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Author Topic: 12 y/o with Femoral anteversion  (Read 13289 times)

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Offline schinz

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12 y/o with Femoral anteversion
« on: September 08, 2010, 02:50:04 PM »
Hello,
  I am hoping to pull from the vast knowledge that appears to exist on this sight.  I have a 12 y/o daughter who has excessive femoral anteversion bilaterally and symetrical.  She is otherwise completely healthy and always has been.  Of course, the standard treatment of observation and it will go away has been done and it hasn't alleviated itself.  The ortho feels it might be good to watch it for another couple years but that it probably won't change much at this point.  My wife and I are considering bilateral rotational osteotomies to resolve the problem.  She has been able to play travel softball <65 games per season>, Rec soccer and ski.  She basically has had no limitations caused by this condition other than occassional shin splints, which even people with normal angulations get.  I had an osteotomy myself for arthritis and am familiar with the recovery and extent of the surgery.  We are not taking this, or the possible complications lightly, however, there is a social aspect that my daughter, should we do nothing, would have to live with the rest of her life.  Her intoeing is very very pronounced and wearing heels as she enters high school and grows older will almost certainly be impossible.  Her gait could be described as unsightly especially near the end of the day or when she is very tired.
   We are blessed with very good insurance and I am looking to find the absolute BEST surgeon in this country with the most experience and highest success rate for this surgery.  I am hoping someone with experience or knowledge could provide me some information.

Thanks so Much.

Offline crankerchick

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Re: 12 y/o with Femoral anteversion
« Reply #1 on: September 08, 2010, 03:32:08 PM »
Hi! You have come to the right place for some help with your problem. There are a few of us here that have femoral anteversion and ultimately ended up traveling to see the best of the best to have it fixed. As you have said this is a big surgery and you absolutely want the best doing it.

Its awesome that your daughter doesn't have pain or instability. My knee problems started around age 9 and the pain was off the charts. I played sports too all the way through high school before I said enough is enough. It still took another 10 years of instability and pain before I finally started to find the right doctors to talk to to figure out what was wrong with my legs and how to fix them.

Having the right doctor makes a huge difference. My doctor is Dr. Mark Sanders in TX. I travel from MD to see him and it is totally worth it. He is amazing at dealing with these issues. I will PM you some more information.

Best of luck to you and your daughter.
« Last Edit: September 08, 2010, 04:10:41 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 schinz

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Re: 12 y/o with Femoral anteversion
« Reply #2 on: September 08, 2010, 04:22:53 PM »
Thanks...I will look forward to your PM.  I am actually from Maryland also. 

Offline crankerchick

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Re: 12 y/o with Femoral anteversion
« Reply #3 on: September 08, 2010, 04:28:25 PM »
Awesome :-)

The only place I found in MD to address this was the center limb lengthening and limb deformities, I believe affiliated with Hopkins. I will try to dig up their website for you if I can find it. In general, I was not impressed.

I sent an email to the address in your profile. Please feel free to ask me questions. I would like to help in any way I can.
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 The KNEEguru

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Re: 12 y/o with Femoral anteversion
« Reply #4 on: September 08, 2010, 07:39:03 PM »
Without symptoms, this would fall into the classification of 'cosmetic' derotation, and you are likely to find many western orthopaedic surgeons unwilling to undertake surgery in such a case, particularly in a young person. The surgeons in eastern Europe, where a lot of cosmetic work is done, take a different stance. It is important that you speak to several surgeons and get a balanced viewpoint and understand the issues before putting her forward for this surgery.
« Last Edit: September 10, 2010, 08:41:41 AM by The KNEEguru »
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Offline schinz

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Re: 12 y/o with Femoral anteversion
« Reply #5 on: September 08, 2010, 08:38:08 PM »
If it doesn't get fixed doesn't that predispose her to a host of future conditions and complications?

Offline crankerchick

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Re: 12 y/o with Femoral anteversion
« Reply #6 on: September 08, 2010, 08:52:15 PM »
Predispose is a good word. I would think your statement is accurate.

But of course, no one really knows if she would have issues down the line or not. There are ladies on this board who didn't have problems until they were teenagers, some in their 20s and even 30s. Others like me, the problems started at a young age.

It is a tough position to be in to have to decide what to do. Definitely gather information and do a lot of research.
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 schinz

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Re: 12 y/o with Femoral anteversion
« Reply #7 on: September 09, 2010, 01:49:41 PM »
I think what makes it a tougher call is my daughter's age.  At 12 is there still a chance of additional natural correction?  Researh seems to disagree on the age where there can be no more correction.  Also, she just went through a growth spurt and puberty changes all at once.  I am wondering if these physiological changes could be contributing to the seemingly more prounounced intoeing lately??

Offline Lyndsey

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Re: 12 y/o with Femoral anteversion
« Reply #8 on: September 09, 2010, 03:38:55 PM »
Hi,

As crankerchick said, you have come to the right place to seek information. Your daughters age does make it an awfully hard decision. I was 14 when I really started having intense pain in my legs especially my knees. Even before that, my gait wasn't right at all, and I really could never run. By the time I was 17 I realized that something was really wrong and started to see different surgeons. Like you, I thankfully have parents with really good insurance. After seeing about 10 different surgeons, we finally found Dr. Teitge in MI. He knew exactly what was wrong, and how to fix it. He ended up derotating both of my femurs, and it almost totally eliminated the knee pain. Now though, my left hip has really been causing me issues. Hopefully with this next surgery, it'll be my last and i'll be good as new.

My sister is 15, and her legs look just as awful as mine. We were really worried, so we took her up to see Dr. T and he did find that her legs are sort of twisted, but on a different plane than mine were. Anyways, the point is, she doesn't have pain. Sometimes her leg collapses, but not that often. My advice to her, as a sister and someone that has been through all of the surgeries, is without pain I wouldn't do anything. I can't imagine enduring the pain from the surgeries if I didn't have pain to begin with.

I agree with crankerchick, your best bet now is to gather as much information as possible to make an informed decision.
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 schinz

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Re: 12 y/o with Femoral anteversion
« Reply #9 on: September 09, 2010, 07:07:13 PM »
Hi Lyndsey,
   Thanks for the reply.  Let me tell you how much I admire you for your courage to go through getting what needed to be done to help you with this issue.  I looked at your pictures from your profile and I have to tell you that my daughter's legs do not look nearly as affected as yours.  You have a wonderful attitude considering everything you have been through.  Thank you.

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Re: 12 y/o with Femoral anteversion
« Reply #10 on: September 10, 2010, 12:00:23 AM »
A child with a dysfunctional gait, unable to wear what our society considers normal shoes, is not a "cosmetic deformity" like not being blessed with large breasts.  This is also a functional deformity.  If it were not, the entire children's brace industry, which thrived fromt eh 1960s to the 1990s whould not have existed.

Offline crankerchick

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Re: 12 y/o with Femoral anteversion
« Reply #11 on: September 10, 2010, 02:51:33 AM »
How was the femoral anteversion diagnosed for your daughter? What are her degrees of rotation?

I got a bit ahead of myself and my thoughts went straight to doctor recommendations and surgery with your original post. The reality is, if she hasn't already had it, your daughter should just have an expert set of eyes looking at her legs and the appropriate imaging studies performed before even considering surgery. The degree of rotation on the femur and if there is any rotation on the tibia should be assessed with a CT scan. Appropriate x-rays should also be done if not done already. These include a standing leg-length view of the whole leg from hip to ankle as well as a standing lateral view of each knee flexed to 30 degrees. You want to see the whole picture of the alignment of the leg, as this affects what surgeries might be recommended or indicated. Lyndsey had femoral derotation osteotomy but in my case I had my femur and tibia "unspun" along with a TTT to bring the patella down, all at the same time, to correct all of my alignment issues at once. The amount of surgery might be a consideration for you and you'll only know what all procedures might be warranted once the appropriate imaging is done.

From my experience, the best rotation docs usually prefer to have their own CT scans and xrays performed too.

So, the proper exam and diagnostic workup (if it hasn't already been done) to know exactly what all is malaligned in the legs in the first place should happen along with gathering information and researching. I think you need both if you want to make an informed decision.
« Last Edit: September 10, 2010, 02:58:01 AM 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 The KNEEguru

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Re: 12 y/o with Femoral anteversion
« Reply #12 on: September 10, 2010, 08:47:07 AM »
This list of knee surgeons that we have identified who have a special interest in lower limb alignment problems may be of interest to you - http://www.kneeguru.co.uk/KNEEnotes/node/418
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Offline schinz

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Re: 12 y/o with Femoral anteversion
« Reply #13 on: September 10, 2010, 02:29:26 PM »
Thanks for the replies.  We actually have an appointment scheduled with Doctor Andrew Abramowitz on 9/22/10.  He is a pediatric orthopaedic specialist that operated out of Kernan/University of Maryland medical system.  I am hoping to have a lot more specific information at that time as far as specific angles of the femur, tibia and hip rotation.  I will let you know what I find out at that time.  From there we can see a more specific specialist, if needed, to determine whether surgical intervention would be appropriate.

Offline Lyndsey

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Re: 12 y/o with Femoral anteversion
« Reply #14 on: September 13, 2010, 02:22:37 AM »
It sounds like you have a plan. You'll have to let us know how the appointment goes. Actually knowing the angles and the specifics will give you alot more to go on. Good luck, and well wishes!
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