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Author Topic: High Tibial Osteotomy (UK)  (Read 3206 times)

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Offline glasgowgirl

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High Tibial Osteotomy (UK)
« on: August 27, 2007, 03:44:21 PM »
Hi Everyone!

I'm brand new here, this is my first post. You all seem pretty normal, so I've decided to join in.

Anyway, I was just wondering if anyone 'out there' has had this procedure done? Like everyone else here, I've had my fair share of knee issues over the last few years, and have osteoarthritis in both knees. I'm (only) 30 so my treatment options have been limited as my surgeons are very reluctant to start down the knee replacements road as they'll just spend the next decades replacing them and obviously that's not ideal for anyone.

To cut a long story short, I had my left High Tibial Osteotomy done 13 weeks and 4 days ago. I think I'm making good progress but it's really hard not knowing if I am as I can't compare myself to anyone as it's not a commonly performed procedure. I just wondered if anyone else here has had the same op and how they were doing at this stage (3 months).

I'm still off work and don't see my surgeon again for another 3 weeks. The last time I saw him 3 weeks ago, he seemed a bit concerned with my xrays although he denied it when I asked him if he was worried. I came away feeling disappointed as he gave me another 6 weeks on cructhes and I really thought I'd be off them and possibly back at work by then. The movement in my knee is great - bending it is easy and not at all painful. I can't straighten the leg completely but get pretty close. I'm still on crutches and walking okay with them over reasonable distances. I was non-weightbearing for the first 6 weeks and have been walking for 7 weeks now and I've never had any brace or anything on my knee.

I think, the bottom line is I'm writing this message hoping for a wee bit of reassurance that I'm doing okay or any suggestions as to anything else I could or should try. 

Offline migde

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Re: High Tibial Osteotomy (UK)
« Reply #1 on: August 27, 2007, 05:04:41 PM »
Sorry to hear about the problems, and unfortunately I can't really help you out with it. I'm sure someone will though.

Just noticed your user name as most people on here are from the States. Can you recommend any OS in Glasgow?? I'm from Aberdeen and have seen a couple here, but the best one only works on the NHS and I don't think I can bear to go on the waiting list for a year or so....

Thanks

Gordon

Offline kneedy8

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Re: High Tibial Osteotomy (UK)
« Reply #2 on: August 27, 2007, 09:53:19 PM »
Hi: I am having this surgery Sept 12th. There is alot of information regarding HTO's under the arthritis dept, changing the forces through the joint and the post-op section. I would like to know more about your experience thus far. No brace?  ??? Did you have an open or closed HTO?

Offline glasgowgirl

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Re: High Tibial Osteotomy (UK)
« Reply #3 on: August 28, 2007, 01:32:06 PM »
Thanks for your messages.

Midge, I had my operation at the Jubilee in Glasgow (national waiting list hospital) Unfortunately, you can't refer yourself there, but have to be referred by your current nhs consultant. I would highly recommend it - the whole experience has been great - I honestly can't fault a single thing. Everyone is pleasant and helpful and there's just a nice atmosphere to the place. I know they treat people from all over Scotland.
As for waiting a year for surgery, I think it is unlikely you'd have to wait that long. Hospitals all have to work to the govenrment targets...  Once you've been accepted or listed for surgery, there's this magic 18 week target figure that hospitals get fined if you breach. The Jubilee seems to be an option for patients who are about to breach.  I'm a bit relucatant to start posting names of individual surgeons here, so if you want more info, please email me through my profile page.

Kneedy8, I'm not sure what exactly you want to know! I had an open procedure and no, I've never ever had a knee brace! Ask me more and I'll try to help you out.

Offline Doc79316

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Re: High Tibial Osteotomy (UK)
« Reply #4 on: August 28, 2007, 02:50:19 PM »
Hi All,

I had TTT/HTO surgery in 2003 at 29. Now I'm going down the road of knee replacement surgery because it all went pear shaped, but that's another story.

It sounds as though your rehab is going OK. Have you started any physio yet? When you do, feel free to push yourself, to try just that little bit harder. You won't do yourself any more damage at the moment - if you overdo things, it'll hurt enough for you to stop long before you can do any damage! At this stage in your rehab you may have very little pain but you still have a long way to go to regain full fitness. With any lucj, your quads/VMO were relatively strong before you had the surgery.

The fact that you didn't have a brace isn't necessarily a good or bad thing. Each OS has their own protocol for treatment and rehab and there are always pros and cons for both sides of the argument. I didn't have one, with the thought that my quads may weaken further. Having said that, I've had a few operations where I was splinted for a few months at a time but it doesn't take long to regain the muscle strength.

If you feel that your knee is particularly weak or you're not happy to carry out certain physio exercises then it's OK to wear maybe a hinged brace during formal rehab. These braces give a lot of support to both sides of the knee joint whilst allowing full ROM at the same time. In addition, you may find hydrotherapy is helpful. It usually makes the exercises that little bit easier and will definitely help you to regain confidence in the operated knee.

If I can be of any more help, please feel free to ask anything, e-mail or IM me.

Take care,

Laura x
Left knee surgery
08/06/02 - L/Release
13/08/03 - Fulkerson TTT
05/06/05 - Stabilisation & Medialisation/Tendon Transfer
13/01/06 - Proximal Hamstring Superior Stabilisation
06/03/06 - RSD/CRPS diagnosed
20/07/06 + 03/04/07- Excision of scar tissue
30/07/07 - PKR suggested by OS (no date yet)

Offline kneedy8

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Re: High Tibial Osteotomy (UK)
« Reply #5 on: August 28, 2007, 09:46:07 PM »
Hi Glasgowgirl: Questions:  ???  ???  ???

Did you have a general or epidural and why?

How did you find the post-op pain and how was it controlled?

How long were you in the hospital?

What kind of plate do you have?

What degree of correction did you need?

When did you get off your meds?

Ummm....I think that is it for now......I'll probably come up with some more!  :D

Thanks!

Offline glasgowgirl

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Re: High Tibial Osteotomy (UK)
« Reply #6 on: August 28, 2007, 10:52:03 PM »
Hi Kneedy,
I can answer some but not all of them!
I had a combined spinal and epidural which was great. It is the preferred anaesthetic route for orthopaedic surgery in that hospital and I was really keen to have one too. During the op I had a very light anaesthetic for sedation too. I had a really good experience and would definately go for the same combination in the future. My first night post op wasn't much fun as the spinal anaesthetic had worn off and my epidural got dislodged and stopped working so I ended up on a PCA morphine pump which wasn't very nice although it did work. The first 3 or 4 weeks post op were quite sore and uncomfortable, but now, 10 weeks on from then, I have almost completely cut out all my painkillers and only take them occassionally, and usually for my 'good' other knee. I was in hospital for 6 days. I don't know what the plate is called - it's kind of long and flat and has 4 screws through it. I can't describe it! I also have no idea what degree of correction I needed - I've never even thought to ask that!!!
Hope this helps. I would have loved to have had the opportunity to ask someone who'd been through it all this stuff beforehand so please don't hesistate if you think of more.

Offline kneedy8

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Re: High Tibial Osteotomy (UK)
« Reply #7 on: August 29, 2007, 12:35:58 AM »
Thanks Glasgowgirl! Okay I was really wondering about the anaesthetic as I have to decide which route to go. That is good information as I have siding towards the spinal route. Just a few more questions. Where you asleep with the light sedation during the entire surgery? Just not sure I want to hear the "saw".  :(

How long were you on the morphine pump?

6 days in the hospital...wow. They are telling me 2 or 3 days...sure doesn't seem like much!

Yes this site has been wonderful...don't know where I'd be without it.

My surgeon uses a smaller "pudda" plate for small to medium wedges and a larger "tomofix" plate for the larger ones. He thinks I can get away with the pudda plate. I'm glad... :D

Am surprised you had no brace...I have to wear mine for 15 weeks. I am sure I will be glad to get rid of it by that time!  ;)

Offline glasgowgirl

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Re: High Tibial Osteotomy (UK)
« Reply #8 on: August 29, 2007, 10:43:29 PM »
Hello again!
Kneedy, yes I was properly asleep with the sedation drip during the operation so don't worry about hearing the saw, drill whatever! I vaguely remember talking to my anaesthetist at some point during the op but he must have turned the sedation up after that. I had a really good experience. My epidural just fell into place first time and wasn't at all as uncomfortable as I was led to beleive. The morphine pump was only for a few hours from the middle of the night to the next morning but it let me get some sleep. I did feel pretty groggy and woozy the next morning but was a lot more comfortable. I was a bit disappointed the my epidural gave up on me so early as I believe it would have been left for a couple of days post op for pain too.
I was also surprised at the 'no brace' thing, but I guess it is surgeon's preference and mine was definate that he did not want one.
Hope that's helped a little.

Offline kneedy8

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Re: High Tibial Osteotomy (UK)
« Reply #9 on: August 30, 2007, 12:36:55 AM »
Thanks again Glasgowgirl...so you started this thread to get some help/advice and you ended up helping me!  ;D

I do hope you get the advise you need from someone here...there are lots of good, well-informed people on this site, so I am sure someone can help you out. Did you check out the other threads I mentioned? There is one by knee-will-be-great describing her post-op and recovery experience after an HTO that is very positive...check it out.

Am definitely thinking the epidural/spinal route now. Thanks again!  ;)

Offline glasgowgirl

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Re: High Tibial Osteotomy (UK)
« Reply #10 on: September 03, 2007, 04:39:56 PM »
Hi again!

I don't think I'm looking properly, but I tried to find the threads or info mentioned there by 'knee will be great' but I can't seem to find it on the site.
If someone could point me further in the right direction I'd be very grateful.

My knee continues to be good (I think) I was away for the weekend with friends which was like a test of how well I could cope without my family around to help me. It went really well. I got lots of help and managed fine. Made me feel a lot better about myself. Had a fair amount of walking to do and although I'm 'good' at walking, I'm not very good at walking for long if that makes sense. I found I would start off walking at the same speed as the others (not that fast) and then I'd be exhausted 2 minutes later!  I realised I need to start off at the speed I currently end up at - like take it slower to begin with and just take longer.

I can't wait to ditch the crutches though - will be fab!

Offline CASS

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Re: High Tibial Osteotomy (UK)
« Reply #11 on: September 04, 2007, 07:35:43 AM »
Hi: I am having this surgery Sept 12th. There is alot of information regarding HTO's under the arthritis dept, changing the forces through the joint and the post-op section. I would like to know more about your experience thus far. No brace?  ??? Did you have an open or closed HTO?

in the UK you'll find alot of surgeons dont give braces anymore,except in some cases for major ligament work, the whole braces question was one i asked the surgeon myself, reason being they see them as a tool for slowing recovery down, the same for crutches as well.  and research has shown if you use braces you will have a slower recovery the same for over use of crutches.

Offline CASS

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Re: High Tibial Osteotomy (UK)
« Reply #12 on: September 04, 2007, 07:43:51 AM »
Sorry to hear about the problems, and unfortunately I can't really help you out with it. I'm sure someone will though.

Just noticed your user name as most people on here are from the States. Can you recommend any OS in Glasgow?? I'm from Aberdeen and have seen a couple here, but the best one only works on the NHS and I don't think I can bear to go on the waiting list for a year or so....

Thanks

Gordon

i have alwaysthough that was funny a UK board but full of people from over the pond! which is great and adds to the experiences and advice.  we do need more people from the UK, only reason being is procedures in the  UK and US are different, the way things are done is different.

example, make sure you choice a good OS, if your having it done on the NHS you cant really choose, who get who you get, good, bad or rubbish.  if you go private it's a different story. 

things like braces etc, you are not likely in most cases to get one for example.   i think the out come of the op's are mostly the same but the whole lead  up but from being told who your surgeon is (no choice given) to the OP are in the most case different.