Osteotomy to realign the knee - good? bad? indifferent?

[PrincessEssex]

Hi there,
For those of you who didnt read my last post I am a very nervous person when it comes to my knee and always expect the worst. I recieved my MRI results this morning and they informed me that my knee is intrinsically higher than normal and due to the amount of muscle wastage I have they are referring me for an Osteotomy. I have to say that when they said they would be taking a piece of tendon from my hamstring to rebuild my knee ligament I went a funny shade of green before understanding that this problem should have been picked up on years ago and that this is my last port of call otherwise it will be total knee reconstruction. Obviously I Googled it and on a webpage it said this particular op isnt really suitable for people who suffer from sublaxation but the consultant told me this morning that my knee spends 50% of its time sublaxed due to the tongue not sitting in the groove properly. So my question or advice asking is: Have you or anyone you known had this operation and would you recommend it? They did tell me it would cause arthritis but am prepared to take that as I have had enough with the dislocations. Any advice would be most welcome and I thank you in advance! 

[crankerchick]

PrincessEssex, I'm a little confused reading your post and wonder if you might not fully understand what is going on either.

First, you say your knee is higher than normal. I wonder if you mean actually your kneecap itself is higher than normal, as in patella alta. This means that your kneecap sits higher than normal from the trochlear groove.

From this you say they are referring you for an osteotomy, which makes sense, as the fix for a high riding patella is an osteotomy just below the knee to basically relocate the patella tendon and bring the knee cap down. This is called a tibial tubercle transfer or TTT for short.

Next you say something about rebuilding a knee ligament with some of your hamstring. I presume you mean a medial patello-femoral ligament reconstruction, which is not an osteotomy, but another procedure. It makes sense to do this if the ligament is torn or stretched, which it likely is because of the dislocations. I just want to make sure you understand that this is a different and separate procedure from the osteotomy.

I'm not sure what exactly you googled, the ligament reconstruction or the osteotomy, but both are most certainly suitable treatment for instability. The osteotomy addresses a potential root cause of why your patella wants to dislocate, and the ligament reconstruction is like an attempt to fix the medial restraints that have been damaged so they can do their job once again to help hold the kneecap in place.

A total knee replacement is only as good as the alignment is. It's also a big jump from dislocations to TKR/TKA. Correcting the alignment in your leg with the appropriate surgery to address the root cause of your problem will go a long way in fixing your problems and is absolutely imperative to correct, even if things progressed to the point of a TKR.

That said, I haven't had MPFL reconstruction, but I did have the TTT. I was told that the point of my surgery is to avoid arthritis by getting things lined up correctly so the dislocating can stop and the kneecap can track properly. I do not have any regrets so far with my surgery. My instability appears to be fixed and the pain in my knee is almost nonexistent.

[PrincessEssex]

I have to say I clearly have no idea what it is going on then! I was sure that he said to me about having realigning the knee by taking a piece of tendon out of the hamstring and rebuilding the knee. Then he started talking about Osteotomy. Oh dear. I am seeing the specialist in 2 weeks and will have to ask him to explain fully as I thought I knew what I was having but obivously I dont! Thank you for getting back to me and sorry for being so confused!!

[crankerchick]

Yeah I think talking to your consultant again might be a good idea, just so you have a good understanding of what is going. That was my best guess at what it might be based on your original post and your history with dislocations, but really that is just a guess LOL. Best to get the low-down from the source. One bit of advice that might help is for you take a pen and paper with you to the appointment. You can write down your questions on it so you don't forget anything you want to ask and you can even write down the responses if you are so inclined. Sometimes it is hard to process things when first hearing them, but writing them to look over again after the fact helps to make sense of it.

[dol]

Hello, Just joined this website.  I had a knee osteotomy three weeks ago to realign my right knee.  My leg was bowing below my knee.  If you need after your specialist appointment any information on this type of information, I'm more than happy to give you a run down.  Too early for me to say if it's been sucessful or not.  I'm certainly hoping so as its been quite an experience to say the least. I'm not sure how you can contact me but guess it must show up somewhere when I sign in?? Thanks Dolores

[PrincessEssex]

Sorry to drag up very old thread!! My operation is in June and I am still bricking it! I am too scared to ask my surgeon anything in case I sound dumb!! Does anyone know roughly the recovery time? I have no idea how much time to book off work! Anyone had this op recently?

[Lottiefox]

Hi there

You simply MUST ask your consultant these questions!! Do you know exactly what is being proposed for your op? Crankerchick has highlighted some of the possibilities but you REALLY need to understand what is being suggested and why. You must be your own advocate on this one, and no decent consultant will think you're dumb for asking questions. In fact, not understanding why and what you are having done is more dumb in my view - if the doctor won't explain or help you then I'd question whether i wanted him doing major surgery on my knee....

I think for either a MPFL or a TTT you're looking a good stretch of time off work, depending on the job you do. You are going to need to elevate, ice, possobly follow ROM protocols and start PT when the doc recommends it. You have to get more information from him - I'd be bricking it too if I didn't know what to expect. I am having a foot op soon, and I have asked my consultant So much -  and he always answers fully.

Please do some questioning, you must be so scared otherwise!

good luck

Lottie 

[crankerchick]

In fact, not understanding why and what you are having done is more dumb in my view - if the doctor won't explain or help you then I'd question whether i wanted him doing major surgery on my knee.

^^this^^

These are questions not only best answered by your doctor, but questions that should only be answered by your doctor. Any answer you receive here is just people sharing their experience, and experience varies widely from patient to patient and doctor to doctor. Quite honestly, if you are too afraid to ask questions about major surgery on your your knee--the only knee you will ever have that is yours--then you aren't ready to have surgery. We aren't talking about a trivial matter with little consequence. We are talking about cutting your leg open and rearranging it. This has far reaching potential benefits, consequences, and risks. It's not something you just "leave to chance" and "hope it all works out." This should only be undertaken by an informed patient who has thought it all through and weighed the risk versus reward. It is simply not possible to make an informed decision if a patient doesn't understand the procedure and the recovery protocol.

If you don't have all of the information you need to make an informed decision for yourself, then you simply aren't ready for any surgery. If you don't have all of the information you need to know what you need to do for your recovery, then you aren't ready for the after surgery recovery phase.

It's your body, you have to be an advocate for it. Talk to your doctor. You will feel better. I will feel better for you. I won't think you are dumb if you ask questions. I'll think you're dumb if you don't. And if your doctor thinks you are dumb for asking, or thinks a particular question you ask is dumb, then you really need to consider if he/she is the right doctor for you.

Real talk.