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Offline Jackie2324789

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Double Osteotomy...very scared..
« on: January 15, 2010, 12:57:03 AM »
Hi, I'm 15 and have had very, very bad knees since i was about 10. I've been to 5 different orthopedics and they always diagnosed me with condomalatia, patella alta, femoral patella syndrome and some other things. Nothing they have ever helped or made me feel any releif. MY mom finally took me to a specialist in a hospital where he did a very thorough examination and discovered that I have very severe malalignment in both my legs. The doctor said it was the worst case he had ever seen and he is going to write a report on it. Im getting a double derotational osteotomy in a few weeks and I am very scared as to what i should expect, recovory time, if i have to be in a wheelchair, ect. They are going to cut right above my ankel on my tibia and above my kne on my femur. Also which is beter...the external pin thing or the other one...and could someone please explain what the external thing even is? I fel very sscared and I need someone to talk to about what is going o happen to me...thank you

--Jackie
2/11/10   Derotational osteotomy right tibia
3/25/10   Derotational osteotomy on left tibia
1/12/11   Derotational osteotomy on right femur

Offline mmrocker13

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Re: Double Osteotomy...very scared..
« Reply #1 on: January 15, 2010, 01:07:16 AM »
Hi Jackie!

I can't help you much with the details on your procedures...but I bet they will take extra good care of you :-) After all, you're going to be starring in his next paper, right ;-) :p

Head over to the arthritis--changing forces throughout the joint section of the forum. There are a lot of folks who have had similar procedures there, perhaps someone can better answer your questions.

I have been dealing with knee issues since I was a little kid, so I can empathize with you to some degree. I know you're scared, but believe me, it's GOOD you are taking care of this now, while you're young. (Don't you love it when us old people say stuff like that :p) I wish my surgeons had been a bit more proactive when I was younger.

Welcome!

ETA: I will say that the BEST thing you can do when you are scared or uncertain about something--esp. regarding your medical care--is to arm yourself with knowledge. Both anecdotal stuff like you'll get here, and then reading all you can find about the procedure. Understand it, and what your options are, and what teh risks and benefits are.

And don't let people talk down to you--at 15, you may still rely on your parents' consent, but you're definitely old enough to dig in and understand what's going on, and help make informed decisions about your care. Hugs!
« Last Edit: January 15, 2010, 01:10:39 AM by mmrocker13 »
89: Pat. dislocation, lat. meniscus tear, femoral OCD lesion
89: debridement, chondroplasty, lateral partial menisectomy
02: partial lat. menisc., debride
02: mfx
09: subtotal menisc., debride, c'plasty
10: scope/debride
10: varus DFO
13: HWR
15: total menisc., debride, c'plasty, notchplasty

Offline doublemom

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Re: Double Osteotomy...very scared..
« Reply #2 on: January 15, 2010, 05:09:46 AM »
Hi Jackie - I can't say I know what you're going through, because I haven't had derotational osteotomies, but I will be facing a different, fairly nasty knee surgery this spring to realign my kneecaps.  I think the advice given about doing your research and getting as much knowledge as you can is a great thing... everyone should be responsible for knowing what's going on with their own bodies (and especially knees when they refuse to behave properly!!!)  Don't be afraid to ask as many questions of your doctor as you need to, remember that your doctor is working for YOU, and that it's YOUR knees we're talking about.  You need to have a realistic idea of what it's going to be like for you after surgery, what type of wheelchair/crutches/other aids you'll need, for how long, what kind of physical therapy you will need, etc.  That's all something that you should know about ***BEFORE*** the surgery so you can start to get an idea of what things will be like.  Those aren't things that you should be told for the first time after you've already had the surgery.

Crankerchick has recently gone through the same procedure you will be having... take a peek at her post-op diary on the Post-Op Diaries (<100 posts) section.   It's called "Derotational Osteotomy + TTT".  It will give you a good idea of what her surgery and rehab were like. 

Best wishes to you!

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 crankerchick

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Re: Double Osteotomy...very scared..
« Reply #3 on: January 15, 2010, 06:18:10 PM »
Hi Jackie, I'm glad you found this forum. There are a few of us here that have had derotational osteotomies, although I seem to be the lone "regular" poster at the time. I will try to dig up the diaries of some of the others so you can read about their experiences too.

As Andi said, I had my femur and tibia derotated on 10/20, so 12 weeks ago. I had also a tibial tubercle transfer (TTT). This is all on my left leg. I have the malalignment (femoral anteversion and excess tibial torsion) and patella alta in both legs, but my left knee has always been the problem child. My problems started very young, just like you, in 4th grade.

Everybody is different, but I know for me that it's true, educating myself before hand about my condition, the procedure, my doctor, and the recovery helped immensely. I mean, of course the jitters about surgery itself are what they are, but researching the topics I mentioned really helped me to feel more comfortable with what I was having done and with my decision that it was the best route for me to take to have a shot at fixing my knees.

You don't have enough posts to send private messages yet, but I will PM you with my email address. Feel free to email any questions you have. I can provide some of the literature I have accumulated along my journey regarding the procedure. Dr. Teitge in MI is basically the undisputed king of this type of procedure and has published papers and chapters in books about the condition and the procedure. Many doctors have not jumped on board with his school of thinking unfortunately, but no one can deny that he and those who have followed his teachings have helped many people finally have a life after knee problems.

My procedure was a bit different from yours. My osteotomies were proximal, meaning higher up. Yours are distal, meaning going down. My femoral osteotomy was proximal on the femur, so just below the hip. My tibial osteotomy was done proximally on the tibia, at the tibial turbercle (the bumpy thing on your shin just below your kneecap). First the osteotomy was performed, then the bone derotated, and then the tibial tubercle was affixed at distance lower than it was originally (distal TTT). Moving the tibial tubercle down is what corrects the patella alta.

I won't even attempt to sugar coat this, this is a big surgery. I had all three things done at once and the recovery has been long. But I'm happy to say that while it has been long, for me it has not been very painful at all. Of course there are times where it has hurt, it's surgery, pain is to be expected, but never has my pain been out-of-control. I am actually surprised at how little it hurt, both immediately post-op and through these 12 weeks. The biggest challenge has been getting the strength back and the muscle soreness that goes along with that.

I researched the procedure as taught by Dr. Teitge and did my homework on who to let do the surgery. This isn't the kind of surgery for just any doctor to perform. In fact, there aren't many that even do this surgery. It's very important to have trust in your doctor and to have a skilled surgeon performing a procedure like this.

Are you having both of your legs done at the same time?

M best advice for something like this, besides educate yourself (and your parents) as much as possible about the condition, the procedure, the choices of doctors, and the recovery, is to basically prepare your body physically by doing quad conditioning now if you are able to--riding the bike everyday for an hour at your target heart rate is a good way. That is what my doctor had me doing before the surgery and starting 1 week after the surgery. Gather together plenty of things to entertain you, within arms reach. You are going to need a lot of help doing basic tasks for a long while after the surgery, so just get used to accepting help. Ice is your friend. Ask your doctor about calcium and vitamin d supplements if he hasn't already talked about that.

Good luck and expect a PM from me soon.
« Last Edit: January 15, 2010, 06:20:54 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 Jackie2324789

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Re: Double Osteotomy...very scared..
« Reply #4 on: January 16, 2010, 04:03:42 AM »
Crankerchick- i've read almost all of your other post last night about the osteotomy and TTT. I'm not going to have both done at the same time because my doctor said I will be non-weight bearing for about a month and I do not want to be stuck in a wheelchair for that long.
I'm trying to get as much info as I ca. But their doesn't seem to be much online about what exactly is going to happen so that's not much of a help.
I think I'm most scared knowing that I'm going into the surgery in one piece and coming out with broken bones. Will I need a cast after? If so, how big? A full leg or just below my knee? And how long do they keep you in the hospital? Ugh soo many questions...
2/11/10   Derotational osteotomy right tibia
3/25/10   Derotational osteotomy on left tibia
1/12/11   Derotational osteotomy on right femur

Offline crankerchick

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Re: Double Osteotomy...very scared..
« Reply #5 on: January 16, 2010, 04:20:47 AM »
yes it would be rough to do both at the same time!

I was partial weight bearing for 6 weeks (it ended up being 7 only because I had to send the results to TX).

As for your hospitql stay, that is best answered by your doctor. in fact, a lot of your questions are best answered by your doctor, as the protocol can and does often vary.

I was only supposed to stay overnight. no cast. I hqve titanium plates inside my leg. they stay in forever unless they give me a problem. a cast for you is probably unlikely, but your doctor would say for sure.

all of your questions I asked my doctor early on and it felt much better to have those answers. I made lists of all my questions and then emailed them to my doctor. we discussed the answers over email and over the phone. perhaps you can make a list of all your questions and then call or email your surgeon?
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 Jackie2324789

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Re: Double Osteotomy...very scared..
« Reply #6 on: January 16, 2010, 12:17:03 PM »
Im going to see my dr again on wendsday so hopefully he'll make me feel better about things. Does it hurt a lot after the surgery is done though like I'm expecting it to...and is the scars really big
2/11/10   Derotational osteotomy right tibia
3/25/10   Derotational osteotomy on left tibia
1/12/11   Derotational osteotomy on right femur

Offline crankerchick

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Re: Double Osteotomy...very scared..
« Reply #7 on: January 16, 2010, 02:45:14 PM »
Pain is really a subjective thing--it varies from person to person. I also feel like pain is somewhat dictated by the skill of the surgeon. It's also affected by the type of anesthesia and pain management in place.

I had spinal anesthesia and went straight to oral meds when I woke up. My pain was never out of control and I never needed any IV meds. As soon as I opened my eyes after the surgery, of course the first thing I did was look at my leg. The next thing was think to myself, "hmmph this doesn't really hurt too much." Then my doctor came in and started exercising my leg and I just remember being so afraid it would hurt really bad, but it never did.

I also kept expecting to feel the spinal wear off and the pain levels increase. But that never happened either. I've read some diaries for people that had epidurals or nerve blocks talk about feeling the pain get worse and worse as the anesthesia wears off, and since I wasn't feeling terrible pain, I was just so worried that at some point it would get bad. But it never did.

I rated my pain immediately after the surgery as a 5 out of 10. It was more of a discomfort than anything. Yes it hurt to move in various ways, but as long as I just laid still, I was fine. The day after the surgery, my doctor suggested dropping me down from 2 percocet to one percocet and tylenol, and I really wanted to do it, but I again, I wasn't sure if the oral drugs were what was keeping the pain to a minimum, or if it really just was that it didn't hurt very bad, so I didn't reduce the meds that day. The next day, I reduced the drugs to 1 percocet and 1 tylenol every 4 hours. 5 days after the surgery, I dropped the percocet completely and have taken maybe 5 in the 11 weeks since.

My doctor put me in contact with some of his patients that also had osteotomies, 2 of which had derotational osteotomies. One of them had the same 3 things done as me and my experience was similar to his. Prior to my surgery, he said he kept waiting for it to hurt as bad as a previous surgery and it just never did. That is how it was for me--it just never hurt as bad as I thought it would. With respect to pain, I've said all along that it has never been as bad as I expected it would be, but it has been more than I hoped it would be.

One of the worst pains I experienced so far had nothing to do with surgery or bones per se. About 2 weeks post-op, as I really started using my quad to get the strength back, I kept having muscle spasm while I was riding the bike. Let me tell you, those spams hurt more then the post-op pain ever did. In general, my pain has been more elevated in the weeks following the surgery, as I do more and more to get my strength back, then it ever was in those first days after the surgery.

But this is all anectodal because everyone's experience is different and there is so much that goes into it all. My best advice for the pain is just to one, recognize that you are having surgery and duh it's surgery its supposed to hurt (my doc kept saying this to me), so try not to fear it so much--it's going to be what it's going to be. Two, stay in front of the pain. Take your pain meds as prescripted. Make sure you and your parents are clear on what you can and cannot take in combination with the prescribed drugs. Some people find that staggering the drugs helps the best--take a narcotic and then 2 hours later take a tylenol or motrin and then 2 hours later the narcotic again and 2 hours later the tylenol so that you are on an every 2 hour schedule, with each individual drug being taken every 4 hours. I didn't find the need to do this. Like I said in my diary, I was never convinced that the drugs made any difference. My leg felt how it felt and it never really mattered if i took drugs or not--I was just too afraid in the beginning not to take them because I wasn't sure if they were helping or not.
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 doublemom

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Re: Double Osteotomy...very scared..
« Reply #8 on: January 17, 2010, 01:08:25 AM »
Jackie - I'm also seeing my surgeon on Wednesday, to get things sorted out for me to have kneecap realignment surgery.  Since I've already had minor surgery on both feet and both knees, I know from experience that it's best to write down your questions, and definitely take that list with you when you see your doctor.  You may think that you'll remember everything to ask, but when you're actually at the doc office and your brain is trying to remember everything the doctor is telling you, it's impossible to remember it all without writing it down.  Don't be afraid to hand the list of questions to your doctor and ask him/her to go through the list with you one by one.  That's what their job is, and since it's your leg, you need to know all the answers. 

Let us know how your appointment goes :)

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 Lyndsey

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Re: Double Osteotomy...very scared..
« Reply #9 on: January 17, 2010, 08:25:02 PM »
Jackie,

Hi! I agree with Andi that a list of questions is always a good idea to take with you to your OS. I find that if I write them down as I think of them, then I remember them. If I don't, then I get there and forget what I wanted to ask.

I have had both of my femurs derotated, but not my tibias. I have to say that I was really nervous before my surgeries, but as far as pain goes the surgeries weren't too bad. I had an epidural for each one, and my legs were numb. They didn't shut it off all at once, they turned it down over a day, and then gave me oral meds. My pain was really well regulated. My derotations were around the same spot as crankerchicks, right below the head of my femur bone. I was never in a wheelchair, just on crutches for about 7 weeks with each one. The time seems to go so slow at first, but now it's been over a year for both of mine and it seems like forever ago.

My scars aren't too big, and actually I expect them to almost completely fade over time. Dr. Teitge used blade plates and screws to secure my femur bone. It's shaped kind of like a 7. I actually just had my hardware removed 4 weeks ago, and am now metal free. I am really glad I had the surgery, before it I was in so much pain and had a really hard time just getting around. Now, I can walk pretty much pain free, and am even planning on starting to run soon.

Like, Crankerchick said, staying in front of the pain is important. For me, the meds did make a difference, and I was afraid to take them at first, but by the second surgery I realized they really do help and as long as I take them as the doctor prescribed I wouldn't have any problems.

Hope everything goes well for you. I was 16 when my knee issues really got the worst of me, and about 18 when I had my legs derotated. I'm glad you found the board, if you have any questions for me you can always email me, i'll pm you my address.

Lyndsey



5/15/08      R femoral derotational osteotomy
1/19/09      L femoral derotational osteotomy
12/17/09  hardware removal (L&R femoral blade plates and screws)
10/28/10 removal of bone chip and cleanup of scar tissue on left
4/2014 15 deg. Re-rotation of L Femur
9/2014 L. Plate Removal & Fix Fracture

Offline Jackie2324789

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Re: Double Osteotomy...very scared..
« Reply #10 on: January 20, 2010, 11:23:09 PM »
Hey guys thanks for the replies...so I just went back to the doctor today and I'm getting my surgery feb 11th. I will be in a full leg cast, non weight bearing for a month. Then I will go into a smaller cast for another month. After that I will have to get my other leg done. How long is the recovery time? How dependent will I be/ GDP u know how much school I'll be missing? Thanks

Jackie
2/11/10   Derotational osteotomy right tibia
3/25/10   Derotational osteotomy on left tibia
1/12/11   Derotational osteotomy on right femur

Offline crankerchick

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Re: Double Osteotomy...very scared..
« Reply #11 on: January 21, 2010, 01:37:17 AM »
Hi Jackie. The casts really surprises me, but then your realignment being distal surprises me too. Do you have knock-knees?

Are you having plates or external fixation or just the casts?

I'm glad you're feeling better about things after having talked to your doctor. now to just get ready for it. I hope you like reading and watching tv!
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 Jackie2324789

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Re: Double Osteotomy...very scared..
« Reply #12 on: January 21, 2010, 03:21:18 AM »
Yes my knees touch each other when I walk but my feet are perfectly straight. I'm probably not getting an external fixator but I'll have rods and plates and stuff

I'm still really scared about the surgery, but the olympics will be starting the day after surgery so that gives me something to look foward to... Hopefully it'll be my inspiration for a quick recovery!
2/11/10   Derotational osteotomy right tibia
3/25/10   Derotational osteotomy on left tibia
1/12/11   Derotational osteotomy on right femur

Offline crankerchick

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Re: Double Osteotomy...very scared..
« Reply #13 on: January 21, 2010, 07:02:52 PM »
Ah, so when your knees are together, your feet are pretty far apart? I think that is why at least your femoral osteotomy is being distally, as opposed to proximally. I was talking to my doctor about your case (he sometimes posts here), and he was saying distal procedures are sometimes done when the patient has knock-knees or bowed-legs.

I had my surgery done in TX. I traveled from MD. Will you have to travel far for your surgery?

I ended up staying in Atlanta with my in-laws after my surgery for 5 weeks since I have a lot of stairs in my home. I took all my entertainment crap with me like my PS3, a bunch of movies, laptop, ipod, everything. I was still bored. ::sigh:: LOL!
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 Jackie2324789

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Re: Double Osteotomy...very scared..
« Reply #14 on: January 21, 2010, 10:30:23 PM »
I live in long island so I will have to travel about an hour and a half to get to lij childrens hospital in the city. I have a lot of stairs in my house too, so I don't know how that's going to work for me just yet...I havnt quite figured that out. I am one to get bored easily so I'm hoping I will have enough to keep me entertained!
2/11/10   Derotational osteotomy right tibia
3/25/10   Derotational osteotomy on left tibia
1/12/11   Derotational osteotomy on right femur