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Author Topic: Distal Femoral Osteotomy - Pre & Post-Op Diary  (Read 115197 times)

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Offline aturpin

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Distal Femoral Osteotomy - Pre & Post-Op Diary
« on: December 09, 2008, 09:06:47 PM »
I recently had a distal femoral osteotomy performed on my left femur and wanted to share my experience for the benefit of any of you out there who might find yourselves in my shoes.  I found these message boards very helpful, but also very scary when I was researching my procedure and learning of others' experiences.  I found the color commentary and anecdotal stories of others' experiences to be worrisome so the purpose of my posts will be to offer a straightforward day by day account of what happened to me.  I also found it very difficult to find a person who matched my particular circumstance (i.e. age, activity level, degree of deformity, lifestyle, etc.) so perhaps I can offer the experience of a different segment of the population that hasn't been offered yet.

History:  I am 27 years of age, 5'9", female, 140 lbs.  I have arthritis in my left lateral compartment of my knee and also have a 12 degree valgus deformity.

Procedure:  Distal Femoral Osteotomy;  I had a lateral opening wedge with a bone graft from my iliac crest (hip).  Basically, the Dr sawed through part of my femur and jacked it open about 10mm (enough to correct the deformity and straighten the leg), he then took 3 bone plugs from my hip bone to fill the whole which accelerates healing and helps the bone fill in the gap.  The grafts and the gap are secured with a plate and a few screws.

I have led a very active lifestyle and competed in the heptathlon in college at a Division I school. During my competitive days I tore my ACL throwing the javelin.  I had it reconstructed and continued to compete for the next 4 years. it wasn't  until I was playing basketball just over a year ago (March 2007) that I was having a problems with the knee. In sum, I landed funny on my knee and sheared off some of the articular cartilage on the lateral condyle of my femur.  While I was originally a little knock kneed, the missing cartilage and continued wear worsened my condition and the knock kneed-ness.  My doctor recommended a femoral osteotomy in order to stave off a knee replacement (because I am too young for this procedure) and to preserve my existing cartilage.  We are also planning on an allograft cartilage transplant once I have rehabbed from this surgery.  Having the correct alignment is key to the success of the next procedure as well.

I underwent my distal femoral osteotomy on Dec. 6th, 2008 at Scripps Green Hospital in San Diego, Ca.  My doctor is William Bugbee and he is well published and very experienced with this procedure. The following account is my experience.  All in all, this surgery was not nearly as bad as it sounds or as I thought it would be.... at least for me.  It is absolutely true when they say that "everyone is different and everyones experience is different."


Post-Op Day 1:  I was given a femoral block which numbed my entire left leg during surgery. Because of the block, I did not need to be that deep under anesthesia and, therefore, I came out of anesthesia quickly and pretty pain free.  The surgery took about 90 mins and the time in recovery was about an hour. The remainder of the day I spent watching TV, eating (I had no problem eating with the anesthesia), and chatting with my roommate and visitors. i stayed in the hospital for 2 nights and left on the morning of the 8th. I slept well that night with the exception of my roommate who was elderly and got up every couple of hours to use the restroom. Also, the nurses come in to give pain meds and take vitals every 3 hours. I was able to keep the pain at about a 2 on a scale of 1 to 10 throughout the day.

Post-Op Day 2: The femoral block began wearing off around mid-morning but the pain never crept above a 3.  I was given Perkoset to control the pain and the only side effect I felt was sleepiness. I was fitted for a brace that I am to wear 24/7 and keep unlocked.  I was encouraged to begin range of motion exercises and to practice crutching around.  I was also instructed that I am to be only 30lbs. weightbearing which is akin to touching a toe down.  This is a nice relief though, to be able to put a foot down.  It takes some pressure off the hands and you don't get tired as quickly when crutching. I will be 30lbs. weightbearing for a minimum of 6 weeks. I had a physical therapist come visit me today and take me through range of motion exercises and crutching around.  There wasn't much pain associated with the PT and I was able to get around well.  I was also able to lift my leg unassisted which is very nice for moving around. I slept well through the night and was woken up once for vitals and pain meds.

Post-Op Day 3:  I got to leave the hospital today and go home.  My dad is taking me home to Simi Valley, approximately 2.5 hours north of San Diego.  He drives an SUV so I rode home in the back of the car lying flat. Aside from some bumps the ride was relatively pain free.  I took a Perkoset before I left and napped part of the way.  My dad is taking me home to help me out for 2-3 weeks where I will be off of work focusing on rehab and resting. I am trying to wean myself off of the pain medications and my pain has climbed to about a 4.  Before bed I took a Perkoset and got my best night of sleep yet. I woke up once to try and get more comfortable as I prefer to sleep on my side rather than my back. My knee is pretty swolen and ice helps a lot. I am happy the surgery is over with and now I am on the way to recovery.


Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #1 on: December 10, 2008, 01:11:01 AM »
Post-Op Day 4 (Dec. 9th):  The hospital arranged for at home physical therapy for me and they came to visit today.  We worked on range of motion and leg lifts.  At this point I am able to get about 40-50 degrees of flexion and can do a few leg lifts.  The pain is concentrated mostly in the side of my leg where the cut through the iliotibial band to get to the bone.  A lot of my pain is in my hip where they took the bone grafts.  I was warned of this and it hasn't been too limiting, just more annoying than anything. It hurts to lay on directly and bites a little bit when I try to sit up or turn.  In addition to the leg lifts and flexion, I am also doing quad sets (flexing and releasing the quad).  The swelling has caused my quad to be less active so the flexing helps wake it up.  I also took my first shower in 3 days today... it felt great.  However, showering with one leg is tough.  I would highly recommend a stool to sit on and a hand held shower head so you can reduce the amount of standing and moving around. I have lowered my pain medication and am down to one pain pill in the day and one at night. I find the pain tolerable but still uncomfortable.  I am still ve ry swollen within the knee joint and the lower part of the quad.  My incision is a solid 4-5 inches and will probably leave a pretty good scar.  I also have a 3 inch incision on my hip that will probably leave a decent scar as well. 

Also, if anyone has any questions please feel free to contact me, I hope I can provide all of the information anyone needs to make this decision and make they're way through this procedure.  As a point of reference for anyone who had an ACL reconstruction,  I have found the pain and mobility to be very similar to what I experienced after that procedure.

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #2 on: December 11, 2008, 01:12:57 AM »
Post-Op Day 5 (Dec. 10th) - Last night was a difficult night of sleep as I attempted to cut out the pain medication all together.  I took an anti-inflammatory in the middle of the night and slept fine through the rest of the night.  Today I continued with physical therapy and practiced crutching around.  I continued with straight leg raises, range of motion and quad sets 4 times a day.  I am working to get to 90 degrees of flexion by the end of the week.  The pain associated with straight leg raises, quad sets and range of motion is pretty intense and I am looking forward to getting further along in the healing process.  This is certainly a lesson in patience and hard work. My swelling has gone down a tad today which is nice to see and I can bend further today than I could yesterday.  The progress in encouraging.

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #3 on: December 12, 2008, 01:18:15 AM »
Post-Op Day 6 (Dec. 11th) - My knee was pretty sore last night after doing extensive physical therapy throughout the day.  With the help of pain medication  I had a very good night of sleep, however.  The swelling in my knee seems to be at is lowest in the morning and each day is a little less swollen than the last.  Today I continued with physical therapy with 6 exercises (quad sets, heel slides, straight leg lifts, leg dangle, leg extensions, partial quad extensions) four times a day.  I can see definite progress in my flexion, pain and strength today as I have gained about 5 - 10 degrees of flexion and had less pain with leg lifts and quad extensions. I am also experiencing far less hip pain from where my bone graft was taken.  My overall daily pain level was also lower today than yesterday.  So far I am pleased with my progress and am staying positive and working hard.  No sense it dwelling in any pain or frustration.  My in home physical therapist is coming again tomorrow.  My goal is to show significant progress from her visit a couple of days ago.  Although the therapy is painful, the knee responds really well to it and the benefits definitely outweigh the pain.... that, and its necessary for proper healing.

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #4 on: December 13, 2008, 06:16:07 AM »
Post-Op Day 7 (Dec. 12th) - Today is the completion of my first post-op week and I am glad to have put it behind me.  The surgery was definitely the easiest part.  The hardest part has been range of motion and pain control....they kind of go hand in hand.  My in home physical therapist came again today and gave me some twists on the exercises I have been doing.  Most of the exercises are aimed at regaining flexion.  My goal is to be at 90 degrees flexion by two weeks at the very longest.  Desiring to over achieve, I am aiming for Tuesday of next week.  It is motivating for me to set real goals.  Today was a bit of a speed bump.  I was feeling more significant pain than usual so I went easy on the PT today. I am also experiencing a new pain today.  I am having pretty sharp and significant pain on my medial joint line.  It feels as though all of my weight was unloaded from my lateral side to my medial side (when it actuality the weight is distributed even across the joint).  I think this is made worse by all of the muscles and tendons which are confused and are adjusting to new angles and a new joint.  My lateral ligaments and muscles are all stretched out and my medial muscles and ligaments aren't bearing as much of the load as they used to.  If any of you out there reading this have had this surgery I would love to know if you have experienced this and, if so, how long did it last?  The pain is pretty sharp and it feels like the little weight I am bearing will cause the knee to give out a bit.

So, all in all, the first week has been challenging but I am proud that I have made it through and made good progress in my recovery. I am heading to outpatient physical therapy next week.  As far as resuming a normal life, I am having a hard time standing for longer than 5 minutes as the blood rushes to my knee and I can feel it swelling up and getting achy. I was able to sit at a restaurant today and I was able to walk/crutch through the parking lot to get there.  That't about all I can manage for now.  I am hoping to visit the gym this weekend (assisted of course and for upper body exercises only) and to make it through a movie at the movies in a week or so.  We'll see......

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #5 on: December 15, 2008, 08:02:52 PM »
Post-Op Day 8 (Dec. 13th) - No real changes to report on Day 8. I am continuing with physical therapy and am getting close and closer to 90 degrees of flexion. I am having far less pain with the straight leg raises and some of the other more difficult strength exercises.  This could be a result of taking yesterday a little easy.  I was having some increased stiffness and achiness so I went easy on the PT.  I think the easier day did my leg well. The swelling is continuing to go down as well and I am getting some very good nights of sleep waking up only once or twice during the night to change positions.  I am sleeping with my knee brace as well, it hasn't been a problem though.

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #6 on: December 15, 2008, 08:16:26 PM »
Post-Op Day 9 (Dec. 14th) - I went to the gym for the first time today (assisted, of course).  I rode the stationary bike with one leg (propped the bum leg up on an exercise ball) for 10 minutes and did the hand bike for 10 minutes. I also did some abdominal exercises, only one of which was inhibited by my hip where they took the bone grafts were taken from, and some upper body lifting where my friend brought me the weights from the racks. It was really nice to get a good sweat going, however, it is amazing how much fitness you can lose so quickly by being idol and taking pain medications.  My knee held up pretty well through the hopping and moving around. I didn't put any weight on the leg but it did get jostled around a bit. I am continuing with the aforementioned PT exercises for the knee itself and have gotten to 90 degrees in some positions. Also, when experiencing discomfort it helps to lightly massage the quad and IT band.  I am also trying to stretch my IT band out

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #7 on: December 16, 2008, 05:24:54 AM »
Post-Op Day 10 (Dec. 15th) - My range of motion continues to improve and my pain has also been decreasing each day.  Tomorrow I have my first day of outpatient physical therapy (where I go to them).  I am looking forward to getting another opinion on my progress but I am not looking forward to the pain I anticipate from new exercises and for a longer time. I was able to go to the gym today again and this time I drove myself there. This was my first time driving  post-op and I am lucky I had my left leg done instead of my right. I did the hand bike, PT and ab exercises and it felt nice to get in a good sweat.

Offline aturpin

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #8 on: December 17, 2008, 05:27:58 AM »
Post-Op Day 11 (Dec. 16th) - I slept terribly last night as I forgot to take my pain medication before bed.  I woke up in the middle of the night, took it, and slept well.  It appears that although I don't require pain medication during the day, I do need it to sleep. I have kicked the Perkoset all together (I think my last pill was 4-5 days ago) and am taking Ultram which is an anti-inflammatory with some Tylenol I believe. There doesn't seem to be any side effects particularly compared to the Perkoset. I am also taking Advil throughout the day to help with the swelling.

I went to my first day of outpatient PT today and it went really well.  I got my ROM officially measured and I got 95 degrees of flexion and am 3 degrees away from getting the same extension as my right leg. My therapist continued to work on my range of motion and brought to light one significant exercise that I hadn't been doing for my range of motion. He put me on my stomach and bent my leg up to try and get my heel to my butt (incredibly painful, btw, but temporary). I had significantly less flexion this way than I did with heel slides.  He measured the diameter of my quad, calf and knee and, to no surprise, I have had some pretty decent atrophy in my quad and am still carrying swelling.  We also did Russion Stem where he hooked me up to the E-Stem machine which causes your quad to contract involuntarily. When the machine made my quad contract, I flexed my quad.  This retrains the quad to fire properly.  We also did short arc quads while attached to the Stem machine.  I am glad to be able to get a hold of this equipment and feel good about my progress.  I go back again tomorrow for more work.

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #9 on: December 18, 2008, 05:47:32 AM »
Post-Op Day 12 (Dec. 17th) - I had my second outpatient PT session today and continued to make good progress.  I was able to get 118 degrees of flexion today and got to ride the recumbent bike.  I went very slowly (35 rpm's) but was nice to be able to make it all the way around. I was also able to get 10 solid straight leg raises with minimal pain.  My knee remains pretty swollen and is still achy.  I am icing as often as possible (5-7 times per day) and trying to stay horizontal.  If I stand for too long my leg aches and the knee swells.  My steri-strips are beginning to come off and I will begin with the Vitamin E and scar management once they come off. I am on my own for PT tomorrow and then have my third session on Friday.

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #10 on: December 19, 2008, 05:06:55 AM »
Post-Op Day 13 (Dec. 18th) - I am beginning to feel a lot better in activities of daily living.  I am able to sit in a chair through a whole meal without a ton of discomfort, I am able to hop around without feeling pain from the jostling, sleep is coming easier, walking (allbeit w/ 30% weightbearing) is getting easier.  The pain I mentioned on my medial joint line earlier has gotten much better as well. I feel like the better my range of motion gets, the easier life gets.  I think time has a little to do with it too. Coming up on the completion of my second post-op week I am pleased with my progress.  I am hoping to see some greater strength gains and less swelling in my third week. So far so good!

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #11 on: December 20, 2008, 02:03:48 AM »
Post-Op Day 14 (Dec. 19th) - Yay!  Today is my two week anniversary.  I celebrated by going to physical therapy. Things are going well there and I have gotten very good range of motion; 120 degrees.  That said, I am still partial weight bearing for 4 more weeks so it doesn't make a lot of sense to keep pushing it...aside from the fact that life is easier and I get less pain when I move around. I am going to try and get some more strength but there is only so much you can get from straight legs raises and quad sets. Nevertheless, I will try and get all the strength I can. For those worried about the pain of the surgery, the majority of the pain has dissipated now and I am able to get around pretty well. The first week was the toughest but if you have good company and people to help, it is definitely manageable.

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #12 on: December 21, 2008, 07:08:47 AM »
Post-Op Day 15 (Dec. 20) - I attempted to sleep without any pain medication last night (I have been taking Ultram before bed and Advil throughout the day).  I wish I could report a restful night but I can say that I had a much better night last night than I did the last time I tried to forgo pain medication. I woke up often in mild discomfort and just had a hard time getting comfortable.  I will go another week or so before attempting this again. Today was my first day on my own in my own apartment; up until this point I had been staying with my family at their house.  My apartment is upstairs but I had no problem getting up them, taking a shower (tub shower) or getting around.  It is comforting to know that I am capable of living independently now.  Things like tidying up, feeding myself and laudry are a bit challenging but not impossible by any means.  I carried on with PT and am about 10 degrees away from full flexion.  I am about 3-4 degrees from full extension (actually hyperextension which is my normal extension). Also, the medial joint pain I talked about earlier has gone away now and I am walking/crutching normally without problem.

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #13 on: December 22, 2008, 06:35:38 AM »
Post-Op Day 16 (Dec. 21) - I did a fair amount of driving today and was able to get around independently and pain free. I am capable of doing most things I want with the exception of walking. I am still carrying some swelling in my knee but am able to stand for longer periods of time without any throbbing or blood rushes. I am continuing with outpatient physical therapy and am continuing to work for more strength gains.

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Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
« Reply #14 on: December 22, 2008, 01:22:04 PM »
Sounds like you are doing well. Keep up the good work and thanx for sharing. I know some folks will be acutely interested in your progress.
 ;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