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Author Topic: Osteotomy failure  (Read 2701 times)

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Offline aloharob

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Osteotomy failure
« on: July 04, 2009, 01:35:45 PM »
Hi all,
Im new to the forum so please excuse any info I may overlook. I had a closed wedge osteotomy dome to my left femur on 2/2/09 as a result of a vargus knee. I am 42 yo, and was a healthy active(even with the discomfort) edical professional prior to the surgery.
Approx 9 weeks ago I was informed that the bone had healed and started agressive PT, and began ambulating with a cane. After the initial muscle soreness from PT, I noted that I was having increased pain in my knee. Every week it seemed to get worse. After 4 weeks of PT I saw my Dr. again, x-rays were done, and he informed me my pain was from my patella, increase my pain meds, wrote an order for a brace to stablize the patella, and said the pain would improve with more PT and increased muscle strength. 2 weeks after this day I was in PT and was in very bad pain, I had ambulated the day before for about 1 hour straight, the longest I had been up at once the day before. My therapist didnt like the swelling I had, and with my high pain level sent me immediately to my Dr office who informed me all was ok, and to keep going with the PT but wrote orders to do stim and ultrasound for pain reduction as well.
My pain continued to get worse, and on Wed I went for a regular check with my Dr. Following the x-rays he took me to a veiwing room and showed me on the x-rays that 2 pins had broken on the plate, and the plate had rotated. The angle of the osteotomy was different, and he told me the bone was not actually healed. He told me he also thought I may have inflammatory athritis as well, not osteo. He let me know he would call me by Monday for what my options are. If anyone could share their opions or experiences I would sure appreciate it. Im more upset than one could imagine, and very unsure as to what will happen here. My pain level is even worse this weekend, and Im a person who has had multiple traumatic injuries in my life and never took pain meds for more than a few days.

Offline aloharob

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Re: Osteotomy failure
« Reply #1 on: July 07, 2009, 01:10:41 AM »
Well my OS called today and went over my options at this point. Given what he discussed it seems to me as though getting a total knee done with a stem in the femur component to secure the fracture is the best option. I will have to discuss things with him more at the office due to the fact I still have some concerns about any problems that might arise during the procedure. Basically he said that the pins and blade-plate from the osteotomy will be removed, and the stem attached to the TKR component will secure the femur, but I will need to know whats done about the angle from the osteotomy, will I then have a secure open wedge? Do they now close the wedge once the pins and plates are gone(Im assuming since the plate has moved and the femur is not intact the angles have changed) and correct the angle with new cuts for the TKR components? I have several more questions as well.
If anyone has gone through this stituation I would appreciate any input. My surgery will probably be in 4-6 weeks, and I will have to be non-weight bearing once again until that time. I guess quad sets will be about the only thing I can do now to try to keep the muscle I got back during 2 months of PT, seems like Im starting this journey all over again!  :-\

Offline Skijammer

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Re: Osteotomy failure
« Reply #2 on: July 24, 2009, 06:38:12 AM »
Hi there,

I'm sorry to hear about your problems with the osteotomy. I will be interested to hear about the TKR if that's the direction you go.

I had a distal femoral osteotomy a year and a half ago, which took an extremely long time to heal. After the osteotomy, I developed a severe case of arthrofibrosis, which could not be addressed for 9 months because of the risk of re-fracturing the femur. 9 months after the osteotomy I had arthroscopic lysis of adhesions, then another LOA a couple of months later, then a z-lengthening of my patellar tendon to deal with patella baja.

After this last procedure I had a similar experience to yours with increasing pain at the osteotomy site during and after physical therapy. The pain became excruciating and my ROM rapidly decreased. My doctor thought that the osteotomy hardware was causing problems. Though x-rays showed the bone was healed, he sent me for a nuclear bone scan, which showed so many hot spots across the joint line and at the osteotomy site that the radiologist came out and told me my knee was a disaster and I needed a TKR. (I'm 46, and previously, have always been told that I'm too young for a TKR.)

With the bone scan news, my doctor decided hardware removal and possible bone grafting of the osteotomy site may be the next step. He sent me to a trauma orthopedist for a second opinion. He in turn had me get a CT scan of my knee, which was hard to read because of the internal hardware.

To finish up my story, I'm scheduled to have hardware removal with exploration of the osteotomy site to see if the bone has actually healed. The doctor will stress the bone while I'm under anesthesia, and if the femur does not seem stable, he will use bone graft from my hip to add to the fracture area, and will put in new hardware. I'm at the point of begging for a TKR despite my age, but was told by the trauma doctor that the hardware has to come out first, and the bone needs a few months to heal before they can put in a TKR. My doctor is hoping that we can still postpone the TKR. In the meantime, my ROM is absolutely terrible and I still have awful pain across the femur fracture site and lateral side where the plate and screws are.

You don't realize what an integral part of your body a knee is until it doesn't work!















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