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Author Topic: Derotational Osteotomy + TTT - 10/20/2009  (Read 120094 times)

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Offline crankerchick

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Derotational Osteotomy + TTT - 10/20/2009
« on: October 08, 2009, 07:43:09 PM »
Well, I was trying to hold off till closer to the surgery to start the diary, but since I'm incredibly impatient, here it is.

In 4th grade my knee problems began, both aches and pain and patellar dislocations (the patella always went back though). In my early 20s, the pain was much better, although I did have 1 dislocation then. I'm 28 now, and in the last 2 years, I've been experiencing subluxations just while walking around. After scheduling a Fulkerson + LR, I backed out after I got another opinion (my fourth since January) and a CT scan and learned that I have patella alta, femoral anteversion and external tibial torsion. So my bones are all twisted. There is literature available that suggests that procedures like the Fulkerson will fail when there are underlying long-bone deformities. It makes sense to me, so I'm getting my bones untwisted instead of doing the Fulkerson. I'm having osteotomies of the femur and tibia to untwist the bones, and osteotomy of the tibial tubercle to bring it down to correct the patella alta.

For those following that like to compare numbers, my femur on the left leg is internally rotated to 37 degrees and my tibia is externally rotated to 45 degrees. My left leg, the "good leg" is similar at 32 and 46 degrees for the femur and tibia respectively.

My doc says he's going to correct my femur by about 25 degrees and my tibia by 20 degrees. The patella is going to come down about half an inch, but I'll be having another x-ray before the surgery to confirm. I'm going to end up with plate on the femur below the hip and a TOMOFIX plate on the tibia below the knee and some unknown number of screws. I don't know, I might faint when I see my xray for the first time and see all the hardware.

I will stay in the hospital overnight, and fly out the following week. I will be partial weight bearing (<25lbs) for 6 weeks. I will not use the CPM or any kind of brace, but I will have a cryocuff for the swelling. I've been told I should not lose my range of motion (since the surgery is not within the knee joint) and my doctor will have me doing stretches every hour or so starting immediately post-op presumably to keep the stiffness at bay. I'm likely going to do spinal anesthesia if I don't chicken out, since I can go to sleep before they stick the needle in my back (yikes).

As for pre-op stuff, I did have a MRSA swab along with the other pre-op tests, which my GP thought was "cool" because he has never had to do one for a pre-op test but thought it makes a lot of sense to do to in preventing MRSA infections. My OS wants me on the bike every day for an hour at my target heart rate, so I've been knocking that out. I'm taking calcium and vitamin D supplements and will continue those after the surgery.

So at this point, I'm just waiting (12 more days) to head out and do it. I've got my crutch covers and no-slip socks. I'll get a shower seat for home and I'm gonna stock up on more shorts, since some of my doctor's patients that I talked to said the bleeding from the incision site for the femur can be a bit much. I've been going through my netflix queue lining up movies and I've got my media server all set up so I can game and watch tv and bluray movies and stream stuff from the internet. Got a few books to read also, although I'm not much of a reader. 6 weeks is a long time to be nwb though, and with the 'rents and husband being anal about me staying off my feet, I imagine I won't be doing much, so plenty of entertainment is a must.

I'll try to keep this journal up to date, since there aren't many derotational osteotomy diaries on here. Thanks to all the kneegeeks on here that have helped me research and learn about knee problems. Thanks for sharing your experiences and I look forward to sharing mine. Hopefully it will help someone else.
« Last Edit: April 10, 2010, 03:38:26 AM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline FormerlyActive

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #1 on: October 09, 2009, 06:15:16 AM »
Hi
If you have external tibial torsion don't your feet go out to the side? Take a before picture and send to us if you don't mind (or just keep for yourself you will be glad to compare to the after). Best wishes.
3/82 - Medial Synovial Plica removal both knees
9/89 - Lateral Release both knees
3/08 - Reinjury left knee hiking Asia Pac
5/08 - Miserable Malalignment diagnosis
4/08 - 9/08 Five doctors diff. opinions
7/08 - 02/09 - In PT, no chg.
4/09 - Dr. 6 opinion femur & tibia derotation together

Offline crankerchick

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #2 on: October 09, 2009, 02:28:21 PM »
My feet "generally" point straight as in, I make them point straight. I've been paying attention to this lately because I kept wondering why my patellae don't point in. It seems that my feet "want" to point out ever slightly, but I've always just walked with them point straight just because. Like when I sit, I notice my feet usually point out, and when I walk, its not uncomfortable at all to let them point out some, but I've always just made them point straight at no consequence or pain. I can even make them point in like I'm pigeon-toed, and I've found that sometimes when I walk, the do just that too.

I did find a site on miserable malalignment that talks about the ankle's influence too. It doesn't just stop at the femur and tibia. The ankle can have a deformity too (perhaps to compensate) so that the feet point straight. My conclusion is that there are enough things going on to compensate that its entirely possible for the feet to point straight. I mean, I'm an example of that. My feet are mostly straight as in whether they point in, straight, or out, it is not an obvious deviation.

I will find a picture or take one to post.
« Last Edit: October 09, 2009, 02:32:50 PM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline slmac

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #3 on: October 09, 2009, 07:29:06 PM »
Hey Cranker! you impatient lady you...I totally understand though. It's hard waiting. I'm glad my wait was so short. Definitely pick up more shorts. I didn't stock up before hand and I should have. Specific short advice is look for ones without buttons on the back (like on the pockets) because you wouldn't ebelieve how uncomfortable they can become when you're stuck on your back or you butt all day long. Buttons are a pain when you're doing stretches too.  I wonder if you'll go through all of the back pain that I've been dealing with from my op...it's unreal when you can't get comforable on your back. For me the only truly "comfortable" position for long term is in a recliner. Good luck if you try to read for the first few days (or couple of weeks). I still don't retain everything and that first week, I was so high from all the drugs that I could barely look at words on a page without them moving. I thought I was going to be able to do some puzzle books in the hospital...that was optimistic. This may sound awful, but ask your doc about stool softener too. The meds that they give you during the op and after will totally mess your system up, and the last thing a person needs to be painful after an op is that. :-) That's my two cents...good luck
Knee pain and issues during HS...played tennis
7/30/09 dislocations began
9/18/09 TTT (Fulkerson Osteotomy), MPFL Repair, and arthroscopic debridement
12/29/10 hardware removal
8/12 dislocations started
9/11/12 MPFL recon with allograft

Offline CHILLYdogs

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #4 on: October 09, 2009, 07:32:22 PM »
Dear crankerchick,

I just found this.  This is very, very exciting.

I couldn't possibly not be one of the first ones to wish you well, here, now..could I?


Can't wait to hear your success stories.


Rooting for you, always,

Kyle
[email protected]

contralateral BPTB ACLr: Nov'08
back to sports, no restrictions: Feb'09
( yep!! that's @ 12 weeks post-op :-)

Thank you, thank you, thank you, Doc Sanders!!!!!!
(http://www.sandersclinic.net/)

Offline FormerlyActive

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #5 on: October 09, 2009, 08:13:00 PM »
Dear Crankerchick - that is VERY interesting about your feet. My measurements are similar to yours but my feet go out at 45 degrees. However you are right the ankle adapts, I have a bone that slips under when I walk apparently. When your feet are together do you have a big space between your legs?
Did you do the CT rotational study if so where? Is that how they found out your exact measurements?
You are very brave! Keep us posted! Best healing wishes
3/82 - Medial Synovial Plica removal both knees
9/89 - Lateral Release both knees
3/08 - Reinjury left knee hiking Asia Pac
5/08 - Miserable Malalignment diagnosis
4/08 - 9/08 Five doctors diff. opinions
7/08 - 02/09 - In PT, no chg.
4/09 - Dr. 6 opinion femur & tibia derotation together

Offline FormerlyActive

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #6 on: October 09, 2009, 08:34:53 PM »
Sorry Crankerchick one other thing - do you know how long he has been using the tomofix plate for the derotations? when I look it up online it appears it is relatively new? But highly used for the high osteotomies. If you look at the picture of it you can see why they don't take it out. It seems to have a good union rate from a few articles I saw.
Best healing wishes
3/82 - Medial Synovial Plica removal both knees
9/89 - Lateral Release both knees
3/08 - Reinjury left knee hiking Asia Pac
5/08 - Miserable Malalignment diagnosis
4/08 - 9/08 Five doctors diff. opinions
7/08 - 02/09 - In PT, no chg.
4/09 - Dr. 6 opinion femur & tibia derotation together

Offline crankerchick

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #7 on: October 09, 2009, 08:56:04 PM »
Well thanks for the advice and well wishes everyone! There are so very helpful. Waiting is the worst, for sure, LOL.

For my shorts, I plan to pick up more athletic shorts. I'm a sweat shorts and t-shirt kind of gal, so I can never have too many, LOL. Stool softener, interesting idea, I'll have to add that to the list. I've been keeping a journal of basically all of my correspondence with my doctor to date, all of the things I need to do, and tips I've received from people, so I'll have to note this because we all know some of us aren't all there when we come to from the anesthesia!

FormerlyActive, I did have a CT rotational study as well as standing leg radiographs and the radiographs with legs bent to various degrees. They were done in TX at Methodist SugarLand, which by the way is a very nice, new facility. That is where the measurements come from. I found a paper by Dr. Teitge's group detailing the way the measurements are done.

My legs aren't bowed, they are valgus, so when I put my legs together, my ankles/feet don't touch. The gap is about 2 inches maybe? I can make my feet come together, but that puts significant pressure on my knees in that case. My tibias do bow a bit though, so they go out from my knee and then come back a bit at the ankle. My knock-knees are not drastic in the sense that my legs don't look terribly different from anybody else's, for if they did, I'm sure my mom would have had me fixed a long time ago.

I don't know how long my doc has been using the plate, but I can ask. My osteotomies are proximal for both the femur and tibia.
« Last Edit: October 09, 2009, 08:58:55 PM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline slmac

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #8 on: October 09, 2009, 11:13:08 PM »
Don't forget to Visualize Success! I swear the power of positive thinking has done wonders for me in all of this...you will have a good outcome. :-) sandra
Knee pain and issues during HS...played tennis
7/30/09 dislocations began
9/18/09 TTT (Fulkerson Osteotomy), MPFL Repair, and arthroscopic debridement
12/29/10 hardware removal
8/12 dislocations started
9/11/12 MPFL recon with allograft

Offline nikkiluv

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #9 on: October 12, 2009, 02:23:46 AM »
Sandra,

I just read that you've had back problems since your surgery. I had a distal femoral osteotomy and ACI, and spent the first 6 weeks post-op on my back, as I had to have a towel roll constently under my ankle, ESPECIALLY when I was sleeping, to make sure I got all of my extension back. The day I came home from the hospital I made the investment in a bed wedge. I know for a fact if I didn't have one of these I would have NEVER survived. It helped me to sleep and get comfortable and my back did not end up in pain or anything because of the bed wedge. I could prop myself up more and make it "softer" with extra pillows, especially placing one down where the bed wedge met my bed to help my back. I was able to get myself into different positions that made sleeping much easier/less painful for me.

Also, the bed wedge can be used with the larger, higher end at your ankle, and the slimmer part down by your behind to elevate your leg when you ice and such. Something that serves a dual purpose!! I got mine at a local medical supply store.

Unfortunately, insurance companies consider this a "luxury item," and therefore it's not covered, but I totally believe it was worth every single penny spent on it. Maybe one would help you with your back!! :)


Nicole

P.S. TOTALLY agree about the stool softeners. I was on those and a laxative starting in the immediately post-op, and I don't even want to imagine how life would have been without them. Even on both of those (which under normal circumstances would be horribly unpleasant for anyone, I assume!!) I was still on a bit of an irregular schedule. It's REDICULOUS how much those pain pills mess with your entire system!! I've had numerous surgeries in the past and experienced this before, but it's extremely important when you're on them for longer than a day or two, which is pretty much the guaranteed case following major surgery.
03/25/05 - RK debridement
12/22/05 - RK medial meniscal repair
10/31/08 - RK partial lateral menisectomy
03/13/09 - RK ACI biopsy
05/18/09 - RK ACI/DFVO
01/06/11 - ACI failure confirmed
*Currently awaiting call for fresh Osteoarticular Allograft Transplant cadaver match & removal of femoral hardware

Offline crankerchick

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #10 on: October 12, 2009, 02:16:40 PM »
10/12/2009
8 days until my operation

I'm holding up ok, I think. I haven't had any freak out anxiety attacks like I was having when I was scheduled for the Fulkerson+LR so that is good. But the nerves are definitely alive and well. I just keep fearing that I'm having this huge surgery to fix this "little old problem" and I worry about being worse off afterward. It's the whole, "fear of the unknown" I guess, plus I'm a worry-wart, but I'm just trying to visualize success even though I'm having a hard time with it.

Right now I'm trying to ward off the frustration that is building up dealing with my doctor's office. My doctor is great. Any questions I have I email him and he responds back and even calls if its something he thinks needs to be explained better over the phone. Friday when I asked about the nerve issues was an occasion where he phoned me to talk about my concerns. However, in terms of paperwork, I still haven't been able to submit my forms for disability claims and handicap parking, or my mom's FMLA form because I haven't received them back yet from the office and I can't seem to get the office on the phone nor are they returning calls. Just praying I can be civil when I finally get the nurse on the phone.
« Last Edit: October 12, 2009, 02:30:30 PM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline crankerchick

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #11 on: October 12, 2009, 03:10:57 PM »
Sooooo i finally talked to my nurse at the office. It seems they don't start doing any of the paperwork until the week before the surgery, which is why I haven't received my stuff back yet. But I should get all of it faxed back to me today or tomorrow and I will find out about any issues with my insurance in the next few days. So finally things are rolling and I can sigh relief.

And special gold star for me for being civil instead of going off. I think my husband's people skills are finally rubbing off on me! :-)
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline slmac

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Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #12 on: October 12, 2009, 06:58:55 PM »
nikki, Thank you for the advice. I saw a medical supply store on my way to PT today and I think I'll ask my Dad to stop in there with me on Wednesday. I'm going nuts with the back pain making it so I can't sleep. My fingers are crossed! sandra
Knee pain and issues during HS...played tennis
7/30/09 dislocations began
9/18/09 TTT (Fulkerson Osteotomy), MPFL Repair, and arthroscopic debridement
12/29/10 hardware removal
8/12 dislocations started
9/11/12 MPFL recon with allograft

Offline WorkinWings

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  • Fixed my failed lateral release: back to flying!
    • Failed lateral release: medial subluxation of the patella
Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #13 on: October 16, 2009, 05:33:18 PM »
cranker! cranker!
How are you holding up??

I hope that you enjoy your very last weekend as a fully-twisted crankerchick, because by the following weekend you will have been transformed into a half-twisted crankerchick!   ;)


When do you go? How long do you stay? Who is going with you?
Please keep us posted?

We're here, and will be here, thinking of you and wishing you all the very best down there in Texas.
I'm really very happy for you.  ;D  You are in great hands!

*** Now go get yourself straightened out!!  ***

« Last Edit: October 16, 2009, 05:41:43 PM by ClippedWings »
Feb'00: Twisting injury (w/"pop")
dx - bone bruise of lateral tibial plateau
Apr'00 to May'07: intermittent pain; NO instability
7/May/07: Lateral Release (which created instability)
17/Jan/08: dx - iatrogenic medial patellar subluxation s/p LR
16/Jan/09: Back to function!
[email protected]

Offline WorkinWings

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    • Failed lateral release: medial subluxation of the patella
Re: Derotational Osteotomy + TTT - 10/20/2009
« Reply #14 on: October 16, 2009, 07:01:32 PM »
Hey again, cranker!

Here's a fitting "puppy therapy" pic for ya -- always good for calming those pre-op nerves...




Iz dese ACTUALLY a straight leg?! 
Coooool!






...and BTW, hope you also liked the Burgundy and Gold 



 8)
« Last Edit: October 16, 2009, 07:04:50 PM by ClippedWings »
Feb'00: Twisting injury (w/"pop")
dx - bone bruise of lateral tibial plateau
Apr'00 to May'07: intermittent pain; NO instability
7/May/07: Lateral Release (which created instability)
17/Jan/08: dx - iatrogenic medial patellar subluxation s/p LR
16/Jan/09: Back to function!
[email protected]