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Offline sb22678

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persistent anteversion
« on: May 21, 2008, 10:54:47 AM »
Hi,

Im 23 and since i was about 11, i have had pain and aching in my knee when going upstairs/downstairs, kneeling, squatting and all the usual triggers. It has got increasingly worse over the years to the point that i can no longer cycle or swim and going up stairs takes me forever.

after years of my GP telling me it was only growing pains, i finally got her to make me an appt to see an orthopaedic specialist who diagnosed persistent anteversion. After 2 years of Physio in all, which made no improvements whatsoever, the only other option apparently is to have a derotational osteotomy - break both femur and tibial bones in both legs.

This seems a very drastic measure and wandered if there was any other option available? Ive tried braces with no effect. Surely there are huge risks involve with the op - and wandered what these might be?

Also im keen to know what things would look like if i didnt have the op? - will my knees wear down and be useless (in which case by having risky surgery i would not be losing anything!)

How long would i be unable to walk too? Im a very active person and would be keen to get up and go asap!

Ive talked to the physio and another GP who both think i should not have the op - as does my chiropractor (who thinks it is all emotional), but then the surgeon says my legs would certainly merit an operation.

Just dont know what to do - completely in the dark and feel overwhelmed by having to make such a big decision   :'(

Im at the point  where im making career moves etc and i suppose i want to plan ahead so i know what to expect.

Please can someone help me!

Thanks for listening,

Stephanie

Offline cat

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Re: persistent anteversion
« Reply #1 on: May 21, 2008, 01:50:40 PM »
Hey Stephanie,
Welcome to the twisted leg club. There aren't too many of us and even less that have had a derotation surgery. Seems like those who have had the surgery don't hang around the board much. I like to think they're living happily ever after.
You're OS would be the best to get specifics from and I'd make sure I got additional opinions from true patella femoral experts. I would also want to make sure my OS had done alot of derotations before I let him cut and spin my leg around. Have you had a CT rotational study done?

I had my surgery about 7 mos ago. Not sure if it's helped but that may be due to having other less appropriate procedures done first. My post op diary can be found here-
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=39065.0

Then there are these links from j_smi001-
http://www.kneeguru.co.uk/KNEEnotes/node/238
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=26324.0

A case study where external fixation was used-
http://www.kneeclinics.co.uk/KneeProblems/RotationalDeformityCaseStudy.aspx

And here's Lyndsey's post op diary. She just recently had surgery.-
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=42532.msg371489#msg371489

You might start with those links but of course, feel free to ask questions,
 ;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 sb22678

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Re: persistent anteversion
« Reply #2 on: May 21, 2008, 03:09:21 PM »
Thanks so much for that Cat - really helps. Im new to this board, and so glad to have found you all! I live in Cornwall and think my OS is specialised in Osteotomies (though he's only done 1 in 8years!). So you dont think its made much difference to your pain then? God, that must be quite disappointing. Really sorry for you.

Thanks again,
Stephanie ;)

fawn2388

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Re: persistent anteversion
« Reply #3 on: May 21, 2008, 03:23:37 PM »
If you can live your day to day life. Do not do it. It's a radical surgery that requires quite a bit of work at PT. It's a highly specialied surgery that is usually only left as last resort. My rotation is 57 degrees in rigt fumer (finally got the papers) You can see it when I walk, run etc. You cann see that foot and whole leg are strange. I was told that to stop the pain and dislocations that I was the options. Still attempting to avoid it. It's usually not done for just 'general aches and pain' especial since I'm guessing you've never had a dislocation.

Offline cat

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Re: persistent anteversion
« Reply #4 on: May 21, 2008, 03:34:14 PM »
No, Stephanie,
I'm really not disappointed. I knew going into this that I might not see alot of benefit because of how screwed up my knee already was. And I was told that I wouldn't get better without the procedure. So if I see even only a bit of improvement and the surgery will help me not get worse, I will be glad. Plus, I'm thinking that having the derotation might help make a possible future knee replacement more successful. Not that I'm in hte market for one but it would seem that those glued in pieces might hold better if they're not constantly being abnormally tugged.
 ;D ;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 Lyndsey

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Re: persistent anteversion
« Reply #5 on: July 01, 2008, 03:28:46 PM »
Stephanie,

As Cat said, welcome to the twistee club! My femurs are rotated internally 67 degrees, and I had the derotation on my right femur 6 weeks ago. I am happy with the results so far, but I haven't walked yet so I am not sure of things yet. Everything has gone really smooth so far. I never knew what it felt like to be pain free. I will tell you that so far for me the pre op pain was worse than the post op pain, although I haven't started PT yet. I had my derotation done by the same Dr. as Cat. The derotation was actually the only thing I have had done, so I am hoping I will have better results than Cat because my knee has never been messed with before. Who really knows though! Only time will tell!

Good Luck!
Lyndsey
5/15/08      R femoral derotational osteotomy
1/19/09      L femoral derotational osteotomy
12/17/09  hardware removal (L&R femoral blade plates and screws)
10/28/10 removal of bone chip and cleanup of scar tissue on left
4/2014 15 deg. Re-rotation of L Femur
9/2014 L. Plate Removal & Fix Fracture

Offline sb22678

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Re: persistent anteversion
« Reply #6 on: July 01, 2008, 08:48:05 PM »
Thanks Lyndsey,

So pleased to hear you are enjoying a life of freedom from pain - bout time too eh?! I was told by a pain specialist not to go for the op as because ive had the pain for so long i would probably still get the pain despite my knees being corrected - she seemed to think that much like amputees, i would experience phantom pain, as my pain signals are so used to sending me pain messages, they'd keep on even when they are false. But you dont seem to have had that problem?

Im off to get a second opinion at the end of the month - so be interesting to find out what he has to say.

Keep getting weller and weller,

Stephanie

Offline FormerlyActive

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Re: persistent anteversion
« Reply #7 on: July 01, 2008, 11:16:14 PM »
Hi Stephanie
I also have miserable malalignment but I don't yet know the degree of rotation on both knees as I have not gotten the results of the gait analysis yet. I also have bow legs and flat feet (total bad combo), There also is a something called a CT Rotational Study which gives answers, did you have that done? (I did not). It does not sound like your OS is an expert in this field, you would definitely want to try to consult with one even if you aren't sure about the surgery. Do you know who your next OS is?
This surgery is more often done on cerebal palsy kids so a doctor who treats them sometimes does these, which is the case here in MN. Apparently not many doctors do them.
I am 46 and I would have to say if I had been offered this option in my 20s I would have taken it and avoided many other years of knee issues, pain, limitations. Also I was always somewhat self conscious as sometimes people notice and make remarks however that is really secondary and they don't do it so much now that I'm older.
What the mal-alignment does do is put stress on your system, hips, knees, shins, ankles, feet etc. so you may experience issues in other areas later in life. I've been lucky mine are primarily knees. I haven't been able to wear any kind of attractive shoe since 1979.
Cat and Lyndsey have alot of good information and have been enormously helpful. There are some studies which show that people who have the de-rotation but did not have other knee surgeries/issues naturally do much better. The main issues other than the usual surgery ones of infection, seem to be with the bone graft itself and some potential neurological issues related to dropped foot perhaps (I read some cases on the web).
May I ask what did they have you do for physical therapy? Also is your pain caused by rubbing or by swelling? Because if your pain is from rubbing due to mal-tracking then it could be causing some damage. I'm quite sure the pain isn't in your head, after all who could imagine these things! It is caused from something not working right and that is what they need to find out. I wonder if they could do a diagnostic arthroscopy on you to really look at your knee tracking (they can do it quite well when you are in the surgery and they can see the patella through the scope) that might show them the source of your pain.
Please let us know how you are. Warm wishes.
3/82 - Medial Synovial Plica removal both knees
9/89 - Lateral Release both knees
3/08 - Reinjury left knee hiking Asia Pac
5/08 - Miserable Malalignment diagnosis
4/08 - 9/08 Five doctors diff. opinions
7/08 - 02/09 - In PT, no chg.
4/09 - Dr. 6 opinion femur & tibia derotation together

Offline cat

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Re: persistent anteversion
« Reply #8 on: July 01, 2008, 11:46:12 PM »
Stephanie,
please let us know how your second opinion apt goes.

Formerly Active,
glad Lyndsey and I were able to help. I bet you can't wait for the results of that gait study. Let us know what you find out.

Lyndsey,
give me a holler when you get back!
 ;D ;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 FormerlyActive

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Re: persistent anteversion
« Reply #9 on: July 02, 2008, 09:37:41 PM »
Cat
You are a lifesaver. I do have a few more questions for you but nothing urgent. I started PT but not doing much. They taped me from outside to inside (because they think the kneecap is pulled over to the outside on the bone when standing) but it really hurt and caused alot of swelling. It did impress upon me however how such a small change can have such a huge impact on the knee.

The taping seems very imperfect because my knee is only out of line when extended, yet the tape pushes it over, I think, thorughout the whole tracking? Really really hurt.

July 14 is when the doctor in MN who assesses the rotation will go over the results with me. They sent me the videotape of me walking (and trying to run) but no other results, I guess its just a "complementary copy". I can barely look at it I look like such a dork and am wondering why on earth I didn't suck in my stomach muscles.
I'll be in touch via e-mail.
Stephanie keep us posted, and really wish you all the best.
3/82 - Medial Synovial Plica removal both knees
9/89 - Lateral Release both knees
3/08 - Reinjury left knee hiking Asia Pac
5/08 - Miserable Malalignment diagnosis
4/08 - 9/08 Five doctors diff. opinions
7/08 - 02/09 - In PT, no chg.
4/09 - Dr. 6 opinion femur & tibia derotation together