HTO after meniscal transplant... good idea?

[rkent]

Hello everyone,

I had posted on here several times when I had my meniscal transplant and everyone was so helpful I wanted to get some opinions on my current situation.
I just got back from my OS. I was going for my 17 month checkup after a medial meniscus transplant. My knee has been bothering me and he suggested an HTO. This would be my 5th surgery and I'm very nervous. I have been reading the different posts here, but could not find someone with this exact situation.

Some questions- I am only 24, if I do not get this HTO, will I need a TKR in the very near future?
If you are post-op, do you think you would go through this procedure again, has it been helpful?
Does the hardware have to be removed?
Does the leg always have to be casted?
My OS said I would be non weight bearing for 6-8 weeks, does that seem to be the norm?

Thanks so much for any advice anyone can give, I really appreciate it!

Rachel

[Plumb]

At your age .. I do think an HTO would be a procedure you would want to read up on.  There is a poster called Knee will be great who has some great info . At your age.. I would say go for it..   20 years.. you may need a pkr or TKR but live life now and get the HTO

[rkent]

Thanks so much for your reply. I have seen some of that users post and your right, lots of good info :-).

Thanks again,
Rachel

[nikkiluv]

Hi Rachel,

I'm not in the same situation as you but right now my doctor (the second OS I'm seeing since my first has done all he can with me) is considering two different options for me, one being a distal femoral osteotomy with a meniscal transplant, the other a distal femoral osteotomy with autologous chondrocyte implantation (ACI). Which route he chooses depends on what he sees during my exploratory surgery which is scheduled for March 13th. If he decides that most of my meniscus is in good condition still then he will just go for the ACI and do the cartilage biopsy during the surgery so it can have enough time to grow before the second surgery where he would do the DFO along with it. If my meniscus is crappy and to far gone then I'll have the meniscal transplant.

I can't really offer you advice because I haven't had the surgery yet and both would be done at the same time and not two different times like you. However, my doctor did say that the hardware is pretty much permanent unless someone complains of pain or feels the hardware is causing them issues in which case he will remove it. Also, 6-8 weeks nonweightbearing seems to be around some of the ranges I've read on other posts. In the literature my doctor gave me it doesn't look like he casts the leg, I'd just be put in a brace for awhile and then an unloading brace for up to a year following the surgery. I've read that many people have felt that it was worth the trouble and they are now in a much better situation then they were prior to the surgery. In fact, my primary OS sent me to the new OS because he had problems with his knee and ended up having the osteotomy with an ACI and now he feels so much better and it was great for him. The fact that the success rate is very high and many people seem to be better for it is the only thing that keeps me going and wanting to have this procedure done. I'm currently 23 (24 in June) and I've already had 3 knee surgeries....a cartilage debridement, a medial meniscal repair, and a partial lateral menisectomy all on the same knee. The one I'm having in a couple of weeks will be number four and then the big one (and hopefully the final one) will be surgery number five.

I hope that I've been of some help to you as this entire board has been such a big help to me.
Nicole

[Mr.Qaili]

Hello everyone,

I had posted on here several times when I had my meniscal transplant and everyone was so helpful I wanted to get some opinions on my current situation.
I just got back from my OS. I was going for my 17 month checkup after a medial meniscus transplant. My knee has been bothering me and he suggested an HTO. This would be my 5th surgery and I'm very nervous. I have been reading the different posts here, but could not find someone with this exact situation.

Some questions- I am only 24, if I do not get this HTO, will I need a TKR in the very near future?
If you are post-op, do you think you would go through this procedure again, has it been helpful?
Does the hardware have to be removed?
Does the leg always have to be casted?
My OS said I would be non weight bearing for 6-8 weeks, does that seem to be the norm?

Thanks so much for any advice anyone can give, I really appreciate it!

Rachel

Hello dear Rkent
I have questions : where u did meniscus transplant, how much that op costs ? how about recovery post op, and did that helped u ?

About HTO yes thats the best option that u can go. With HTO the leg is re-aligned, weight bearing is moved to healthy side of the knee .
This procedure if it is done successfull prolonges TKR and u can live 10-15 years with no pain .


Before taking decision :
Why u dont try stem cells which maybe can help regenerate ur articular cartilage ?
Also u can do chondrocyte implantation, microfracture, taking injections that can help relieve,reduce pain and let u think about the best option decision what u will do in future .

Wish u all the best dear
Greetings

[Mr.Qaili]

I forgot to answer :

Yes after HTO u have to do another op to remove the plate and srews .
That is done after 6 months or more, when in x-rays is seen healed bone .

[WonkeyDonkey]

Hi Mr Qaili

I have had an HTO but had an iBalance implant so do not have to have a second op to take out the metal plate.

WD

[smartdriver]

Hello everyone,

I had posted on here several times when I had my meniscal transplant and everyone was so helpful I wanted to get some opinions on my current situation.
I just got back from my OS. I was going for my 17 month checkup after a medial meniscus transplant. My knee has been bothering me and he suggested an HTO. This would be my 5th surgery and I'm very nervous. I have been reading the different posts here, but could not find someone with this exact situation.

Some questions- I am only 24, if I do not get this HTO, will I need a TKR in the very near future?
If you are post-op, do you think you would go through this procedure again, has it been helpful?
Does the hardware have to be removed?
Does the leg always have to be casted?
My OS said I would be non weight bearing for 6-8 weeks, does that seem to be the norm?

Thanks so much for any advice anyone can give, I really appreciate it!

Rachel

I've had an HTO in both legs - but nothing done with the meniscus.  From my understanding, an HTO is meant to buy you some time before a knee replacement - and you may never need a knee replacement after having an HTO - it all depends on the individual - age, activity level, etc.

When you mention that your OS "suggested" an HTO, have you had the appropriate imaging done (CT scan, long standing x-rays, etc) to determine the degree of rotation?

The hardware doesn't have to be removed unless it is causing you pain/discomfort.  Once the bone has fully healed, then it could be removed.  However, yes, this will be another surgery, but you will be restricted activity-wise until the holes fill in from where the screws were.  And you may be on crutches for a couple weeks afterwards as well - depends on your OS.

Each OS has their own protocol as to if you are in a cast, brace, etc.  One thing to keep in mind is that if you have internal hardware, then I wouldn't think you would need a cast or a brace as the hardware is doing the work of the cast.

You may also want to ask your OS about post-op protocols in regards to  do you have to go to physical therapy?  When can you start activity, PT after surgery?  When can you start range of motion activity?  If you are on crutches and have no cast, will you be partial weight-bearing?  6-8 weeks does seem to be the norm, but again, it depends on the individual and how quickly the bones are healing.

Good luck and keep us posted!

[silverghost]

Hi

I concur with smartdriver.  I was told the metalwork only needs removing if it causes problems and normally after about a year.

I was also advised that the HTO can buy the 10-15 years as stated but inevitably a TKR or PKR will be required.  I have heard of a few people having HTO's that have gone 20 years plus but I think this is rare..

[greatfulgann]

What does metalwork feel like? I have had alot of issues and recently found out I have metal in my knee but I shouldnt have any. I've never had anything but knee arthroscopy so not exactly sure how it got there.

[silverghost]

Hi grateful

Chances are you won't feel it unless its causing a problem i.e. its wearing or its moved slightly or you have some inflammation in a joint.  I wasn't aware I had a large screw in my leg from an ACL reconstruction from 13 years before as I hadn't researched or been told that was what was going to be done.

You will need to find out what procedures were carried out during the arthroscopy as various things can be carried out during one. Ask your doc for the medical notes they normally provide these to your gp as a matter of course.

good luck

[greatfulgann]

Chances are you won't feel it unless its causing a problem i.e. its wearing or its moved slightly or you have some inflammation in a joint.  I wasn't aware I had a large screw in my leg from an ACL reconstruction from 13 years before as I hadn't researched or been told that was what was going to be done.

You will need to find out what procedures were carried out during the arthroscopy as various things can be carried out during one. Ask your doc for the medical notes they normally provide these to your gp as a matter of course.

I have the OR reports and no metal anything is mentioned.

[silverghost]

Grateful

How do you know you have metal in your knee was it from an x-ray?  It would be unusual for anything to be left in there as arthroscopy is normally done only with a small opening.

Have you had any previous ops or just the arthroscopy and what was the arthroscopy to do?

[greatfulgann]

MRI shows this but its not a screw or anything identifiable.  I had the typical arthroscopy clean up & debridement. It is located in an area that I have scar tissue, chronic irritation and swelling. I agree this is quite unusual.

[silverghost]

Have you asked your doc for advice?  He may be able to identify this and if it is abnormal get you straight in for an op.  You certainly don't want any  loose metal in your knee it could cause all sorts of damage.