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Author Topic: Distal Femoral Osteotomy - Pre & Post-Op Diary  (Read 115209 times)

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Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #45 on: February 11, 2009, 07:14:13 AM »
Hi Chereb,

I remember very vividly the pain that came with getting off the pain meds too soon.  No fun. My best success with getting off the meds was to ween myself off of them.  I only took them at night and started cutting pills in half and that was pretty successful.  I can't imagine how much harder it must be to be in a cast, you're tough....and with a 4 year old too.

As for the foot coloring, I think I might have had a darker tint to the foot on my surgery leg for the first week or so but not much longer than that.  I would venture a guess that it may have to do with circulation and the cast.  I was advised to do ankle pumps after surgery to help the blood flow better.  I don't know if you have been told to do this but it might help.  As for the bone healing, I think it is pretty well accepted in the medical community that bones take a minimum of 6-8 weeks to heal.  If that happens to coincide with the color coming back in your foot then great, but I wouldn't try to walk or mess with the leg before then.  With the kind of "break" we have had, I have learned that it just takes time to heal.

I understand your frustration with the amount of time, the boredom, the pain, the doubt, all of it. Only time will tell if you did the right thing and there is nothing you can do from here except heal...you definitely can't take it back. Try and be as positive, patient, and hopeful as you can muster.  Time will pass, it will feel like forever, but it will get here. You will also have good and bad emotional days. Days where you are frustrated and bored.  This surgery is as much a psychological and emotional battle as it is a physical one. You're doing a great job so far, keep up the good work and be strong.

I will definitely keep everyone posted on what my OS has to say on Thursday. Till then....

Offline chereb

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #46 on: February 11, 2009, 02:33:42 PM »
Hi Aturpin,

Thanks for the wise words. Feeling better today and probably because the pain is less. Good idea cutting them in half. I will give it another week and try again. Will half my dose and see where it takes me. I had to go and pick up my 4 year old from nursery for the first time. What normally takes me 15 mins took an hour,lol. Still I felt good that I managedeven though the arm muscles were begging to get the crutches down. I am not going to try and stand on it just yet. I am only 4 weeks post op and would be terrified of doing any damage! Like you i look forward to my next follow up and hope that I can lose the cast at least! Its great to read your progress and imagine myself there in a few weeks. How does the walking feel? Is it very strange and hows the muscle tone? I have been doing foot flex excersises, left,right, up,down ect. Is tha what you mean? Also been paddling them. I have thigh presses, leg raises and knee bending excersies. I am struggling with the knee bends or maybe i just expect it to be quicker? I am just going to keep trying and eventually it will come right. How did you feel with the first partial weight bearing? Did it hurt?     

Offline Tailwind

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #47 on: February 13, 2009, 07:05:14 PM »
Aturpin
Hi.  I have been lurking here for some time and following your progress for the last week since I saw a top OS here in Chicago who recommended a DFO and a possible meniscus transplant and articular cartilage graft if I am a good candidate for those. Background I am a 45 year old male triathlete. I have completed 5 ironman races in the last 7 years and scores or shorter races and stand alone marathons. I also enjoy skiing. 2 years ago I had a man v. dog collision to my left knee. 14 mos ago I had a arthroscopic meniscectomy and debridement of cartilage -- focal defect in weight bearing area of lateral femoral condyle. I did PT and returned to running and training last spring. I completed Ironman Canada last August in considerable pain. Now my lateral compartment has collapsed and I have a severe valgus malalignment. My old OS said my only option was to manage the pain and hold off for a TKR, which I would need in 2-4 yrs. My new OS is recommending the DFO, but he asked me to wear an unloader brace for a perioid of time to see if I am a good candidate.
I am following you to see what I'm in for! I have to say your recovery is not as rosy as that painted by my OS .  I am probably going to schedule my surgery for late August and hope to be walking by Halloween. Reading your posts makes me think more like Thanksgiving. Thanks.
10/06 - Man v. Dog Collision
12/07 - Meniscus Trim
4/08, 12/08 - Synvisc
6/09 - Diagnostic Arthroscopy
8/09 - DFO

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #48 on: February 16, 2009, 07:37:15 PM »
Post-Op Day 73 (Feb. 16th) - Happy President's Day everyone.  I hope none of you readers had to work, especially the post-op readers :).   Apologies for my lag on my walking update.  Great News!, I can walk!  I saw my OS on the 12th and we took xrays and he was really really pleased.  My bone has completely healed, you can't tell where the saw went through and the gap has completely filled in with bone.  He said my recovery was the best it could possibly be including my range of motion and he released me to return to my normal activities including walking, bike riding, all rehab.  He also said that in less healthy people he would still expect to see some fissures or lines where the bone was filling in at this stage, which was just short of 10 weeks. He did, however, caveat the whole thing by saying that I should not run, jump, etc. since my leg is weaker and I still have cartilage issues in my lateral compartment. Even though the bone is healed, I couldn't imagine running or jumping right now, it would be so painful and I dont know if I could even physically perform the motion.   To celebrate my progress I left my doctor's office and took my first post-op spin class.  I made it through the entire hour though I have to confess that I did not get out of the saddle for the second half of the class as my knee and leg was fatiguing and I didn't want to overdo it on my first day back. The following day my knee was a little sore.... By sore I mean it feels tight and kind of warm.

I am now about 10 weeks and 2 days post-op and have been walking for 4 days.   I am walking with a limp but I am really trying to concentrate on walking properly.  I think I will have to go to physical therapy to get their help with learning how to walk again and what exercises to do. I am so relieved to see that my leg has healed and the surgery has been successful so far.  Walking hasn't made my knee feel any better or worse, just the same. I am taking this as a good sign, a sign that I am ready to walk and the leg can handle it. Now it is up to me to have the dedication and discipline to learn to walk and rebuild my muscle, strength, balance, etc.  I can tell this will not be easy but I am well on my way. I am really excited to be walking, I feel like I can do a lot more things now and I get a lot of my life back.  I haven't gotten all of it back yet as I can't go hiking or walk for long periods of time, but now I can go shopping and carry things, run errands, tour new homes (part of my job), and just go through life with more ease and fewer stares. Its a really nice feeling. I am really pleased with the outcome of the surgery so far and look forward to getting back to 100%. This has been a great mood lifter for me.  I will try to post pix of my xrays, my leg looks bionic with all of the screws and the plate... kind of a trip.

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #49 on: February 16, 2009, 07:46:53 PM »
Hi Chereb,

I'm sorry I haven't gotten back to you sooner.  I posted the results of the doctor's visit last Thursday but I wanted to answer your questions about how walking feels and how it felt to bear weight for the first time.  I hope you are hanging in there ok and you haven't pulled your hair out in boredom yet. Don't you have an appt. with you doctor coming up?

Bearing weight for the first time was a process in a way. I started by testing the leg by trying to stand with my weight distributed evenly between the two legs to see how it felt and then I progressed to limping around and then walking around. I never felt like I was pushing it or that it was too soon and if I felt any pain or discomfort I stopped immediately.  I can't explain the mental feeling but you might understand what I am trying to convey because you are in my shoes.  I feel an instinct about what I am capable of doing without testing it... its like I mentally know without trying what I am capable of.  For instance, after I woke up from surgery and had to go to the bathroom, I knew that walking was going to be impossible even if I was allowed to and I didn't think that crutching was even a good idea. A week later, I started touching my leg down when I was crutching because it just felt like it would be ok.  I didn't try doing anything until it made sense to me mentally and I felt comfortable with the idea of doing it. When I finally started bearing weight, it didn't hurt. It hasn't hurt at all so far. It definitely fatigued in the beginning and would get stiff but it never hurt. I hope that answers your questions, I wish I could describe it better.  You'll find out soon :).

     

Offline chereb

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #50 on: February 16, 2009, 08:10:35 PM »
Hi Aturpin ;D

Many thanks for the answers. I know what you mean. Itslike raising my leg onto the sofa. t first I used the other leg to support it and then one day i just felt ready to try lifting using the muscles in my leg. It was a bit sore at the knee but i was so happy as it felt like an acheivement. Now i am standing on my two legs evenly positioned but no weight on the op leg if that makes sense. Could not have done that without being very unstable a couple of weeks ago. I sort of fell the other night. Caught my crutch the wron way, spun round and reactively put the leg down to stop me going backwards downstairs. I felt no pain in my thigh but a good bit in my knee. Was worried i might have done some damage but nothing i can do about it now. It happened! I m going for PT tommorow again and back to OS on Monday.

I am so happy for you. I had a big smile reading your update as i know you have been desperate to get to this point. Well done you!! I bet you feel rather jubilant now. I know i would! Its great that the bone is completely healed now and just remember not to push too hard! I am sure the limp will diminish through time. Do you still have the crutches? Or are you completely off them?

I seen my xrays at my first post op and it really is a sight to see all those screws and the plate. One of my screws goes through the full bone and pokes out the other side! Its amazing to think they are inside you!

Good luck with the recovery, you have come through the worst bit now. Please keep updating your progress as its very helpful to me!

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #51 on: February 16, 2009, 08:15:23 PM »
Hi Tailwind,

(I like your name, Tailwind's are my favorite running shoes :) ).  It sounds like you have been through quite a knee ordeal. I have a ton of respect for all of those Ironmen out there... its truly an amazing feat to complete that race. So you are a runner, and not just a runner but a marathoner, a skier, you've had an arthroscopy, and had an acute injury to top it all off.  Your knee has taken quite the beating. I can't believe you were able to run marathons on your knee with the cartilage defect and with what you have been through. I am sorry to hear your knee is so beat up, you really don't appreciate how great knees are until you wreck them.

It sounds like you have really done a job on your knee and you have some decisions to make.  If I understand your dilemma, you have two options.  1) Do nothing, try to be mellow and control the pain for a couple of years and then go for a TKR.  2) Do a DFO to take the pressure off your lateral compartment as a means to control the pain and perhaps put off a TKR.   I don't think there is any question that you have a TKR in your future at some point given your synopsis and the damage done to your knee so it is just a question of whether or not it is worth going through the DFO or, in other words, will the DFO give you some relief in the near term and put off a TKR in the long term?  I think the Dr wants you to wear the unloader brace to sort of mimic what the DFO will do and see if it gives you some relief.  If it does, the you can only imagine how great a DFO will be in relieving your pain.  I have read some posts of people who have tried the unloader braces and weren't able to get the relief they were looking for until they actually did the DFO so don't put all of your eggs in the basket of the unloader brace.

I hope my experience has given you some insight into what you are in for but also keep in mind that everyone is different and yours could be even better.  You are an athlete and I think athletes recover really well from surgical procedures because we are healthy, we work hard, we are determined, we have a good perspective on set backs and expectations, and in large part, we take good care of our bodies (even though sometimes we abuse them). The unfortunate and frustrating part of this surgery is that it doesn't matter how hard you work or how well you take care of yourself, healing just takes time.  That's not to stay that you can eat hotdogs and kick-it and expect a good recovery because I think exercising and eating well is key, but what I am trying to say is that you can do your rehab religiously, eat 100 fruits and veggies a day, eat tons of protein and drink gallons of milk and it still takes time to heal. I think your time frame is very realistic; if you have surgery in late August I think you will definitely be walking by Thanksgiving and you will be flirting with walking around Halloween or the first week in November... assuming you have no complications, of course. Part of this depends on your OS's philosophy too.  Also keep in mind that my OS told me 6-8 weeks to walk (I think he did this to keep my hopes up even though he knew it would be more like 10 weeks).

If you can do Ironmans and marathons I have no doubt this surgery will be very doable for you... I hesitate to use the word easy because it isn't easy no matter who you are, but you will be just fine. The physical pain will pose the smallest issue to you while the time frame and lack of mobility will probably pose the greatest issue. No matter what you find to be your particular challenge, you will get through it and you will likely be better for it.... patience is the key.   Good luck and please feel free to ask any questions and use me and my experience for your benefit and peace of mind.

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #52 on: February 16, 2009, 08:21:34 PM »
Hi Chereb,

It sounds like we are on the same page... you just know when you are ready.  Bummer about your fall but I wouldn't worry about it much.  I think I had 2-3 falls where I put my full weight on the surgery leg instinctually to prevent the fall.  I had the same sensation as you in that it wasn't very painful, very scary, but not too painful.  You likely have a decent amount of bone filling in the gap and the plate is there just for those situations to protect your femur. I think you had a couple of falls a day you would have an issue.  Short of that or a big fall down the steps I think you are fine.

I am completely off crutches, haven't even looked at them since I put it in my car after my Dr.s appt.... its sooo great, those things are like a ball and chain after 10 weeks.

Offline chereb

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #53 on: February 16, 2009, 08:25:03 PM »
Hi Aturpin. Glad you dont need the crutches, they certainly are a ball and chain! What i forgot to ask was do you still have the brace on? if you do have you to wear it much longer. Thanks for taking the time to answer all my questions. :)

Offline Tailwind

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #54 on: February 16, 2009, 09:31:55 PM »
Aturpin

Thanks for the long reply. You are spot on with your assessment of my mind set as an athlete. We are prepared to work harder to make things happen and sometimes patience and time are the only thing that helps.

One part of my post you overlooked. While I'm having the osteotomy, I'm also having a biologic knee restructuring.  Meniscus transplant and cartilage plug transplant. My OS told me that while there are no guarantees, if all goes as expected I can avoid a TKR and possibly get back to triathlon. I don't think I will ever do another IM and probably no more running, but I'd like to continue my active lifestyle and, most importantly stay molbile and pain free!

I've had a good response to the brace in the 4 days I've worn it.

I was wondering if your doctor suggested walking in a pool as a bridge from the crutches to regular walking. Also, do you swim and what did your doc recommend regarding that?

I hope you keep progressing and you keep us posted. Thanks.
10/06 - Man v. Dog Collision
12/07 - Meniscus Trim
4/08, 12/08 - Synvisc
6/09 - Diagnostic Arthroscopy
8/09 - DFO

Offline jumpi5d

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #55 on: February 17, 2009, 12:09:05 AM »
Sorry I haven't posted to much. I'm still trying to get things ready. My surgery is in 16 days, its crazy to think that it's so soon.

 Aturprin Congrats on getting off the crutches!!! I bet that's a really awesome feeling. 
-Paige

3/5/09 Right Distal Femoral Osteotomy for Patella Alignment 
11/19/09 Left DFO for Patella Alignment.

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #56 on: February 17, 2009, 05:04:05 AM »
To Chereb:    No brace, no crutches, nothing at all supporting me.  I wore my brace for the first 6 weeks post-op but since then I haven't used it.


To Tailwind:  Apologies for the oversight.  It sounds like you are having both the surgeries that I am scheduled for at the same time plus an extra. I don't know anything about the meniscus transplant so I am useless to you in that respect.  However,  I am also going to be having a cartilage plug transplant... the orthopedic name for my procedure is OATS. I was hoping that I could do both the DFO and the OATS procedures together but my OS recommended I do them in two separate procedures... needless to say I was disappointed with that recommendation because who wants to go through knee surgery twice, back to back?  Nevertheless, his rationale was sound and it was this.  One of the keys to successful cartilage transplant is getting blood to the cartilage so it can re-vascularize and become one with your knee. It is my OS's philosophy that the blood and healing properties that are necessary to heal the cartilage, get obstructed and shared with the DFO site when they are done together, thereby not giving 100% healing to the cartilage site. I got many opinions before embarking on this surgical journey and one of the doctors I saw suggested that I do what is most comfortable to my OS, putting him out of his comfort zone may bring an unnecessary amount of risk or room for error.  You want your surgeon as comfortable and confident as possible. Additionally, the same doctor said, rather candidly, that doctors are humans too and if they go into surgery with multiple very serious and technical tasks, often the individual tasks may be compromised. For instance, if you knew you had to perform an exacting, very tedious operation you might get fired up for it.  But, if you knew you had to perform 3 back to back very tedious, exacting operations you might become overwhelmed and you may become fatigued during the operation before it is complete.  Just some food for thought.

As for returning to activity, that is a decision that is both personal and also informed by your OS's own philosophy.  It is the philosophy of my OS that I should never take another running step as long as I live.  To him, he doesn't think the risk and the wear and tear is worth the risk or acceleration towards a TKR. I am 27 years old so I have a lot longer to go before I am eligible for a TKR also and I need to make my knee last.  That said, I fully intend of keeping up my active lifestyle and have adjusted from running and jumping and track and field to swimming and biking and hiking. I have had knee problems for too long and with enough intensity that I know that I don't want to deal with this any longer than I have to and if I have to cut running out to avoid it then I will. At the same time, I have another OS I see who encourages getting back to any activity you want and regales me with stories about athletes he knows who have had the same procedure who are now doing tris and playing beach volleyball.  Like I said, its a personal decision.

My OS doesn't have a lot to say about my physical therapy and has not recommended the pool.  However, the physical therapy place I went to suggested pool walking as a means to practice normal walking before I was allowed to bear full weight....they even had an underwater treadmill. I have been swimming since surgery but had to wait until my wound was completely healed.  My OS recommended no flip turns until I was allowed to bear 100% weight and suggested I use one of those thigh buoys to take kicking out of the picture in the beginning. I really didn't have any problem with flipturns and continue to do them.  My leg fatigued a little when I swam laps in the beginning so then I ran in the water (no floaty and not touching the bottom) and I get a really good workout. I usually do intervals of all out sprinting and treading water and it gets be super tired....great workout.

Glad to hear you are responding well to the brace, that's a great sign. Keep the questions coming and good luck with you surgery prep... enjoy your freedom every second you have it  :).

Offline nikkiluv

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #57 on: February 20, 2009, 05:47:30 AM »
Tailwind,

I am in nearly the same exact situation as you. I visited my OS today and I was told that I will have to have an exploratory arthroscopy so he can see the condition my knee is in to decide on one of two options:

1. A DFO with cadaver meniscus transplantation. This all depends on how much of my meniscus is still intact, since he can't really tell well from the contrast MRI I had.

2. A DFO with cartilage cell transplantation. I have about a quarter-sized lesion all the way to the bone on my tibial plateau. Right now my OS believes that there may be softening of the lateral femoral condyle as well because it's most likely rubbing on the area of no cartilage on top of my tibia.

Currently as it stands I've already had the following procedures done to try and fix my pain and problems:
-3/05 - Arthroscopy for debridement of osteochondral defect
-12/05 - Arthroscopy medial meniscal repair (received a meniscal tear following being rear-ended in a car accident)
-10/08 - Arthroscopy lateral partial menisectomy (freak accident at work, just turned around and felt sharp pain and bam, ended up tearing my meniscus)
I've also tried braces, Synvisc injections, cortisone injections, anti-inflammatories...nothing provides relief.

I'm 23 years old and have been living with knee pain for about 7 years now, all which started from a minor soccer injury and everything has gone down hill since then. My doctor did want to try the unloading brace for a few months before surgery, but I know the surgery will be inevitable as just wearing a brace will not fix the alignment and cartilage issues I'm facing. As with everyone else that has been talking about osteotomies, as soon as my OS mentioned the word and discussed the procedure, I became freaked out. I'm not really sure how I feel about having the largest bone in the human body purposely broken to only have it screwed back together with metal. However, I am looking more and more forward to this surgery, as I believe it will finally provide me with relief I'm looking for and allow me to get back to the things I enjoy doing without worrying that my knee will give out on me, lock, or end up in extreme pain.

Do you have a surgery date set yet? I forget how long you will be wearing the unloader brace for before you go back for another visit. I was hoping if you ended up having surgery before me you'd be able to provide me with information on how your rehab/post-op experience is going. My OS is supposed to be calling me back in the next few days to set up my first sugery appointment, which will most likely be next month. I find everything that everyone has written very helpful, as it helps me to know that I'm not the only one in the world with such a messed up knee! :)
03/25/05 - RK debridement
12/22/05 - RK medial meniscal repair
10/31/08 - RK partial lateral menisectomy
03/13/09 - RK ACI biopsy
05/18/09 - RK ACI/DFVO
01/06/11 - ACI failure confirmed
*Currently awaiting call for fresh Osteoarticular Allograft Transplant cadaver match & removal of femoral hardware

Offline nikkiluv

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #58 on: February 20, 2009, 05:54:54 AM »
Aturpin, Cherub, and everyone else on this post:

It is so good to hear from everyone's personal pre- and post-op experiences. I only found out about 2 weeks ago that a DFO is in my future and I freaked out the first time I heard it and became really uneasy about the whole thing. Most of my history and information is in the post I just wrote before this one so I will try not to repeat anything. I know my situation is different from others here in that I will be having either a cadaver meniscus transplantation or cartilage cell transplantation (autologous cartilage implantation, or ACI for short) along with my DFO. I know this will significantly increase my rehab time since my OS told me so which will be very unpleasant, however I believe it may be nice to just suffer from one large major surgery and be done with it.

So, although I'm not sure what my road to recovery will end up being just yet, it's nice to know there's an extremely large support system here, which I'm glad I found! :)
03/25/05 - RK debridement
12/22/05 - RK medial meniscal repair
10/31/08 - RK partial lateral menisectomy
03/13/09 - RK ACI biopsy
05/18/09 - RK ACI/DFVO
01/06/11 - ACI failure confirmed
*Currently awaiting call for fresh Osteoarticular Allograft Transplant cadaver match & removal of femoral hardware

Offline Tailwind

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #59 on: February 20, 2009, 12:29:05 PM »
nikkiluv

No date yet, but I'm shooting for mid-August. This is for several reasons. First, I own my own business and I'm super busy right now. Second, my wife will be helping me out and I don't want to ruin her spring and summer being my nursemaid. Third, I want to enjoy my summer and also strenthen up my leg for what will be a tough recovery.

My OS asked to see me again 8 weeks after starting to use the brace. I will see him early April.

It looks like you will be going before me. I hope you will diary here with your progress. Just reading about all of this has eased my anxiety quite a bit. Also, my OS gave me a DVD with a ton of actual videos of the surgeries. Watching these - not for the squimish - has really increased my knowledge and comfort level.


Good luck!
10/06 - Man v. Dog Collision
12/07 - Meniscus Trim
4/08, 12/08 - Synvisc
6/09 - Diagnostic Arthroscopy
8/09 - DFO















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