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Author Topic: Considering a derotatioanl tibial osteotomy  (Read 3482 times)

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Offline Alyce

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Considering a derotatioanl tibial osteotomy
« on: November 12, 2008, 01:07:35 AM »
Hi All,

I flew to MI last week for an appointment with Dr. Teitge.  He lived up to my expectations, and then some.  He is a scientist, biomechanical/phyics engineer, and fabulous doctor.  He spent an hour with me, examining, measuring and listening.  He makes my 7th physician.

Both legs are inwardly rotated at hip, and outwardly from knee.  The right tibial measurement is 47, so you can imagine how far pronated my foot is.  His recommendation was the DTO, although I know he wants to do the femur as well.

After having a failed LR, which left me swollen, and limping and dislocating, I had it reconnected.  I have also had a failed microfracture.  I was in a CPM for 5 weeks for 6 hours a day, totally NWB for 3 months, and on crutches for another month learning how to walk again.

I am afraid that I am too old for such a severe surgery.  I also don't want to be on pain meds for longer than about 2 weeks.  Plus, I think of all the potential complications, i.e. not healing, dropped foot.

I'm tired of being in pain, and just sort of hobbling through life, trying to do as little as possible to keep the pain down.  I work out everyday, by walking, my own PT, upper body weights at Y, and the treadmill on a steep incline.

I wouldn't have it until the late spring or summer.  Any encouragement or comments are most welcome.

Thank you to everyone on this board for their undying support and willingness to share information.  It is a comfort to know others have traveled this path.

Alyce
Patella shaving & Lateral Release 6/2002
Reattachment of Lateral Retinaculum & Microfracture 6/2003.
Both procedures failed.  Reattachment was successful.
Lesion remains 15mm x 9mm x 6mm
Tibial rotational osteotomy May 2009
LPFL rebuild May 2009
Surgery for Baja Patella February 2010

Offline Lyndsey

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Re: Considering a derotatioanl tibial osteotomy
« Reply #1 on: November 12, 2008, 09:37:13 PM »
Hi Alyce,

Dr. Teitge is amazing isn't he! I absolutely love him!

So he wants to do your tibia first? What are the angles of your femurs?

I had my femur derotated by him, and it is the best thing I could have done. The pain in my knee is practically gone! I still limp a little if i'm really tired, or sore. The soreness comes from the plate mostly, and will be gone when I have it removed. My recovery went really well, although I do have the benefit of being young. I was on pain meds for probably 3 weeks or so. I forget how long really, but it wasn't too bad.

I am having my left femur derotated on January 5th. I can't wait for the pain to end. Granted, there is post op pain, but then that goes away eventually.

If you have any questions feel free to ask! The other twistee's on the board that have had derotations include Cat and Amberle.

Have a great day!
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 Alyce

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Re: Considering a derotatioanl tibial osteotomy
« Reply #2 on: November 13, 2008, 01:14:31 AM »
Hey Lyndsey,

Thanks for your encouraging comments.  My femoral anteversion on the right is 30 degrees, and 35 on the left.  The external leg rotation of right leg is 51 degrees right and 32 degrees on the left.  Obviously, both are rotated.

I just came to the conclusion that this was really a remarkable opportunity.  After dealing with Orthopods for 10 years, Dr. Teitge really is outstanding.  I trust him, which is huge.

I think that it takes a year to recover from any major knee surgery.  I'm not working now, so it makes sense.  I might ask for a script for PT to get my VMO, quads, and hamstrings in better shape.

Thanks again.

Alyce
Patella shaving & Lateral Release 6/2002
Reattachment of Lateral Retinaculum & Microfracture 6/2003.
Both procedures failed.  Reattachment was successful.
Lesion remains 15mm x 9mm x 6mm
Tibial rotational osteotomy May 2009
LPFL rebuild May 2009
Surgery for Baja Patella February 2010

Offline Lyndsey

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Re: Considering a derotatioanl tibial osteotomy
« Reply #3 on: November 13, 2008, 03:38:26 AM »
Alyce,

Thanks for sharing your angles! lol. I love to hear what other twistee's are like. My right femur was at 65 degrees antiversion, and it is now fixed! YAY! My left femur is at 67 degrees and it is still as twisted and painful as ever. It's pretty crazy how different my two legs are now that one is straight and one is twisted! I am pretty sure my tibias were somewhere between 37 and 42 degrees, although I really don't remember exactly how much.

I agree, trust is huge. When I had my surgery I was relying on other people's stories about how awesome Dr. T is. Now, after having my right femur done, I can honestly say that he is as good as people say he is, and better. My right derotation went off without a hitch! Now, I can only pray my left goes that well too!

Dr. T has told me it will take at least a year to fully recover. I won't be fully recovered until after the hardware is taken out, and that's in a year. I suspect it will be a while before I am fully recovered, but that's fine with me. After the surgery, I am better than I was before it, as far as pain in the knee goes, and that's what I am really concerned about.

That wouldn't be a bad idea to strengthen your legs before surgery. I did PT for a while before mine, and I am glad I did!

Hope you have a good night!
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 FormerlyActive

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Re: Considering a derotatioanl tibial osteotomy
« Reply #4 on: November 13, 2008, 06:03:11 AM »
Hi Alyce
I saw him also, our measurements are very similar. Is it your right leg which has had all the surgeries? In his famous article (and he also said in the visit) "normal" for women is 13 for femur and 25 for tibia. A deviation of 20 from those justifies surgery, below 20 it is less indicated (some such language). He does not put people back to 0 but I think to the "normal" alignment (that might be a question).
I don't know if it would make sense to have the tibia first or if that is his protocol. I would ask him. Since the rotation starts at the hip he might do the femur first and then see how the tibia/leg recovers. That would be an important question to ask.
He also recommended the derotation for me (femur) but I am somewhat functional, so he said to continue in PT and then evaluate how I am vs. a "normal" person.
I'm not sure which part of the healing takes a year. I know it is a year to have the hardware out, but people seem to be more mobile much earlier than that. He has been saying it takes the soft tissue up to a year to adapt.  I know my LR was 1 year for both knees together, but I don't know if a year of that really equals a year of de-rotation which is so much bigger. So yes it depends what type of year. Some of the patients on the de-rotation boards seem to still be experience significant pain that could be tough for months and months.
Did he think your rotation was causing your damage? Also did he have any other suggestions, like how long to try PT, etc.?
I know where I live my OS doesn't recommend the surgery for people over 18 but Dr. T. does that surgery very successfully on people of all ages. I think he is leading edge in terms of his approach to correct the problems at the root cause instead of lots of other corrective surgeries to change patella position.
Sounds like you have had a long go of it. We all understand.   Keep us posted and best 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 dstevens

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Re: Considering a derotatioanl tibial osteotomy
« Reply #5 on: December 05, 2008, 10:21:59 AM »
Hello Everyone,

Sorry to hijack the thread, will someone tell me how much is the typical cost of having an operation with Dr. T? (say, to derotate one Tibia)
Any rough number would do, even a range is fine!

Many thanks,

Offline FormerlyActive

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Re: Considering a derotatioanl tibial osteotomy
« Reply #6 on: December 06, 2008, 05:50:18 AM »
Dear cost -seeker: You might have luck on the bigger de-rotation threads as this post is related to someone who hasn't had it yet.  I suppose the cost per se, also depends on your insurance coverage and if you have to be in network, etc.

I would also find it very interesting to know if someone can advise?   
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 SarahMN

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Re: Considering a derotatioanl tibial osteotomy & note to Formerly Active
« Reply #7 on: February 09, 2009, 04:42:28 AM »
I had a Tibia Tubercle Osteotomy suggested by an OS.  But I read up on it and it scared me. 

I am 12 weeks out from a LR, and it is very painful.  I still need pain meds.  The OS who did it said he thinks I have a pain problem.  But I saw a few other orthos since then, and they said I need something totally different.  Some here don't like lateral releases, but are into the osteotomy.

NOTE FOR FORMERLY ACTIVE:  I also live in the Twin cities, and saw a Tria MD.  I am very confused about what to do next.  I made an appointment with Steadman for the end of March.  I am at the end of my rope with OS opinions in the area, so many opinions.  I don't know how to contact you, but let me know, there probably is a way to leave mesages, but I am new here and do not know how yet.

3/25/09: R Knee: Arthofibrosis (LOA), chrondoplasty, excise plica, anterior interval release.
11/12/08:  L Knee: LR, Chrondoplasty of patella & MFC, Excise Plica, Synovectomy - 2005-2008: 12-16 weeks bi liateral knee injections with steroids. 
---& tried Synvisc, nothing but cost & 9-10 pain.

Offline FormerlyActive

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Re: Considering a derotatioanl tibial osteotomy
« Reply #8 on: February 18, 2009, 04:34:24 AM »
Hi Sarah
I left you a PM (Personal Message) so that we can contact one another. Would be interested to talk with you as some similiarities in our situations. When you get the chance please contact me. Warm regards, FA
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 SarahMN

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Re: Considering a derotatioanl tibial osteotomy
« Reply #9 on: February 18, 2009, 06:16:30 AM »
Hi FA, An email has been sent.  Thanks!  I would love to compare notes.
Cheers,
Sarah MN
3/25/09: R Knee: Arthofibrosis (LOA), chrondoplasty, excise plica, anterior interval release.
11/12/08:  L Knee: LR, Chrondoplasty of patella & MFC, Excise Plica, Synovectomy - 2005-2008: 12-16 weeks bi liateral knee injections with steroids. 
---& tried Synvisc, nothing but cost & 9-10 pain.















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