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Offline lady

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osteotomy QUESTIONS
« on: April 23, 2009, 07:45:51 PM »
So as of recently I didn't even know what a  osteotomy was or even think it was an option. My Doc and PA have been helping me to keep the knee i have for as long as I can (his idea of 2 years before a PKR). Check out profile. So a few weeks ago with my last orthovisc injection I mentioned that the only thing that has really helped was the unloader and my PA told me about osteotomy and that we should discuss it in a few weeks if the injections didn't help. Not that I'm anti surgery but I do tend to go that route last putting 2 off that I probably should not have. Ok say I have questins about the osteotomy which maybe some of you can help. I plan on asking the Doc and PA but I want to hear it also from people who experienced it. Whatever your feelings/facts are I'd love to hear and to try to get it from people who have dealt with it. I will be posting this in the PKR section as I want to hear how people felt about the 2 surgeries. I feel sometimes the best info is from the people who experienced it themself. Of course that does not mean I'm basing my decisions on other but knowledge is so awesom. I lacked it when I got the ACI and I'm not doing that again.

Q1. At what degree did you get back your activity level? And how long has it been since the surgery. I am very active or was and want to really get back to what I enjoy without the regret afterwards.....PAIN. I love to hike, bike (more than a few miles would be great more than 10 would be fabulous and not on a stationary bike. Coaching soccer more actively. And just being able to be active with my active family without being very uncomfortable.

Q2. Did anyone have a TKR afterwards an osteotomy and  was it adaptable?

Q3. Did you wear an unloader brace before the surgery? If so did you consider wearing the brace until it was time for replacement?

Q4. What did you feel was the biggest benifit of the osteotomy or PKR ?  Do I have the Osteotomy and hope it last 10-15 years or do I have the PKR and hope it last 10-15 years. I have this silly notion of keeping my knee as long as I can.

Q5. What made you think or know the osteotomy / PKR was the way to go.

Q6. Before the surgery did you feel that you had to plan your activities around everyday life or if you were going to have a busy day or say you want to go for a walk but knwo you will be on your feet for a few hours do you go for the walk and suck it up and regret....???

 
THANK YOU ALL!
« Last Edit: April 23, 2009, 07:47:54 PM by lady »
dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline Peg Leg

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Re: osteotomy QUESTIONS
« Reply #1 on: April 23, 2009, 09:45:57 PM »
Hey Lady (and no, that is not a pick-up line!! ;D),

I will try and answer your questions from my perspective.  I injured my knee playing softball and ended up with a medial and patella defect.  Had microfracture and carticel on the medial defect (the patella defect was small, grade 3, and not much of an issue), patella defect was debrided and had chondroplasty done to it.  To make a long story short, the patella defect increased in size with all the rehab and it proved to be a really big problem.  I had a lot of pain with walking and my activities were greatly affected.  Got a Don-Joy unloader and it helped tremendously with the walking pain, but I did not want to depend on it for the long run.  We decided on a Fulkerson AMZ to unload the patella defect; problem was, when Doc got into the knee, the defect had grown significantly and he could only unload about 25% of the defect.  We hoped for the best, but it was not to work out that nicely.  I will say the one great thing I got from the osteotomy  was the ability to walk more normally and also further.  That has been a huge plus for me, but anytime I load the patella, the pain returns.  I can't do a squat more than 60 degrees without pain ( not very graceful falling into a chair!!).  My Dr. told me if this surgery was successful, I would be running at 6 months.  Tried it and it was not pretty!  Weak quads were a big part, but the pain was also still there.

I, too, wanted to "save" my knee, but I've finally reached the conclusion that some things are better not being saved!!  I traveled to Indianapolis to see a Cartilage Specialist, and he told me that my Carticel graft was not healthy and that the medial compartment had to be addressed as well as the patella.  His suggestion was an Osteochondral Allograft with a recovery similar to ACI.  I was very upset to find that the last 20 months of pain and rehab had been for nothing.  Went back to my Dr. and he disagreed with the surgery suggestion for several reasons that made good sense to me.  It was at this point that I started to think of a replacement.  My Dr. is the only Doc in NC who is doing a new procedure with a Company called ConFormis.  They custom make the implant to fit your knee from a CT Scan.  He has done one of these and said it went amazingly well.  So, I have decided to have this custom made Bicompartmental knee replacement.  I was told that it feels more natural than other replacements because the ACL and PCL remain intact and the implant fits so nicely that a minimal amount of bone needs to be cut.  I will probably never run again, but that's fine with me, I really just want to play softball again. I figure if I hit the ball hard enough, I won't have to run too fast around the bases!! ;) ;D

I hope this is helpful to you. I had planned to answer your questions in bullets, but I just got carried away! Remember also, that every person and every case is different, so your outcome may be different as well.  My knee has just been problematic from the start and not an easy one to fix. Good luck with your decision and I wish you all the best!!

Peg Leg
10/06  Miicrofracture Rt knee on mfc
defect was 1.3x2, small defect under patella
04/07 Arthroscopy/Cell harvest for Carticel
06/28/07 Carticel surgery ,Rt. Knee
12/27/07  Scope to debride Patella lesion,Rt. Knee
4/17/08  Fulkerson AMZ, Rt. Knee
6/25/09 ConforMis BiCompartmental Knee Replacement

Offline lady

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Re: osteotomy QUESTIONS
« Reply #2 on: April 24, 2009, 12:39:41 AM »
Thanks for your respones. I'm sorry to hear it didn't work out for you. I keep going back and forth I want to make sure I'm asking the right questions and want different prespecitves. Probably asking for way to much info but I lacked it before and I don't want to do that again. Running is not an issue with me either. I would love to run a bit during soccer practice with my team but thats about it. No 5ks or 10ks for me. I would love to get on the bike and go the distance though and that is not happening riht now. My goals are to beable to Hike, bike and have fun with my team. Is that to much? I really don't know anymore.
dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline chereb

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Re: osteotomy QUESTIONS
« Reply #3 on: April 24, 2009, 12:29:41 PM »
Hi Lady, I will tell you my experience so far. I had a distal femoral osteotomy with opening wedge and hip graft 14 weeks ago. I was non weight bearing for the first six weeks after surgery and then allowed gradual weight bearing. Since immediately after the op the pain in the affected side was gone and still is. I am now down to one crutch although limping around the house on my own. I have a pretty tough physio routine and still do not have full rom. I work hard at it but it is a slow process for me anyway. A lot of my tissue still is tender although getting better. I also have a knee and thigh very thickened with scar tissue which is hard to work through. The other thing i have is a lot of pain on the side where the joint has been moved too. To date the pain is not getting any better. I dont know what the outcome for me will be yet. I keep geting told its very early. My bone has still not fully filled in yet. The wedge was opened as far as it could be so theres a lot of gap to fill completely. If you have a hip graft be prepared for some pain after. This for me was worse than the leg,lol. They did take a larger than expected piece of the hip bone though as the wedge was so big. I am pretty much back to normal. Some things lke getting in/out of bath have to be done with a little support(holding on) I can pretty much go up and downstairs almost normally. I cant run,lol can barely walk normal,lol. I hope i get good results but that is unknown yet. I am not going to fluff it for you. Its hard and painful and time consuming. You would be looking to take 3 to 6 months out of your life to recover to completely normal depending on how you heal and how much they mess around in there. Its a big decision and a big commitment. There are days when i want to cry and days where i get some progress and feel on top of the world. I decided to go for the osteotomy rather than the TKR because of my age. I am 37 and if i went for the TKR option i would probably have worn it out mid forties. Then i would need another and another and eventually it would not be possible to do it anymore and that would be it! So i decided to take a gamble and try my chances with this first. My OS said it has an 80% chance of success. We are hoping for 10-15 years out of it before TKR. But i am aware that i may get one year or five.

Offline lady

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Re: osteotomy QUESTIONS
« Reply #4 on: April 24, 2009, 03:43:16 PM »
Wow chereb you sound like you've had it tough. Thanks for your input. I'm 38 and don't want go the replacemnt route right now. I keep thinking of my 93 year old grandmother who thinks she hald her age. I don't want to be 80 and misarable never mind 93! I'm starting to get  that what I did as a kid really screwed me as an adult.....at least I had FUN! lol.

I'm not sure of all this and I still have a few weeks before I really chat it up with the doc. I'm giving the orhtovisc shots a few weeks and crossing my fingers they work. But I have had these before and if they were going to work they would have by now 3 weeks today since the last one.

Did you wear an unloader before you had the surgery? Did it help and did you consider wearing it for a long period of time.

Did the doc say how adaptable a TKR would be after having a osteotomy?

Good luck, I hope your days get easier. I know what you mean when you say days you want to cry and then days you feel awesome. Such an emotional roller coaster that people without these issues can not relate to. I hope you have a great suport person(s).

By the way what do you do for work? My big concern about this is the time out of work. PKR I would be back sooner but with this I don't think so. I'm a preschool teacher and I'm ina wedding this July so if I do this I have to wait until the wedding is over but I want to get back to work quick also. I am on my feet all day! Those buggers don't let you sit still for a second.

Good Luck with your rehab.
dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline knee-will-be-great

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Re: osteotomy QUESTIONS
« Reply #5 on: April 24, 2009, 03:52:50 PM »
Hi,

Check out my biography and my postings.  I had a high tibial osteotomy in January 2006 (you can read the postings).  The HTO was a complete success.  I subsequently had an ACL allograft, a planned operation to re-stabilise my knee.

You are 38?  You should not even think of knee replacements - be it partial or total knee replacements - they are not a logical solution for someone so young.  One of the previous posters indicated that they are 37 - and that they would have worn out a knee replacement by the time they were in their mid-40s.  I am close to the 50 mark - and in good health, and do not run anymore because that will exacerbate arthritis and the knee degeneration process.

I would be very cautious about TKRs or PKRs ... also they are man-made and do wear out.  AND they are difficult to re-do if you have a problem with your knee replacement.

Knee-will-be-great
« Last Edit: April 25, 2009, 03:13:16 AM by knee-will-be-great »
Medial Menisectomy, 1 ACL Autograft, 3 ACL Allografts, HTO, numerous debridements, good now :)
ACL Allograft #3 Post-Surgery Rehab/Wellness Diary http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37218.0;all
ACL Reconstruction VIDEOS http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37773.0

Offline chereb

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Re: osteotomy QUESTIONS
« Reply #6 on: April 24, 2009, 04:14:25 PM »
Hi Lady, I did not have an unloader brace. My knee joint was bone to bone and there was only the two options available to me. It has been tough but getting better. I am a stay at home mum with a very active 4 year old and a 10 year old. Im pretty much on my feet the whole day long. Weigh up the pros and cons for both. Make the decision thats best for you and think long term and not just the next few years. Thats what i did and it took me about 2 years to go ahead. My OS said the TKR will take a bit more than someone without an osteotomy but definately doable. I also need my left knee taken care of but will make a decision based on the outcome of the right. I was also non driving for 12 weeks. Until i could do an emergency stop i was advised not to. We all recover differently and each OS has their own way of doing things. Good luck and keep us posted. Ask away anything you want and have as much information as you can for both procedures. I agree that its best to have a real persons perspective rather than a physician who will have no idea what the after is like. My OS told me that the op would be the easy bit and he was right. I think i am also taking longer as a week after surgery i was put in a cast brace which totally immobilaised the whole leg. The cast slipped and prevented some physio taking place properly. I was then at 6 weeks put in a material brace which was much better. I stopped using the brace at 8 weeks. My OS is delighted with my progress. My plate and screws have stayed in the same place. I think when I work the scar tissue through i will be much better. Take care.

Offline Robin M.

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Re: osteotomy QUESTIONS
« Reply #7 on: April 28, 2009, 12:57:25 AM »
Hi Lady,

I had a high tibial osteotomy(HTO) in March 2007 for medial compartment arthritis. I was 42 yrs. old and wanted to preserve my natural knee for as long as possible. I wore an unloader brace for a trial period prior to deciding on having the HTO. The brace was a "miracle cure" allowing me to return to the gym and participate in activities with my husband and 5 children. However I knew that I didn't want to wear the brace long-term so I decided to have the surgery.

The rehab was long. I was 10wks. non-wt. bearing and then progressed to full-wt. bearing over the next month or so. I had a very weak quad so it took me quite a long time to gain full strength. I was in PT for 5 months. I will eventually need a TKR. My OS told me to convert to a TKR will be a little more involved due to hardware removal.

Prior to the HTO I had to plan my activities around my knee pain. I've had problems with both knees over the past 5 years with 7 surgeries and most recently a total hip replacement 5 wks. ago. After the HTO I was able to get back to my usual activity level which included playing doubles tennis for a short period of time. However I had problems with my left knee and had a TKR in May 2008.

Due to my alignment issues,etc. I'm not sure how long the osteotomy will be successful. Remember everyone is different and has their individual ortho. issues that can effect their surgical outcome. Do your research and bring a list of questions to your OS appt. Good luck  and let us know what you decide to do.

Robin
Lt. knee- 6/04 scope and chondroplasty of MFC,11/04 Synvisc injections, 11/05 mosaicplasty, 3/06 scope,LOA and MUA, 1/08 degeneration entire knee, 5/12/08 TKA, 7/21/08 MUA
Rt.knee- 10/06 scope,,plica removal-OA, 3/07 HTO, 9/09 hardware removal  12/7/09 TKA 1/10,3/10 MUA, 11/10 LOA,partial revision

Offline fuzzybob

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Re: osteotomy QUESTIONS
« Reply #8 on: April 28, 2009, 12:55:08 PM »
Hi Lady,

Thought I would add my story too. I had an open wedge high tibial osteotomy (HTO) on my left knee in March 2008 for medial compartment post traumatic arthritis - basically for impact damage to my medial femoral condyle (large and deep area of grade 3 damage) caused when I tore my hamstring badly whilst sprinting for a ball during a field hockey game and I collapsed through my knee. I also had the HTO to help correct instability issues as part of my posterolateral corner (PLC) ligament reconstruction - since I ruptured both my PLC and posteromedial capsule, alongside LCL and ACL laxity and hyperextension issues.

I was 39 yrs. old and needed to have surgery to try to unload my medial compartment and to correct for soft tissue instability and wanted to preserve my natural knee for as long as possible as too young to consider a TKR, although aware that is where I will likely end up.

I was in hospital for 3 days and initially placed in a full length cast whilst in hospital as unfortunately during my osteotomy, as my OS placed the final screw, my tibia fractured, propagating from the osteotomy site up through the knee resulting in an unstable lateral tibial plateau fracture. This resulted in longer screws used to bolt through the tibia to help stabilise the fracture as well as the osteotomy and slightly changed my post op rehab. This is a very rare complication and the first time it had ever happened to my surgeon so please don't be too alarmed, but just thought you should know.

Yes the rehab is long and will take a chunk out of your life but it does get easier. I never really suffered any pain which surprised me – had good pain control which is important. The first 6 weeks were the worst for me. On leaving hospital, my cast was replaced with a full length knee brace locked and non weight bearing for 6 weeks. Followed by unlocked knee brace and 6 weeks PWB. After 12 weeks cleared to go to full weight bearing over the following 4 weeks (so 16 weeks in total). I started formal PT at 7 weeks although given gentle exercises to do from day 14 post op. Since then have had both land PT as well as hydrotherapy and still in PT!! But you need to remember that as I was also nursing a lateral TPF so my rehab protocol changed to much more conservative, slow and gradual compared to what it would had been for just the HTO. I have very week muscles, hamstring and quads and still suffering with instability problems due to ligament damage etc.

I am also just one of those patients who seem to not like hardware in my body. I felt my metal work since day one. Whilst it has never been painful as such, it has remained very sore and tender to touch, causing me discomfort as well as interfering with the rehab since it was blocking my final flexion. Again remember I had extra metal work (or longer screws), and it appears one screw had pieced through catching the soft tissues, so causing inflammation and pain. I was told my hardware needed to come out as it was causing me problems otherwise it would be left in permanently. However hardware must stay in for at least 12 months. At 13 months post HTO, on April 15th I had my hardware removed and at home recovering currently.

I have not been able to return to activity yet. I have had difficulties progressing my rehab to date due to hardware and instability issues and giving my TPF time to recover too, so no impact, twisting or pivot work yet. I am still under PT supervision having weekly sessions limited to rowing, recumbant bike, strength and balance exercises. Just need to build up the strength etc and be aware of what my limitations are and acutely aware I need to try to preserve my knee as best as possible and for as long as possible.

Following my most recent surgery (hardware removal, chondroplasty, as well as checking ligaments and fracture site) currently back to basics PT wise, resting, icing, on crutches WBAT, needing to protect my tibia as its is weak and needs time for the tunnels where the screws were to fill in, so need to avoid stressing the tibia as it could fracture. To be reviewed after 6 weeks and see what state my knee is after the initial healing stage is over with and take it from here.

Due to the level of damage I was told I could not return to high impact sports and needed to consider a change to my lifestyle. This was tough at first but over the past year I have come to appreciate just being able to do the basics! At the moment my goal is to be able to walk well and if i can go back to any level of sporting activity then thats a bonus. It is only when you suffer serious knee problems you come to realise just how important and lucky people are to have a healthy knee!

Due to my other knee issues etc. I'm not sure how long the osteotomy will be successful. As the others have already said remember everyone is different and have their individual ortho. issues that can affect their surgical outcome. Overall I do not regret the decision to have an HTO, as I felt I personally had little choice. My injury was causing me signifanct pain and disability and more and more damage to my knee. What was key to me was - it gave me a chance to return to a more normal life and a chance to be active in some way again, a better chance to just walk painfree!. In addition I wanted and need to do as much as possible to preserve my natural knee for as long as possible and stave off a TKR for as long as possible.

Yes it is major surgery and rehab is long. Overall it was the general feeling of sitting round recovering and loss of independence that got to me. But I did get a good rest, so take the opportunity whilst you can. Accept this needs time to recover and you need to be patient but it is worth it in the end. Good luck and let us know what you decide to do.

Best wishes
09/06 bad hamstring tear/undiagnosed knee injury
03/07 >6 months PT.OS referral
05/07 OS#1 diag. old age
07/07 OS#2 scope/EUA. Diag.LCL/PLC/ACL laxity, Grade3 medial femoral condyle damage, medial meniscus displaced
12/03/08 HTO,TPFx in surgery!
04/09 hardware out scope/EUA.PLCr not needed
ACI?

Offline lady

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Re: osteotomy QUESTIONS
« Reply #9 on: April 28, 2009, 07:06:58 PM »
first things first!!! HOLY COW!!!!

Thank you all for your input. Its a lot to take in.But I really wanted your all input and "side of the story". You all live(d) it and you all know. As I am aware right now I would only be having the HTO no other surgery, but we all know how things change when they get in there (thanks for the reminder fuzzybob, lol).
At this moment I want to do it ASAP. I have a lot of responsiblitly with soccer as I am a coach of a pretty competitive team of U14G and I am a Vice Pres. of our league. I have lots of duties taking care of many fields. This past Sat I was on a field from 6:30am until 5pm when my girls finally played. And then had a mini cookout (thanks honey) until 9pm. (don't you love husbands who decide to have spree of the moment cookouts) Anyways. My hip on the good leg and knee were KILLIN' me. I do favor my bad leg even though I try to not I do. I did not sit for exept to drive all day and man did I feel it.

So my thought now is I have ta do something before I completely kill the other leg. My hip is still sore not bad but achy and its 3 days later. I had another game yesterday and had soccer duties (not a game though) on Sunday. I wear an unloader that yipee saved me but it isnt' a cure all and man do I now have funny tan lines....think zebra. Thats the least of my worries but pretty funny. Oh and this thing can get pretty smelly in 90 degree weather. I had to spray it with febreze. YUCK.

Oh ya the other thing that I am concerned about is when I am working out or at Pt I have "crack" my knee to straighten it. Even then it won't often get "strait". I used to have this problem on occasion. But today during PT I had to do it after every exercise before I walked.I wasn't wearing my brace of course. I thought that was interesting. The PT chick thinks I might have more spurs. But said it was normal with OA. My doc told me I had 2 definit spurs but possibly more, I am bone on bone. How fast do these things grow? Could I have more since this Feb?



dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline Mandy

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Re: osteotomy QUESTIONS
« Reply #10 on: May 03, 2009, 04:18:05 PM »
Hi Lady!

I'm coming up on a year post op from a high tibial osteotomy and am 21 years old.  Arthritis runs very high in my family, so the culmination of bad genes and a surgeon who was a little over zealous, I was left with being bowlegged and having osteoarthritis.  I'll share my experience with you and I hope it helps!!



Q1. At what degree did you get back your activity level? And how long has it been since the surgery.
I used to compete at a very high level in hockey before my surgery for years.  I still skate recreationally, but absolutely nowhere near at the level I was.  Keep in mind though however the rest of my body is really beat up from the sport so it's not only the knees that hold me back.  For now, I still play recreational softball and have found that I absolutely LOVE swimming.  First the water puts so much less stress on my joints, but I've found that lap swimming for me is just awesome.  I do rollerblade as well and just love it.  Again, I'm only just a little under a year post op, and hope to even up my activity a bit more once I get this hardware out.  The screws bother me and need to be taken out.

Q2. Did anyone have a TKR afterwards an osteotomy and  was it adaptable?   No TKR as of yet.  My OS and I are trying to obviously delay one for awhile.  She expects this surgery to last about 10 years, so hopefully I'll only have to deal with 2 TKRs on that side in my lifetime.

Q3. Did you wear an unloader brace before the surgery? If so did you consider wearing the brace until it was time for replacement?  I did wear an unloader brace before surgery.  I absolutely loved it.  Well, the brace itself actually was crappy to have to wear all the time, but it for sure did its job.  Because I'm young, we discussed if I would just be able to rely on the brace for relief just for sporting activity, but since I relied on it much more than that to get through the day, my surgeon and I felt it was best to just bite the bullet and get the osteotomy done.

Q4. What did you feel was the biggest benifit of the osteotomy or PKR ?  Do I have the Osteotomy and hope it last 10-15 years or do I have the PKR and hope it last 10-15 years. I have this silly notion of keeping my knee as long as I can.   Again, because I'm young, the PKR wasn't much of an option for me.  I believe my OS knew I wanted to keep my activity levels as high as I could.  In all honesty, a PKR was never discussed so it wasn't an option.

Q5. What made you think or know the osteotomy / PKR was the way to go.  After a long trial with the unloader brace, and realizing how awesome I felt in it, and how much pain I was in without it, I realized this surgery had the possibility of helping me.

Q6. Before the surgery did you feel that you had to plan your activities around everyday life or if you were going to have a busy day or say you want to go for a walk but knwo you will be on your feet for a few hours do you go for the walk and suck it up and regret....     I know I'd really think about what I had to do for the day, and kind of judged whether that day's activities were going have me hurting pretty bad.  I'm still cautious about that even now, but way less than what I was before surgery.


I want to wish you the best of luck with surgery.  Please let me know if you have any other questions!
21 yrs old
12/04: plica removal (RK)
2/05: debridement, LR/TTT (RK)
6/05: debridement, LR/TTT (LK)
10/05: scar tissue removal/debridement (LK)
3/06: screw removal (both knees), debridement on TTT site (LK)
5/08: debridement, HTO, Maquet procedure (LK)

Offline lady

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Re: osteotomy QUESTIONS
« Reply #11 on: May 03, 2009, 06:47:10 PM »
Thanks for your comments Mandy. I haven't decided to even call the doc about it yet, kinda hoping the orthovisc will kick in, but I know it would have by now . I know I should call the doc and talk about sooner rather thatn later I am so avoiding it and he knows I am and will because he saw my face and heard my very anxious WHAT when he mentioned it. Sorry to hear yoru about knee problems so young. I'm starting to really drill it into my team about their knees. Girls seem to really have issues when they are young teenagers, 2 of my girls are going to PT for their knees! Scary. I don't want them like me or you.

Today I decieded not to wear the brace and see how things go. I might tomorrow as well but its a pretty active day tomorrow and I have PT on Tuesday so I don't want to ruin it for PT. So far I have noticed I'm rolling my foot and walking on the outside of it. Not sure why because my bad side iis the lateral side. I would think I would walk on the inside of my foot more. Myabe its because my lateral side is "shrinking" or "caving",  But who knows. I noticed today while cleaning that I can not at all bend my leg to kneel on the ground. The thought of it sends shivers, lol. Its been about 5 hours of no brace and I do have swelling, puffy full feeling. Yesterday I was on my feet very active  all day with the brace and very sore so that is why I decided to see what happens on a moderatly busy day.

Another Question for you all.......I'm a preschool teacher and I am very busy for most of the day not sitting much and when I do in very low seats. So the question is how long do you all think before someone can go to work with that type of job?

dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline Robin M.

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Re: osteotomy QUESTIONS
« Reply #12 on: May 07, 2009, 03:17:56 PM »
Hi Lady,

As far as returning to work I think alot of it depends on your weight bearing status, how your recovery is progressing, and the type of job you have. In my case I work per diem as an RN in rehab/long term care. I wasn't eligible for light duty so would have to return to full capacity which involved  alot of standing, walking, and pushing a heavy med. cart. I also was non-wt. bearing for 10 wks. and took about another month or so before I was crutch free. I could have returned around 5 months post-op. You should probably talk with your OS or PT about it.

Robin
Lt. knee- 6/04 scope and chondroplasty of MFC,11/04 Synvisc injections, 11/05 mosaicplasty, 3/06 scope,LOA and MUA, 1/08 degeneration entire knee, 5/12/08 TKA, 7/21/08 MUA
Rt.knee- 10/06 scope,,plica removal-OA, 3/07 HTO, 9/09 hardware removal  12/7/09 TKA 1/10,3/10 MUA, 11/10 LOA,partial revision

Offline lady

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Re: osteotomy QUESTIONS
« Reply #13 on: May 07, 2009, 09:55:21 PM »
OMG!!! 5 months. I would go NUTS!!!! I'm very hyper. Well I'm still on the fence about all of this and not saying yes or no just yet. I have an appointment on Wednesday and I'm basicly going to ask what can we do to best resolve my knee issues. And go from there. Should I expect to be in pain everday little or alot or should I try something else? So many questions???? Wish I could remember them all when I get to the docs. Ya, ya, I know write them down. lol.

Thanks again everyone. I haven't really decided nor has my doc but just getting enough info about it before I discuss it further is so helpfull. Al though reading all this makes me wonder sometimes if I should just wait a year or 2and get the PKR, recovery for that seems so much quicker and easier. Kudos to all of you for going for it and hanging tuff.

jenne
dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline chereb

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Re: osteotomy QUESTIONS
« Reply #14 on: May 08, 2009, 01:56:54 PM »
I would agree with Robin. I am 4 months post op and not back or near back to normality. I have a lot of thickened tissue above the knee from the op and its hard work trying to break it down. I need a crutch for walking a lot. Manage aroud the house with none but definately not pain free as of yet. Its hard work and the op is the very easy part. Good luck and let us know what you decide.

Offline knee-will-be-great

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Re: osteotomy QUESTIONS
« Reply #15 on: May 11, 2009, 03:56:12 PM »
This commentary is in reply to part of Lady's last comment and question ... "Another Question for you all.......I'm a preschool teacher and I am very busy for most of the day not sitting much and when I do in very low seats. So the question is how long do you all think before someone can go to work with that type of job?"
_______________

Keep in mind that a HTO is major surgery ... it is like having your leg broken - but on purpose.  I was able to function after four months - but I undertook a very aggressive exercise regime - and I was in top shape prior to the surgery.  It does take, in my opinion, at least six months to recover from the HTO surgery.

Lady, please note that I have about 10 years (age) on you and had an HTO three and one half years ago.  A late 40s kind of person.  Not old.  I am a very active woman with a very high-level of exercise in my life.  The HTO has been an absolute blessing.

If you think that you would have issues with an HTO, I would advise that you cruise this website and evaluate the unfortunate situations that you people (young people like you and like me) are having because of Knee Replacements.  After a knee replacement, there is no going back.  Many total knee replacements involve severing and then discarding the ligaments - to install the artificial knee.  So one's activity is not meant to be high after total knee replacement.

And with a knee replacement, there is no going back also - because the articulating ends of your bones that comprise your knee joint - are gone - sawed off to fit with the knee replacement.

In my humble opinion, there is way too much application of this surgery on people who could have other treatments done for them - but surgeons putting in artificial knees provides a continuous source of profit for the companies that produce these things - and of course folks, companies' objectives are to corner a market and make a profit. 

So, instead of research into biological remedies (which in my opinion, should be at the forefront of medical training and orthopaedic research), OS's become replacers of body parts - and these body parts do wear out - and, if not put in properly, or, even if put in properly, there are a lot of things that can go wrong - and essentially you would have only a few opportunities to have the knee replacement re-replaced and re-done.  Because every time there is a knee replcement surgery on one person's knee, bone stock is lost because the ends of the bone where the replacement go have to be re-carved to fit the new replacement.  And the edge of the bone where the knee replacement meets the bone often degrades (read up on osteopenia <bone loss> relating to knee replacements).  Bone loss occurs because of the wear and tear your bone will naturally experience at the site where the bone meets the metal (titanium steel) knee joint replacement.  Metal is harder than bone, and therefore the every day pounding and normal activity of daily life that you undertake results in the bone giving way and crumbling (just a bit) - if you are young and active and intend to continue having a long and active life.  Because it sure as heck will not be the metal giving way - because metal is solid; bone is porous.  In truth, (in my humble opinion), knee replacements just do not make sense - other than for the very old and very sedentary.

I have seen a variety of people become professional patients for life as a result of having knee replacements - be it using vast amounts of pain medication, seeing OSs regularly for follow-up on continuing knee joint clicking problems and joint laxity problems after the knee replacement, infection that will not go away, back pain (because the knee replacement was not put in properly, and one's walking gait is out of whack), depression medication, physiotherapists, psychotherapists, regular pain clinic visitors, and a whole host of other issues including RSD.

I do not mean to frighten you, but I convinced my OS that "waiting" for a knee replacement would nto be the the best option.  Having said that, I will never, ever, ever have a knee replacment.  If need be, I will go to Europe and have "abrasion arthoplasty" to repair the articulating surfaces of my knee - and then go on and on and on into old age.  There are ways to deal with knee issues other than cutting the knee out - so my question is why are orthopaedic surgeons not investigating these options rather than undertaking the Knee Replacement mantra? 

I apologise if this commentary seems harsh, but I am providing you with my concerns that may very well assist you in undertaking a better long term plan for your knee issue.

The knee messes resulting from Knee Replacements are what I have seen and witnessed in other people.  In reading about knee replacements on this web site, there most certainly are successes out there that should be noted and congratulated (with caution - because the proof in the pudding <as to whether a knee replacement is in fact successful> usually occurs three to five years after the knee replacement) - but invariably there are also big, big immediate (post surgery problems) as well as long term problems.

Cheers ... and my knee (which I predicted would be great <after proper HTO surgery>) continues to be GREAT!!!  Even some of the top guys I saw predicted that my HTO would not be a success - and that three years later I would "need"  ::) a knee replacement.  Not true. 

General Recommendation: More longitudinal study (20 - 30 year studies) seems to need to be done on patients who have had HTOs and other biological means of treatment - in otherwise physically and psychologically healthy, active people (from all age groups).  The people who do the best with any surgeries are people with an internal locus of control - and who feel they are in command of themselves.

Knee-will-be-great!!!
« Last Edit: May 11, 2009, 04:40:06 PM by knee-will-be-great »
Medial Menisectomy, 1 ACL Autograft, 3 ACL Allografts, HTO, numerous debridements, good now :)
ACL Allograft #3 Post-Surgery Rehab/Wellness Diary http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37218.0;all
ACL Reconstruction VIDEOS http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37773.0

Offline lady

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Re: osteotomy QUESTIONS
« Reply #16 on: May 12, 2009, 12:50:52 AM »
woweeKazawee, what a post. I found it very interesting and refressing and agree that I want my knee as long as possible if that is possible.

 I am very uninterested in surgery (of any kind) and thankfully my doc is all about trying nonsurgerical things as long as he can. He knows I don't want to even have a scope at this point but has said that may not be possible and also the oseotomy may be the route we need to go. He gave me food for thought and suggested I get as much info as possible on osteotomys before freaking out about it. Also that it was more like food for thought. So of course I jumped on here. A year ago he was saying maybe a PKR at 40 if the biological stuff doesn't work but that was last option. That is why I am thirlled to have him and his PA.

I do however feel as if I am becoming a proffesional patient. I have PT 2x a week and I seem to be visiting the docs every few months unless I'm getting a hylan injection and then its even more. I do feel like my knee is the focus of everything and Its getting old!!!

Ya know whats funny though is that the rehab is so loooooong for a osteotomy but for the PKR not so much so hard not thinking about that. But all good things come to those who wait and work hard, right? I hope all of you will have great knees. And I hope that at some point in my life my knee is not the focus of everyday. Oh ya and my hip which is really starting to bother me recently.
dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline knee-will-be-great

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Re: osteotomy QUESTIONS
« Reply #17 on: May 12, 2009, 01:39:06 AM »
Hi Lady,


I am first referencing what you said in your last post:

Ya know whats funny though is that the rehab is so loooooong for a osteotomy but for the PKR not so much so hard not thinking about that. But all good things come to those who wait and work hard, right?

_________

People who focus on short term (so-called) benefits usually have long term negative consequences.

Short term gain usually means long term pain.
_________

I repeat, you are way too young to have knee replacements.  Find a top surgeon and get some options going - else you will continue being a professional patient - and a long term, continuous source of income for your OS, other OSs, physiotherapists, your HMO, pain specialists, hospitals, pharmacists and pharmaceutical companies once your first knee replacement fails (or wears out).

But you will not be a long term, continuous source of income for yourself and your family - if you do not address this situation.
Medial Menisectomy, 1 ACL Autograft, 3 ACL Allografts, HTO, numerous debridements, good now :)
ACL Allograft #3 Post-Surgery Rehab/Wellness Diary http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37218.0;all
ACL Reconstruction VIDEOS http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37773.0

Offline knee-will-be-great

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Re: osteotomy QUESTIONS
« Reply #18 on: May 13, 2009, 02:43:15 AM »
Read this PKR link about the perils one Knee geek experienced.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=47186.0;topicseen

Medial Menisectomy, 1 ACL Autograft, 3 ACL Allografts, HTO, numerous debridements, good now :)
ACL Allograft #3 Post-Surgery Rehab/Wellness Diary http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37218.0;all
ACL Reconstruction VIDEOS http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37773.0

Offline lady

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Re: osteotomy QUESTIONS
« Reply #19 on: May 13, 2009, 08:50:13 PM »
So....I just got back from the docs but I didnt' see him I saw the PA. Who is stongly suggesting a HTO but wants to discuss it further with the Doc and then come in for another appointment in 3 to 4 weeks. Ya hello professional knee patient. But that is okay because I am glad they are not the type of docs/pa's to rush into cutting. He knows I'm very apprehensive I must have asked him several times is there anything else but cutting and he said No.

They don't do them often he all so said and that kinda makes me glad and nervous. Great they don't do such drastic things but crap experience would be a plus. lol.
Gotta run, what a crazy week. Thanks everyone for your help I know I'll be on again asking more questions. I really do appreciate it. Its so hard to make decsions like this. I want to make the right ones. Whatever I do is going to affect my life forever and man do I not want to screw it up. I got about 60 more years in me and that would suck. lol.

THANKS again.

« Last Edit: May 14, 2009, 01:01:59 AM by lady »
dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline lady

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Re: osteotomy QUESTIONS
« Reply #20 on: June 18, 2009, 08:34:10 PM »
All the worry about a osteotomy and NO CAN DO. I think I've never been so thrilled yet so bummed out at the same time. Basicly no HTO it would have to be a DFO. But he would have to make it so I was significantly bowlegged and he doesn't feel the outcome would be good. Also very concerned with when it would be time for a TKR how it would "fit". Does any of that make sense.

After reading all the posts of people who have had any type of osteotomy I have to say you people are tough! I wish you the best.

Doc says the only thing to do is wait as long as I can for a PKR. Really the only option. I have to wear the unloader now until PKR as that is the only thing helping with pain and with proper walking. He said I can take a break but 2 days 3 at the most and thats pushing it. And now I have to wear it when I work out. I have already done this and I have noticed what an improvement my workout is.
I thought wearing a brace was bad for the muscles but he said so is swelling and if I'm working out with alot a swelling the swelling will only depleat my muscles more. But seriously who cares because I lost 2lbs since I started wearing the beast during workouts so I'm pumped about that. It really does help me to work harder and longer. And my good knee isn't to sore either.

This is the bummed out part. I'm completely shocked there is nothing else. I just have to wait. Thankfully I have the beast of an unloader to wait with and if I didn't have it I would be miserable. I asked how long and he said 2, 5, 10 years. Who knows right now. Go as long as we can.

Thanks again for all your help. Hopefully this thread will help someone else who has questions on this procedure.
dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline knee-will-be-great

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Re: osteotomy QUESTIONS
« Reply #21 on: June 23, 2009, 03:16:26 AM »
I would be quite concerned about someone telling me nothing else can be done ... get more consults - I recommend the Hospital for Special Surgery ... where they do external fixation osteotomies.


Regards ... do not give up ...  >:(

KWBG
Medial Menisectomy, 1 ACL Autograft, 3 ACL Allografts, HTO, numerous debridements, good now :)
ACL Allograft #3 Post-Surgery Rehab/Wellness Diary http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37218.0;all
ACL Reconstruction VIDEOS http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37773.0















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