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Author Topic: Recovering from a Maquet Osteotomy  (Read 11400 times)

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Recovering from a Maquet Osteotomy
« on: March 28, 2011, 03:27:53 PM »

Having just had my second tibial osteotomy - a Maquet osteotomy to be precise - I  realise that the best way of recovering is to know as much as possible about what it takes to recover. Obvious, I hear you say. Well, yes, although it is surprising just how little information and advice is forthcoming from your surgeon or the nurses who look after you in hospital. At least, this is based on my experience from having the same operation twice (both times privately). There is a lack of advice about the operation, the recovery process and the physiotherapy process - and a lack of consistency of advice both before and after the two operations. It is for this reason that I am writing this piece to help first-time sufferers, who are at least as unprepared as I was, through the process.
The Aftermath
Let's face it, it is a serious operation and you are going to be sore afterwards - the first time you get out of bed, normally the morning after the operation, your leg feels like a heavy sack of potatoes with a band of steel around it caused by the swelling and the constriction of the "cricket splint". What really distinguishes how mobile you are and how much pain you are in, however, is whether or not the bone graft taken from your pelvis has damaged the nerve at the top of your thigh. The nerve pain from my first operation meant my mobility was seriously limited in the first two to three weeks of recovery and it was accompanied by a high degree of pain. This pain has left the top part of my thigh towards the groin area very sensitive to touch and still partly numb some four years later. However, the absence of any prolonged hip pain following my second operation on my left leg has been an unexpected surprise by comparison. My surgeon, to whom by the way I am eternally grateful for his skill in giving me back my ability to walk without my knees feeling like they could dislocate at any moment, suggests it was simply luck. Acknowledging the comments made by a radiologist who was required to take an x-ray in my first operation, I am nevertheless still a firm believer that this part of the operation was carried out more carefully the second time around - especially as I had the same surgeon.  
Checklist post-operation:
- ensure that your bed is raised while you are in hospital and for the first week if possible as this will really help with reducing the post-operative swelling.
- stay in hospital for a minimum of three nights rather than two if you are going private - it makes all the difference having an extra day to get stronger and practise walking as well as climbing up and down stairs.
- while getting out of bed is likely to be easier than getting back into bed, my hospital physio recommended using my woollen neck scarf to loop around my foot to help support it when raising or lowering it - an invaluable suggestion!
-tips on getting home from the hospital - you need to use the backseat of a low vehicle (not an MPV)and ensure the driver takes care over potholes and speed humps (I am writing this from the UK!).
- wear TED stockings on both legs for the first two weeks to reduce your chances of deep vein thrombosis- make sure you have these on immediately after the operation!
- second time around, I greatly appreciated the benefit of buying a raised toilet seat particularly with a sore hip and of using a bed pan at night to avoid getting in and out of bed.
- finally, don't get worried about getting into your shower given the risk of slipping- I recommend, for the first month at least, washing yourself thoroughly using a flannel or face towel. The longer you keep your wounds dry while they heal, the lower your chance of introducing infection. On the second day after my operation, a nurse at the hospital asked me if I needed help to get in the shower which meant climbing into the bath first - I thought to myself that I would need my head examining if I were to even consider such post-operative acrobatics!
The First Two Weeks
In my opinion, the first two weeks are the hardest in terms of discomfort. You will need to keep your leg absolutely straight for the first two weeks or so until the initial healing takes place, and you will probably find that your bed is the most comfortable place rather than putting your leg up on a sofa or similar, although you are likely to want to try different seating options particularly as you become sore from lying in one position in bed. Imagine also not being able to move your leg, scratch it or massage it for the most part, and couple that with trying to sleep on your back for two weeks....Yes, it will be really uncomfortable to sleep so keep your expectations low during these early stages and remember that it won't last forever. During this period, take painkillers when you need them, but you are likely to be off them before the end of two weeks. At the end of the first two weeks, which is when you usually go back to see your consultant surgeon, stitches are removed if they are not soluble and x-rays are taken to ensure that the screws in your leg are where they should be. Try not to feint standing up while waiting for your appointment or x-ray - it is surprising how many waiting rooms are characterised by chairs with arms on either side and a complete absence of sofas where you could raise and support your leg.
Physio, physio and more physio
I learnt my lesson the second time around and made sure that I arranged my physio in advance to start at the two week mark. (In my naivety the first time around, I hadn't really thought about physio to any great extent and hadn't realised how soon it was needed following the operation. At the same time, my surgeon was away and his secretary went AWOL at the same time so I didn't have a clue about what I needed to do).
The first time you try to bend your knee or gain any inflexion whatsoever, you should leave it to the physio. Quite simply, he or she will be able to inflict much more pain than you had thought was humanly tolerable. You will need physio once or twice a week in the first few weeks depending on your progress in gaining inflexion in the knee. Each day, I work on bending my knee twice a day for around ten minutes each time and I ice my knee for at least twenty to thirty minutes afterwards. I might increase this over time, but this is working well for me right now. Too much bending can sometimes cause too much inflammation which can be counter-productive too. I have also found it beneficial to stand up and move around the house every two hours or so.
Probably the best advice I had the second time around was to work on my quads as soon as possible, even from the first day after your operation. The muscle mass deteriorates really quickly and by day seven or eight, I found it hard to feel my quads and worked hard to squeeze anything around my knee cap. And when they say work on your quads, it does mean doing your exercises every hour quite literally. I am making sure my quads are really strong the second time around which is helping my recovery in terms of being able to walk around sooner without my cricket pad splint and with confidence (by week three in my case).
While my second recovery is a work in progress, I háve a 70 degree bend in my knee  after 3.5 weeks which feels remarkable as I had at most a 30 degree bend at the same time following my previous operation. I know bones still take time to heal although I fully expect to be on my road bike, albeit cycling very slowly around local roads at first, within 12 weeks or sooner. This is an amazing operation and, while I wish I never had to have the operation on both knees given the potential for total knee replacements in the distant future, I am extremely grateful to my talented surgeon. This time around, I also have the benefit of hindsight and know that there is light at the end of the tunnel. While I won't win prizes for hill walking or running (ouch!), I fully expect to do some road cycling again!