only you can know how much trust you have in your OS. This OS that was treating me then was also the guy that decided against me having carbon fibre ligaments done to replave my ACL - good call in the long run!

Good luck!

anj
1978 - ruptured acl and all cartalidge removed.
several debridements over years
TKR 10TH JULY 2006 http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=28257.0  Aug 07 patellar maltracking - more physio! Still pain - but so much better !
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Offline whitey85

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Re: osteotomy
« Reply #6 on: June 29, 2007, 03:39:21 AM »
hi all...another question..even though my surgery is 8weeks away..i'm still always thinking about it.  is there anyone out there that has had this procedure?  i'm curious what the recovery/ post-op is like...thanks! :-\

Offline PaulAMartin

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Re: osteotomy
« Reply #7 on: June 29, 2007, 05:28:37 PM »
Whitey85 - i hope all goes well with your op - i to have to make a decision at some time, as my left knee is getting worse over the years ( motor bike accident when i was 18 - now 44 ). I have wear on the inside of my knee via arthritis - so they suggest a HTO but as my knee is unstable - my posterior crutiate is knacked - bit worried about the whole thing. Do you chose a HTO  or PKR ?? blimey, they don't make it easy.

Offline whitey85

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Re: osteotomy
« Reply #8 on: June 29, 2007, 09:42:05 PM »
hi paul...i'm going with the hto.. i'm hoping to get back to being able to work out more etc...i had run for 20+ years..plus soccer etc.  Now I cannot run 3 steps  :'(  The pkr would be a bit more limiting as far as future activity level i think..  I'm hoping that this procedure will be successful.  Either way, I am trying to buy some time before a tkr  :(
I do not have any problems with stability etc., just bad pain in the medial area of the knee.  The lateral side is ok so far, so I am a candidate for the hto ...  none of it sounds fun to me! :-\
thanks for the response..and good luck with your knee!!

Offline kneedy8

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Re: osteotomy
« Reply #9 on: July 07, 2007, 10:42:05 PM »
I am having an open high tibial osteotomy in Sept and am concerned as you are. I know of at least one professional hockey player that had this done by the same surgeons as I have and he went back to playing professional hockey.  :) They told me that there are occasions where a TKR is not needed after this surgery and it is now no more difficult to do. :)  I do think it matters what kind of HTO you are having done...ie. closed or open and on which side it is being done. I would recommend a femoral nerve block before your surgery as this apparently really, really, helps with the post op pain for a day for two after. Do you know how long you hospital stay will be? I have been told 1 or at most 2 nights. It seems that everyones experience is a little different. Some have said the procedure is not too bad and others have indicated it is very brutal, so lets hope for the "not too bad" experience!

Offline brattkids

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Re: osteotomy
« Reply #10 on: July 08, 2007, 07:58:50 PM »
Hi there.

My husband had an osteotomy in May of 2003 and it lasted only 3 1/2 years. He now needs a TKR desperately but is having issues with being able to get the TKR due to the osteotomy. The TKR has to be done differently due to the bone weakness caused by the osteotomy and placement of the wedge. OS told him that the stems from the TKR may not anchor as well. He was in the same boat with severe pain on the medial compartment. He could barely walk. He decided on the osteotomy due to his high activity job. He now will get a weaker TKR that may not last as long. I think he may have chosen the PKR if he knew more about the risks for TKR later.

Best of luck to you

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Offline kneedy8

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Re: osteotomy
« Reply #11 on: July 08, 2007, 09:26:09 PM »
I haven't heard that there is bone weakness after a osteotomy, so that is definitely a question I am going to ask when I see my OS next. I understood it used to be a problem doing a TKR after a osteotomy but with the recent techniques it is not. I will definitely ask about this! I am not a candidate for a PKR as I do not have an ACL and apparently it is needed for that operation. I could have it replaced, but do not want to deal with 2 operations, and I am not having any stability problems. There is never any guarantee I guess, on how long a HTO will last.

Question to Brattkids: How did you husband find the HTO operation and the recovery from it?  ??? Thanks!

Offline brattkids

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Re: osteotomy
« Reply #12 on: July 10, 2007, 06:26:24 PM »
The recovery was 6 weeks non weight bearing on crutches and it was really painful for the first about week. After the first week it was more of a bother not being able to walk. Not much pain after that. He did have problems with the hardware and had to have it removed at the one year mark. It was causing bone pain when it got damp and cold.

As far as the pain in the medial compartment until it collapsed it was ok.

Not sure what else you want to know but any questions I will be happy to answer

Paulette
4/04 microfracture
5/04 debris removal
8/04 OATS with synthetic plugs
11/04 OATS traditional autograft medial femoral chondyle
05/05 debris removal and OATS assessment
6/05 Cadaver Allograft OATS lateral femoral chondyle
9/05 OATS redone could not save allograft plug
12/2006 2007 and 2008 scop

Offline kneedy8

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Re: osteotomy
« Reply #13 on: July 11, 2007, 12:28:15 AM »
Hi Paulette

Did your husband have a femoral nerve block? How long was he in the hospital and how long did he need someone around to help when he got home? Do you know what meds he was on and did they control the pain? Did he have a general or epidural? When and what caused his osteotomy to collapse? Sorry for all the questions...but would like to know all I can. Thanks so much!

Offline kneeswontplease

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Re: osteotomy
« Reply #14 on: July 11, 2007, 01:35:28 AM »
Here's  a new alternative to the total knee replacement.   

http://www.bizjournals.com/memphis/stories/2007/07/09/daily3.html?from_msnbc=1

best of luck, kneeswp