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Author Topic: Not sure what to do...  (Read 1257 times)

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Offline deltamuse

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Not sure what to do...
« on: December 01, 2009, 02:51:45 AM »
I am new to the board and stumbled upon it in searching for more information.  I'm slowly discovering all of my intricate problems after suffering from knee pain for 5+ years.  I went to an orthopaedic doctor in October that diagnosed me with bilateral hip dysplasia, with my left hip being worse.  He thought that my knee pain was being caused by my hips, so he referred me to another orthopaedic doctor in Indiana to discuss hip options.  I went to see Dr. Scheid and he said yes, I have hip dysplasia and I will need to do a PAO in the next few years to avoid a hip replacement.  I asked about my knees and he was intrigued.  He had me walk around with my pant legs pulled up, etc.  He said that my femurs were twisted inward and my tibias were twisted outward.  This was causing my patella to rub outside of the groove and giving me the pain.  He suggested having an Elmslie trillat procedure done to relocate the tendon on my knee.  But first he's having me do PT to see if it helps.  I go back to see him December 9th, and needless to say, the PT has not helped.  I'm wondering if this surgery is going help?  I've seen a lot of information about miserable malalignment syndrome and it sounds like me.  I don't want to go through several unnecessary surgeries and never solve the problem.  Any suggestions on what I should ask my doctor on my next visit?
3/22/10- TTT (Elmslie Trillat)

Offline jathib

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Re: Not sure what to do...
« Reply #1 on: December 01, 2009, 01:26:44 PM »
I don't know a lot about hip dysplasia but if it were me I'd have that taken care of before realigning my knees. It would suck having that kind of major surgery and then having it get all undone after a hip surgery. Whatever you do, get several opinions from orthopedic surgeons before you do any kind of surgery.

As for whether it will help or not, there is never a guarantee of that but that is always the goal of course.

Offline doublemom

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Re: Not sure what to do...
« Reply #2 on: December 01, 2009, 03:05:13 PM »
I think the hip surgery could possibly have an effect on the knees, so I'd get the hips taken care of first to see how the knees react to that.  As for the rotated femurs and tibias, I'd get a good orthopedic opinion on derotation surgery.  A TTT will change the tracking of the patella and possibly offload some of the pressure, but it won't correct the actual underlying problem that is making the patella be off in the first place.  As Dr. Mark put it in another post... it would be like plastering cracks in the wall, when it's the actual foundation that is crooked and needs to be fixed.  It certainly wouldn't hurt to get an opinion or two on derotation of the long bones before making a decision.

Hop over to the patellofemoral board here at KneeGeeks... lots of people there who've dealt with the same knee problems and they would be great to chat with and get ideas and info from.

Andi
2000 R patella dislocation
2004 - Soccer injury - LK medial and lateral meniscectomies
2007 - Dx patellar tilt, lateral subluxation, grade III chondromalacia
5/13/08 - RK medial/lateral meniscectomies & patellar chondroplasty
4/6/2010 - RK TTT/LR scheduled

Offline CHILLYdogs

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Re: Not sure what to do...
« Reply #3 on: December 01, 2009, 03:40:26 PM »
Dear Deltamuse,

Welcome to kneegeeks. I'm very glad you are here, as this is a great place to get the information that you will need before making a decision on surgery that will affect the rest of your life.

An Elmslie-Trillat is a type of TTT (tibial tuberosity transfer).  It transfers the tibial tuberosity medially.  This will decrease the internal rotation moment of the knee, and in someone like you with an already externally rotating tibia would only make matters worse.  Think Charlie Chaplin!

If you indeed have miserable malalignment, this is likely to be the root cause of both your knee AND your hip problems.  That needs to be addressed directly, first.  Why go through a whole bunch of surgeries trying to "fix" problems locally when you (lucky you!) already know what is most probably behind all of these issues?

You might want to read crankerchick's wonderful success story.  Like you, she was about to go under the knife for a procedure which would have been garanteed to fail and make matters worse for her.  She ended up contacting the right expert surgeons for her underlying condition and found out that she did have malrotation issues.  I'm including links to her story below.

Be smart and diligent about this.  Don't panic!  Inform yourself well. 
Your knees and hips will thank you forever.

I wish you the best of luck,

Kyle


Re: TTT-type Surgery suggested--weighing options


...I received a PM today. I felt that heart in the pit of my stomach feeling when I saw the PM, and for a second considered not even reading it when I saw it, because I just knew it would be someone saying not to do the surgery. But curiosity (and a genuine concern for my well being) compelled me to read it. It was a referral to a Dr. Sanders in Houston with a phone number. So, I just got off of the phone with this doctor, who suggested that malrotation of bones in the leg could be a reason for my subluxations. He said that if this was the case for me, the TTT would not help me. He also stated that he no longer does TTTs because patients are experiencing arthritis in their later years. He was very against LR. He said a CT scan would show if there is malrotation...



Derotational Osteotomy + TTT - 10/20/2009

...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 in addition to being knock-knee (which is obvious), I have patella alta and excess femoral anteversion and external tibial torsion (not so obvious). 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....




Note: a Fulkerson is yet another type of TTT; it's a variation of the Elmslie-Trillat.




[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 deltamuse

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Re: Not sure what to do...
« Reply #4 on: December 03, 2009, 01:51:07 AM »
Thank you for all the great advice!  Between these replies, PMs, and other threads I have been reading--I have a growing list of questions for my doctor.  I went to him originally because I thought my only problem was my hip dysplasia...but now I have a whole slew of problems to investigate.  My only problem with major surgeries like derotations and the periacetabular osteotomy (my hip surgery) is planning it around school.  I teach at a school with an extended school year so recovery time is limited for me.  I am going to keep reading and adding to my list of discussion points for my doctor visit. 

Thanks!
3/22/10- TTT (Elmslie Trillat)

Offline doublemom

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Re: Not sure what to do...
« Reply #5 on: December 03, 2009, 05:09:09 AM »
delta - by doing your research and talking to people who have gone through the same things, you're so far ahead already.  There are too many people out there who jump into surgery the first time an orthopedic surgeon mentions it, without knowing what they're really getting into.  It's good to see someone who is willing to look at all options to be able to make an educated decision about what it best.  Keep it up :)

Andi
2000 R patella dislocation
2004 - Soccer injury - LK medial and lateral meniscectomies
2007 - Dx patellar tilt, lateral subluxation, grade III chondromalacia
5/13/08 - RK medial/lateral meniscectomies & patellar chondroplasty
4/6/2010 - RK TTT/LR scheduled

Offline ipswich1984

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Re: Not sure what to do...
« Reply #6 on: December 03, 2009, 06:38:58 AM »
I totally agree with Andi, I had a lateral release to try and deal with my patella problems, but knowing what I do now about LR's I would not have had it as most seem too not work, Unfortunately I didn't find this site till I was waiting for my TTT.
November 2005 - Arthroscopy RK.
December 2006 - LR RK.
Febuary 2008 -
RK Subluxation. Back to physio.
October 2008 -
Put on waiting list for TTT/LR.
Told I have Hypermobile joints.
March 2009 -
TTT/LR RK.
11th Jan -
OS agreed removal of screws
5th Feb 2010 -
TTT/LR scheduled for LK