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Author Topic: Rotational Osteotomy of Tibia not healing  (Read 18398 times)

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Offline Alyce

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Rotational Osteotomy of Tibia not healing
« on: July 30, 2009, 07:28:35 PM »
I have had two previous surgeries that had failed in the last 7 years.  I finally found an OS in Michigan who specializes in lower limb realignment.  Both femurs and tibia were rotated, but the right tibia was the worst.  With my patella straight, my foot was at about 45 degrees.

I had surgery May 11th, over 11 weeks ago, to saw through the tibia and fibula, and rotate it inward to properly align it.  In addition, my OS did a LPF ligament rebuild by drilling through the knee cap and using an allograft to tether it down.  He wanted to make sure that the LR was restored.

I had paralytic ileum 3 days after the surgery.  Basically, my intestines didn't "turn back on" after anesthesia.  I had nothing to eat of drink, including water for 8 days.

I had a follow up visit at 7 weeks, and the tibia had started to heal.  I started PT, and she was very aggressive.  She had me walking with one crutch, when I told her I couln't do it without pain.  She also had me on Pilates equipment.  After the last session, 3 weeks ago, the pain was deep.  I have stopped PT.

Called my OS, and he ordered an xray.  I live in Atlanta, so it takes a while longer than if I lived in MI.  He called this week, and said that the tibia was not healing!!  Told me to go back to toe touch WB, and resting.  Do nothing that causes pain.

Now, after crying for 2 days, I am afraid the tibia won't heal.  I am a youthful 50 years old, and worked out 6 days a week prior to this, even though I was limited.  I am slim, so that's not an issue.  I don't smoke or drink.

I guess that I'm looking for confirmation that it will indeed heal.  He said that the plate and pins are all perfectly aligned.  Any help would be very appreciated.

Thanks,
Aree
Patella shaving & Lateral Release 6/2002
Reattachment of Lateral Retinaculum & Microfracture 6/2003.
Both procedures failed.  Reattachment was successful.
Lesion remains 15mm x 9mm x 6mm
Tibial rotational osteotomy May 2009
LPFL rebuild May 2009
Surgery for Baja Patella February 2010

Offline Turtlebug

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Re: Rotational Osteotomy of Tibia not healing
« Reply #1 on: July 30, 2009, 10:05:21 PM »
Aree:

I'm sorry to hear that you are having so many problems.  I know what it is like to do the "out of town" care....

I don't think I can PM since I haven't posted too much, but please email me.

Thanks!

Offline jumpi5d

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Re: Rotational Osteotomy of Tibia not healing
« Reply #2 on: July 31, 2009, 09:25:25 PM »
Aree, Don't give up yet.  Take it easy for a while, things can still change.  If you need anything  let me know.

xoxo
-Paige

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

Offline Alyce

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Re: Rotational Osteotomy of Tibia not healing
« Reply #3 on: August 02, 2009, 03:38:33 PM »


Thanks, Paige for your good wishes.  How are you doing?

Aree
Patella shaving & Lateral Release 6/2002
Reattachment of Lateral Retinaculum & Microfracture 6/2003.
Both procedures failed.  Reattachment was successful.
Lesion remains 15mm x 9mm x 6mm
Tibial rotational osteotomy May 2009
LPFL rebuild May 2009
Surgery for Baja Patella February 2010

Offline jumpi5d

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Re: Rotational Osteotomy of Tibia not healing
« Reply #4 on: August 03, 2009, 12:13:16 AM »
I'm doing good. I just scheduled surgery #2 for Nov. 18th. :-/
-Paige

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

Offline Alyce

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Re: Rotational Osteotomy of Tibia not healing
« Reply #5 on: August 03, 2009, 12:28:44 AM »

Paige,

That's fantastic that you are doing so well!  What are you able to do now?  What surgery will you have in November?

Hope that you are enjoying summer.

Aree
xoxo
Patella shaving & Lateral Release 6/2002
Reattachment of Lateral Retinaculum & Microfracture 6/2003.
Both procedures failed.  Reattachment was successful.
Lesion remains 15mm x 9mm x 6mm
Tibial rotational osteotomy May 2009
LPFL rebuild May 2009
Surgery for Baja Patella February 2010

Offline jumpi5d

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Re: Rotational Osteotomy of Tibia not healing
« Reply #6 on: August 03, 2009, 06:49:06 PM »
I can do about everything for now he doesn't want me doing a lot of running or jumping but in general there is not a ton of limits. I'm having something done to my left leg in Nov. That has yet to be decided.  ( I know I'm trusting haha...)

I'm enjoying summer so far minus the horrible sun burn I got while I was in MI. How's your summer besides the leg?

Paige
xoxo
-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: Rotational Osteotomy of Tibia not healing
« Reply #7 on: August 03, 2009, 07:35:41 PM »
Aree,

Although it may feel very handicapping to have to passively sit and wait while your body does or does not heal, one thing you can actively do to help yourself is to strategically adjust your diet.  You may be already doing this but I know there are a lot of food out there that can help with healing.... it can't hurt afterall.  I had a DFO back in December and I made sure that, for at least the first month or two, I only ate things that were going to help my recovery.  No processed sugars or fats.  Lots fruits and vegetables, esp. broccoli. which has a lot of calcium. Also I made sure to eat a lot of lean protein (beef has a lot of iron, good for building bone) as well as dairy for calcium, omega 3s, antioxidants, etc. Below is a website you might find useful.  Good luck, I hope you are back to new in no time.  Oh, lastly, you may also want to try doing any excercise you can with your upper body.  My gym had a hand bike which I used often.  I also had friends bring me weights to lift.  The idea being that you are not doing anything to your surgery leg, no pain, no effort but you still get the health benefits of exercise.

http://www.thedietchannel.com/Post-Surgical-Nutrition-Speed-Your-Healing-With-A-Good-Diet-and-Supplement-Plan.htm

Offline Alyce

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Re: Rotational Osteotomy of Tibia not healing
« Reply #8 on: August 04, 2009, 01:25:01 AM »
Hey Paige,

I understand the complete trust thing, and am right there with you!  My knee HAS been my whole summer.  We've gone to the pool several times.  We are planning a beach trip soon.  If I have to lounge, I'd just as soon be at the beach.

I'm feeling less inflammed since I've been couch ridden.  Fingers crossed.  Never having broken a bone before, it's hard to tell what healing feels like.  But my body knows.

I go back to see Dr. T. in September.  I have to make the appointment.  I hope my next X-ray is a big improvement.

Keep in touch!  Where is everybody?

Aree
xoxo

Aterapin,

Thanks for your sound advice.  I had to force myself to eat for about the first two months.  Still, nothing really tastes good.  I have been getting calcium in at every meal, and drinking hot chocolate or instant breakfast in between.  I'm lactose intolerant, so it's Lactaid, which tastes exactly like regular milk.  I am probably not getting enough protein.  I really need to add it to breakfast.  I don't eat eggs, so that sort of limits the easy stuff.   I'm still pretty skeletal after the hospital episode, so I'm trying to keep weight on.

I've gone to the Y to ride the stationary bike, which doesn't hurt.  I pass by the Cybex machines longingly.  I'm afraid I'll trip over something and mess my leg up.  I really miss my Y buddies, which are retired men, mostly.  We keep each other company, and they deliver their political views for anyone who is interested.  It's tough being isolated.

I will check out the link.  I am truly grateful for your healing advice.  When he started talked compression surgery, I got nervous.

Thank you so much,
Aree

Patella shaving & Lateral Release 6/2002
Reattachment of Lateral Retinaculum & Microfracture 6/2003.
Both procedures failed.  Reattachment was successful.
Lesion remains 15mm x 9mm x 6mm
Tibial rotational osteotomy May 2009
LPFL rebuild May 2009
Surgery for Baja Patella February 2010

Offline Alyce

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Re: Rotational Osteotomy of Tibia not healing
« Reply #9 on: August 04, 2009, 02:20:28 PM »

aturpin,

I'm sorry about botching your name.  I was trying to make you a turtle!

Warm Regards,

Aree
Patella shaving & Lateral Release 6/2002
Reattachment of Lateral Retinaculum & Microfracture 6/2003.
Both procedures failed.  Reattachment was successful.
Lesion remains 15mm x 9mm x 6mm
Tibial rotational osteotomy May 2009
LPFL rebuild May 2009
Surgery for Baja Patella February 2010

Offline jumpi5d

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Re: Rotational Osteotomy of Tibia not healing
« Reply #10 on: August 04, 2009, 09:35:35 PM »
It's weird to think about the complete trust though, but its there for sure. Everyone keeps questioning me about it .  My summer vacation was a trip to MI to see Dr. T. We just got lucky and could stop at the beach on Lake Michigan.  The beach was awesome but don't forget to use sunscreen...especially on the leg. I had mederma on my leg thank god so it didn't get burned but my shoulders and back sure did. Lounging on the beach sounds fun and relaxing.

I'm glad its feeling better. That's a good thing. I never had a broken bone before either so no help there. This is the first time for me too.  The big changes in my xray came between 9 weeks and 18 weeks. Here's an image that shows the process. Its crazy to see how much it changed between the last two than the first two.





I don't know where everyone is, probably busy with summer and getting ready for school.

xoxo
-Paige

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

Offline Alyce

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Re: Rotational Osteotomy of Tibia not healing
« Reply #11 on: August 07, 2009, 05:27:31 PM »
 
Hey Paige,

Thanks for posting your xray films.  It is amazing to see the healing in progress.  Had you been very active after the first month?  How did you know it was okay to go to one crutch or just ditch the cruthes all together.  I'm still on both crutches, and have so much pain that it stops me.  I've spent the last 11 days on the couch, and I'm about to go crazy.

I don't know if I should ask again about the bone stimulator.  He was very dismissive when I brought it up.  I desperately want this tibia to heal.

One night this week, after riding the bike, I woke up at 2 am with horrific pain.  I'd say it was a 6.  I took 2 darvocets.  It eventually went away.  I was looking forward to getting off the Darvocet.  My doctor here has tapered me off of the Percocet to 200 mg of Darvocet twice a day.  I thought I would come off the Darvocet in the next week.  But now I feel like the meds have been masking a high level of pain.  I hate being on them.  It's difficult to read, as they really effect my cognitive skills.  The doc says that it will be easy to get me off, and that she's not worried about it.  She is worried about me being in that level of pain.

I have just been really down lately.  My hubby is going to take the afternoon off and take me to the pool today.  Just the change of scenery will be refreshing.  It seems like I am crying all the time.  I really miss driving!!

Hope you have fun plans for the weekend.

Aree
xoxo
Patella shaving & Lateral Release 6/2002
Reattachment of Lateral Retinaculum & Microfracture 6/2003.
Both procedures failed.  Reattachment was successful.
Lesion remains 15mm x 9mm x 6mm
Tibial rotational osteotomy May 2009
LPFL rebuild May 2009
Surgery for Baja Patella February 2010

Offline jumpi5d

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Re: Rotational Osteotomy of Tibia not healing
« Reply #12 on: August 08, 2009, 04:11:11 AM »
Hey. I really did nothing for like at least 6 weeks. Dr. T had told me to keep using crutches until I saw him at my 9 week appt and at that appointment he told me it was okay to start walking some. I ended up walking down to x-ray after him pretty much daring me to do it(not in those words but more of ' i bet you can't do it' type thing) I kept using them for the trip home. My appt was on the 5th of May and we got home the night of the 7th. The morning of the 8th we had horrible horrible storms. We were in the storm shelter for like 3 hours straight with constant 80mph winds. When that was all over with there was stuff everywhere outside and decided that I was done and ditched the sticks :P I never used them again after that. He told me to work off of them over a few weeks but I just wanted to be done that day.

It never hurts to ask, all he can do is say no...I've asked like 4 times to do PT and he keeps saying no I don't need it.

Have you tried doing a motrin/tylenol schedule and sticking to it? Thats how I got off my pain medicine. I took 800mg motrin every 8 hours and then 4 hours after I took motrin I'd take 1000mg tylenol (i gradually worked that down to 250mg) and alternated them every 4 hours.  It took a couple doses to get ahead of the pain that way but it slowly worked.

I'm gonna send you a PM. My weekend plans were rummage sale today and tomorrow (but were not having it tomorrow because we dont have enough stuff left to set up) I haven't slept in like 48 hours. I was on my feet for like 10 hours today and man are my legs telling me about it. My left leg gave out more times than I care to know about. The right one just hurts. My IT band is still super tight and its swollen some tonight.

xoxo
Paige
-Paige

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

Offline Mike1968

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Re: Rotational Osteotomy of Tibia not healing
« Reply #13 on: August 08, 2009, 05:07:45 AM »
Aree,

I just found the "Show unread posts" thing the other day so that's how I stumbled across your post.

I will keep you in my thoughts and prayers.  I had an opening wedge HTO and an ACI at the same time.  That was a couple of years ago and I was 38 at the time.....my HTO essentially failed and caused the severe degredation of the joint surfaces OA.  Finally found a wonderful surgeon that completed my HTO 5.5 weeks ago.

I am not a doctor at all but the suggestions of getting a good set of nutrition can't hurt and I know you are doing your best at it.  I have also read that if you are post-menapausal your ability to heal bones is degraded...not sure where I came across that or if you are experiencing that but that may be something to look into.

On the pain med issue, unfortunately, I have become an expert in that field.  I was placed on Oxycontin twice daily for numerous months with increasing dosages.  I ended up having to go to a Pain Management doctor to wean me off of the Oxy.  Not a fun time.  Some of the things he "prescribed" for my "detox" (which I will be going through again since the TKR) are a bit strange but reallly really helped.

1.  I carried around 72% or greater cacao dark chocolate.  This was to ease cravings that I may have had while trying to get off of the oxycontin.  I picked up a bunch at Walgreens on sale and my wife and I have an endless supply now.
2.  I was prescribed "lovasa" which is the only FDA approved (I believe) fish oil supplement.  I take that 4 times daily.
3.  I was also prescribed Clonazepam to help ease the "shakes" which I only had for a week or so.
4.  I was brought from the Oxycontin down, if you can believe that, to Percocet.  I had to get down to two percocet daily prior to my TKR so that the anesthesiologists could deal with my pain better post op.
5.  Post op, I was placed on Morphine sulfate twice daily and percocet for breakthrough pain.

I am now seeing  the doc on Monday for a significant cut in the meds.  I hate being on them more than you can believe. 

Everyone is different on the pain side of the house my Pain doc stated.  It depends on a lot of things weight, tolerance, type of pain etc....so you may want to have your OS refer you to a pain specialist as your pain seems to be where I was months ago with the failing HTO and the bone/bone grinding.

Oh one other thing that my doc stated after my HTO.  Exercise is actually good for bone health...the strengthening kind....however, if you are in such pain that you cannot do that then I would get with my doc as soon as possible.

I wish you the very best and keep your spirits up as best you can!

Regards,

Mike :)
83-Osgood Schlatters in both knees
90-left knee ACL repair
03-left knee ACL revision (hamstring graft)
04-left knee ACL revision (cadaver graft)
06-left knee arthroscopy
06-left knee ACI and High Tibial Osteotomy
30 June 2009 - Left Knee Total Knee Replacement

Offline ArielF

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Re: Rotational Osteotomy of Tibia not healing
« Reply #14 on: August 11, 2009, 08:40:01 PM »
Aree,

I am so sorry that you are not recovering quickly.  I had an HTO and TTO in March and had/have a delayed union.  It is really a very hard time to get through.  I have never felt so trapped.  At my 6 week appointment (1st post op) I had little healing.  I was ordered on toe touch to 1/3 body weight and I could ditch the brace for the most part.  At 10 weeks the bone I was growing had fractured.  I was touchdown but mostly swing through only using the 1/3rd body weight for getting out of the car,shower etc.  At 10 weeks I was given a bone stimulator.  It is very expensive.  Insurance covered it but it is $3000 and I didn't have enough durable medical left to even cover a small fraction.  I just got 2 braces, cryocuff, hospital bed cpm.........you name it. After more weaping and indecision, I am very glad that I have it.  I use it twice a day and according to the Dr it is healing the bone that I could not heal on my own.  I was very obiedient and followed his orders to the letter like you I don't smoke never did.  I had blood tests done before and after.  My calcium was good but vit D was low low low. (a hazard of living in the Northeast).   My doctor is Tom Minas he is conservative and highly regarded, I like him too.  Once I demonstrated that I was a poor bone healer he ordered the bone stimulator, Calcium supplements, vit D supplements, sun exposure for 20minutes /day protecting the scar and of course keep off the knee.  I can't take asprin or ibuprofen they delay bone growth.  No dentist except for emergencies. 

I would ask your doctor one more time for a prescription for the bone stimulator.  It can't hurt.  They sell them on ebay too.  Have your blood checked for vitamins etc.  Eat well.  Find a sedentary activity that you enjoy.  Beading, computer games and reading have been great time suckers for me.  Let your pain guide you.   You just have to get through it.  Try not to think of what should be.  I know that it is hard.  I spend so much time thinking of the promised time tables that I get very frustrated and just a little despondant.  It is not fair.  I am sending you a HUGE hug.  Do your best to find joy where you can.

Ariel















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