Derotational Osteotomy + TTT - 10/20/2009

[crankerchick]

Hi NickiAnn. I really hope your latest round of pain gets under control soon. Ugh, pain really gets old quick, and the couch is only nice for so long before it gets old too.

My twisted leg hurts in what I guess is the tibiofemoral joint. The bones in my knee ache relentlessly. Sometimes it hurts when my knee twists even slightly. It hurts at the medial joint line, more so to the touch than actual pain just at rest. I have pain around and behind the kneecap after heavy activities. I can feel that the patella doesn't track properly. When I bend I can sometimes feel a catching. If I keep bending, not only does it feel off but the patella will "clunk" and go back into place.

I used to feel this same ache in my straight leg, but that leg also had significant medial pain and instability. Since the derotation, I have no pain or instability in that knee. All of my pain/discomfort was from the surgery or the hardware and wasn't in my knee.

I think it's more to it than just angles. My two legs are similar, but only one had instability. We aren't perfectly balanced people, we usually tend to one side more than the other. That has to make a difference. There's a dynamic aspect to it and since we don't use our bodies dynamically the same on both sides, it just makes sense to me that one can't compare one knee to the other and expect them to behave the same just because they look the same on an x-ray or CT scan. But I'm no doctor, so what do I know.

Comparing me to you is of course like comparing granny smith apples to red delicious. We have similar angles, but of course, we are built differently and have a slew of other biomechanical characteristics that differentiate us. And don't forget the patella alta. Do you have patella alta?

[rsuddeth]

Rsuddeth: ...  Dancing for an hour with no pain? That's great! At least it is something you like to do.

Yes, but I realize that I lied. At the time I wrote this it had been almost a week since I'd danced, and I conveniently forget. Sometimes it gets better after the first few dances and between the ibuprofen, a drink, and the endorphins I feel fine (until the next day when I pay for it.) This Wednesday evening, though, I tried dancing & it hurt the whole time. (Was fun, but hurt.) I am still trying to figure out what's wrong, but if it looks like this isn't going to get much better, I think I'm gonna have to quit dancing. I will have to find something else to take that place in my life.

My stupid still twisted leg has decided to participate in a marathon pain contest though. Going on like 8 straight days of ache in that leg ugh.

Sorry to hear that I hope tomorrow will be a better day for you.

[NickiAnn]

Thanks for comparing notes with me.  Somehow I find it oddly comforting that someone out there with the same problem as me is having much the same pain as me.  I certainly don't wish you pain, but it does make it seem less lonely.  I do not, however, have the grinding sensation that you describe, nor do I have that feeling of my knee "clunking" into place.  For me it's just a deep ache under the knee cap punctuated by sharp little jabs when I least expect it.  But the new development is a feeling of pressure and soreness behind each knee.  I'm guessing that's excess fluid pressing on the membranes in the posterior portion of the joint.

Good point that everyone's anatomy is individualized.  I guess we will each experience our "twistedness" in a unique way.  I supposed I'm searching for patterns of symptom and outcome because I feel so lost in terms of what to expect and what to do.  I'm hoping that another course of rest will resolve this latest flare up, but I have no idea whether it will or not.  I would very much like to postpone this surgery until I have children, but I need my knees to hold out just a little longer.  It seemed that even the doctor had no way of predicting for sure how I will progress as the years go on.  I think that's my biggest problem right now, that I have no definable prognosis on which to base my decisions.  I have decided that I am willing to sacrifice some of the activities I love, hiking, walking, etc. just to keep the knees comfortable long enough to have my baby, but will these modifications even be enough?  I guess I don't know...

Speaking of individual anatomy, I do not have patella alta.  I'm assuming that would have been noted in the radiologists report after the CT scan.  Dr. T didn't say anything about it either.  As I think about it, I do remember that years and years ago, when I first investigated my knee issues,  Dr. Mast told me I had good, deep trochlear grooves.  Perhaps that's part of the reason that my twistedness doesn't lead to instability.  I think I have decided that my trochlear grooves are my best feature!

As concerns the outcome of these surgeries, individual anatomical differences worry me.  It seems that some people do beautifully, while others have continued issues with pain.  I suppose I'm also searching for some type of predictable pattern in that regard.  I wonder if people with more dramatic rotations have more trouble with the muscles, tendons etc. resettling into the new position.  It seems that you are doing quite well, and I would hope that I would do similarly. 

Well I guess if we had crystal balls life would be a lot easier!  Sorry to write a book on your post.  I guess I have a lot on my mind!

[crankerchick]

Hi NickiAnn, no worries, having a lot on one's mind is pretty typical around here LOL.

You are right, a crystal ball would be awesome, but then again it would also be boring. We would always know the "best" thing to do, and where's the fun in that LOL?

I opted for taking care of things before trying to start a family. Right now I have no responsibilities to anyone but myself. My husband can take care of himself and I have disability insurance so I can miss work for however long and recover with no worries. Ditto with the rehab. Nothing else to focus on but work and working my leg (and finding time to have some fun). If I choose to fix my right leg, I will do it soon, before starting a family, for the same reasons. It's not a question of whether or not I could handle the recovery and juggle a family because I'm sure I would make it work. It's more like, why even put myself in a position to have to?

I think it's dangerous to try and base your decision on the results of other outcomes. Every case is different. It's fine to use them to get an idea of what to expect, how to prepare, who to choose for the surgery, etc. But using them to compare and gauge if you should have the surgery is dangerous because you just don't know and you can't know how your outcome would compare. The point of the surgery is to make you better, not worse. The right surgery performed by a skilled surgeon on an informed patient willing to do their part in the recovery, to me is the best recipe for success that one could hope for. The rest is out a person's control and really should have no bearing on the decision.

[mermaids]

While my surgeon felt this was the best option for me, he and Fulkerson stressed that there are no guarantees.  It is entirely possible this surgery will leave me worse off than before.  However, for me, doing nothing was not an option.  I was in so much pain on a daily basis that I had to take the chance. 

Fulkerson explained that knee is very complicated joint.  Changing one thing might fix that one thing, but make other things worse.  (He said it much more elegantly... and medically.  )  The patient's physical condition before the surgery is also a major factor.  Fulkerson was thrilled that my OS set me up with such a rigorous PT schedule *before* the surgery.  To me, it seems most of the muscle tone is lost, but my PT guy insists that it will come back quickly when I am allowed to be more aggressive with PT. 

Because the recovery is so long and arduous, timing the surgery is important.  My surgeon's biggest challenge is slowing me down.  I hate to be restricted.  I am use to ignoring pain and pushing through.  He is begging me to not do that with this surgery, to slow down and let my body heal.  He said this surgery is not one to play around with.  If I don't let it heal properly, there will be problems. 

[NickiAnn]

I guess these surgeries are complicated and outcomes are not as predictable as we would want in an ideal world.  Life just doesn't work that way.  Mermaids--I looked at your thread and I'm glad to see that recovery is going so well for you!  It certainly gives a person hope that surgery and recovery can be relatively smooth.  Crankerchick, hopefully you can permanently avoid further surgery, and I can avoid any surgery!  In the meantime, I'm taking the day off work to elevate, ice, and hopefully calm things down before my marathon day of parent teacher conferences tomorrow.  If nothing else, it's lovely to be home today watching the maple in front of my house turn red while the cat snoozes in the corner.  Life always seems so much better on a sunny fall day.

[rsuddeth]

Mermaids, I really believe that's true about the PT/tone before surgery. My doctor didn't push for it, but I did. I am convinced that doing the SLRs before the surgery helped a lot when I had to do them after. It was amazing how I completely lost all tone in my right calf within a day (it didn't look like my leg!) But the PT said it would come back quickly, if it had been as toned as the left, and it did. (My right leg is still smaller than the left, and maybe always will be, since I don't run anymore, nor walk on my toes as much as I used to, but the tone is good, and and the strength is adequate, and both returned quickly.)

[Kat_Walk]

Sorry to jump on your thread Crankerchick, but I just wanted to ask you a question..
About the not being able to do a SLR from locked straight extension, how long did it take til you got over that?
Was it just until you didnt have to put the roll under your ankle to get the knee straight?

Kat

[crankerchick]

No worries Kat_Walk. Yeah I would say it lasted only a few days for me after hardware removal. I remember overnight in the hospital and the next night in the hotel having the mysterious can't-iift-my-leg-after-having-had-it-locked-in-extension. I just usually bent my knee a few times and all was good. It's like the leg is paralyzed or something at first. After a few days, say maybe 5 days post op I didn't have the problem anymore, and after I guess a week I was allowed to ditch that elevation method as an all the time type of thing.

I don't think I had it with my original surgery, probably because by the time I was doing SLR I wasn't elevating like that all the time anymore. Even still, I recall having the strange feeling of not being able to use my leg properly after having elevated like that. Its like it was "stuck" if that makes sense.

NickiAnn, here's to hoping for no more surgery. I sure hope your day off brought you some relief.

Mermaids, the derotation surgeries are a bit more involved than the TTT, but that fact still remains like you said, that the patient has to slow down and heal. Being in good shape going is definitely important too. The bike is a good thing to do everyday going in to surgery since it is non weight bearing.

When it comes to twisted bones, I just have to believe that straighter is greater! It's definitely better for me. For a lot of the. Twistees on here, the same can be said. My doc never once entertained the idea that surgery might not help. The point was to fix what was clearly abnormal. I didn't fly 3 hours to hear, "it might help you, it might not." I could get that answer at home LOL.

[Kat_Walk]

Thanks Cranckerchick, I was wondering if it was gonna be something that would last a few days or a few weeks. I hope the OS lets me out of the immobilizer when I have my appt on thursday, which I am praying will help with the SLR's. Funny thing is the OS said I wasnt allowed to come out of the immobilizer until I could do a SLR so its a bit of a vicious circle!

I have read through your diary, not all of it admittedly as its alot.. LOL! But I get the idea of what your surgeries involved and I must say you a truly remarkable person. I have really struggled with the TTT & LR though I dont think I had the most informative or proactive OS either. You have been through so much and come so far, you are such an inspiration to others, keep up the good work!   

Kat

[Lyndsey]

Hey everybody,

I completely agree that straighter is greater! As with any major surgery there are ups and downs, but I believer overall that it has been well worth it!

I got on today to see what was up with everyone, and this thread is definitely where the info is1 I've been doing pretty well the past week and a half until yesterday when it really all started catching up with me. I went whitewater rafting a week ago, then last wednesday i went kickboxing with my aunt. That wasn't a very smart decision, but i was doing well and thought I could handle it. Come to find out, that was way too much. So starting last night there were really bad storms and so I think between the weather and my activity level I am really paying. If I didn't have to go to class I would probably take something stronger than motrin.    I only have a couple more weeks until my surgery and hopefully things will shape up after that.

BUT, to leave it on a good note, I would never have been able to go kickboxing or rafting before the derotation. So yes, it has caused me a great deal of pain, but at least I could do it!

Hope everyone else is doing well!

Lyndsey

[crankerchick]

Lyndsey:
Whitewater rafting sounds awesome! Me and some friends are planning a trip to go, probably next spring. We are going to go tubing this winter though, should be fun. It's funny you mention kickboxing, because I'm thinking once I get the ok to do more (once this dang thigh pain clears up), I'm going to start with either karate or kickboxing, I haven't decided. I know my straight leg will hold up just fine, we'll see about the twisted one. I hope your pain tapers off soon. Only a few more weeks!

Kat_Walk:
Hope your OS let's you out of the immobilizer tomorrow. I'm just not a fan of those things at all. Hehe, indeed this is a long diary, LOL, I just hope it is helpful for others, otherwise it's just a lot of typing for nothing. Thanks for the kind words. I hope you start to turn the corner soon. In the end when you are all healed up and pain free, it will be worth it.

[crankerchick]

6 weeks (+1 day) post-op hardware removal & arthroscopy

Well 6 weeks ago I got all my metal out and had a looksee in my knee. A week from today will be 1-year since my derotations & TTT. I wish I was kicking butt doing everything I want, but I think I'm doing pretty good nonetheless if I turn off my over-achiever attitude and accept that this stuff just takes time.

So I think I've finally got the swelling under control. It's not blowing up like clockwork anymore. It's hard to believe there are parts of my leg that are still sore this far along, but it's nothing intolerable so no sweat. The thigh-pain on weight bearing is a lot better, but still hurts a bit so I am to keep taking it easy until the pain subsides completely.

[duckie857]

Whitewater rafting is SO. MUCH. FUN.

I went this summer up in New Hampshire with a bunch of family on a class 2-3 rapid. My Dad got remarried to this awesome woman who loves the outdoors as much as him. For her bachelorette party she brought all the women in my family, plus my cousin-in-law Travis and my boyfriend out rafting (they can't golf and didn't want to get made fun of by the doctor and chef that works on a golf course  ).

I was in the raft, but some of them, including my boyfriend, went in the duckies (inflatable kayaks). We did two runs down the river and I've never had so much fun. It's definitely exhausting, though. Once I heal from this surgery I want to go on a class 4 and really go at it! If I had the strength and nerve to go in a duckie, I would have...but I've never kayaked before and didn't want to get stuck!

The one thing I'd warn against is that you have to be ready to carry the raft with your group down to the river.  This might involve some wet and rocky trails that are steep. I was SO horrified when I did this...it was in August when I wasn't doing too great and I knew that if I wasn't careful I could really hurt myself. Plus, there's a lot of strain on your leg to stay in the boat, and other people are depending on you to grab on to if you start to capsize. There were definitely some close calls and I paid for it that night in pain and swelling.

But...it was so worth it! 

[lizzy123]

Were you restricted from driving. I am so upset, because i am getting cabin fever in my parents house. I cant do anything cause I still am not allowed to but more than 30 lbs on my leg and no driving for another 2 1/2 weeks.

This is starting to really take a toll on my mental health. I think it would be a different story if I was recrupationg somewhere where I knew people and could go out and do things. But all i do is spend my time on the couch or in bed cause I have nothing to do.

I was praying they would let me drive three weeks post surgery but they want me to wait six weeks.

anyone else the same way?