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Author Topic: uni-lateral OA - HTO or TKA  (Read 1066 times)

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Offline PattyC

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uni-lateral OA - HTO or TKA
« on: October 30, 2009, 07:04:45 AM »
About two years ago, I had a horizontal tear in my right lateral meniscus.† My surgeon performed a partial meniscectomy.† Unfortunately, three months post-op I tore what was left of my meniscus ("complex tear").† I had a total meniscectomy ten months after my partial.† Unfortunately, this time, my surgeon found two areas of exposed bone on my lateral tibial plateau.† So, now I have OA in my right lateral compartment.† The medial side is fine.†

He has been talking TKR & I really don't want to do that at my "young" age (51).† I donít have a good track record with knee surgeries & the odds of having to do it again are too high for me at this point.† In the interim, he's given me two rounds of Orthvisc.† The first one I definitely felt I got some relief from, but not too sure this round.

I noticed (& brought it to my OS's attention) a valgus deformity of my right leg.† He said part of it was due to the lack of meniscus & partly because I'm knock kneed.† He estimates the valgus angle to be about 18 degrees.† A big factor in the valgus deformity was compensation for a bad proximal tib/fib fracture on my left leg at the age of 12.† I had four surgeries as a child on my left knee, including a HTO due to a valgus deformity from a prior HTO.† So I've been "protecting" my left leg, at the expense of my right knee for a loooong time.

He's not pleased with my knee, the rate it's deteriorating, or my level of pain & neither am I!!

I was reading this board & found that an osteotomy can be an option to a help with unicompartmentalized OA - & that's what I've got.† I asked him about an osteotomy & he didn't seem too thrilled about it, but I so DONíT want to replace my knee - once it's gone, it's gone & I've not read good things about revisions.† And I'm one of those lucky ones who usually end up with revision surgery (additional four on my left knee, additional one on my right - so far!)

I've read there can be an 80% success rate for 5-10 years from an osteotomy done to ward off a TKR.† My left tibia is exactly one inch shorter than my now damaged knee.† I never had a limp because I never straightened my right leg when I walked.† He talked about an opening wedge osteo, but that would ADD length to a leg that is already an inch longer.† I imagine he'd rather do an opening wedge v. a closing wedge because there is on cut with an open & two cuts with a closing wedge.

I got back to him tomorrow & he's going to take full leg weight-baring x-rays, make measurements, etc.

Here's my question:† is a HTO a valid surgery to put off a TKR?† I'm pretty sure I'll have the TKR eventually, but taking out my knee just really scares me.† Six of my seven knee surgeries have needed revisions.† Revision after at TKR - not a good option!!

Oh yeah, I just started a new career - one in which I'll have to be standing for 1 - 1/2 hours straight during part of my shift.† Iíll be looking for a rolling stool VERY shortly.

So has anyone had an osteotomy for compartmentalized OA?† Maybe with a quickly progressing valgus deformity?† What have you heard about an osteo to ward off a TKR?† What have you read?† Have you been through this??† What were your results???† Did your doctor talk you out of having an osteotomy prior to a TKR Ė what did he say??† Where you offered an osteotomy & decided to have a TKR - please tell me your story!† What is recovery like from an osteotomy??† When I had mine back in the dark ages, it was plaster hip to toe for three months, NO weight bearing & lots of PT after it came out of the cast. My OS told me this is PWB a day or two after surgery!!† If youíve had this Ė how long ago did you have it?† If anyone had an osteotomy & then had to have a TRK soon after Ė please tell me your story too!

Thank you all!

« Last Edit: November 03, 2009, 02:54:14 PM by PattyC »
'70 closed reduc
70 horizontal pin
72 HTO allograph rebuilt anter & length ĺ"
73 15 deg valgus HTO 1" staples
95 RL & debride
12-07 lat horiz menisc tear - partial menisc
2-08 lat menisc complx tear
10-08 total menisc
12-09 HTO - closed valgu
now plate pain & funky looking lat 90*