High Tibial Osteotomy or half knee replacement?

[Contractorarsenal]

Hi,

I'm new to all this.
I've had two tears in my medial miniscus on my left knee within a year.
After key hole surgery I have torn it again.
I've been told my knee has 'collapsed' due to lack of cartilage but there has been no mention of Arthritis.
My new consultant (not my choice) has given me the choice of HTO or HKR.
I'm currently wearing a brace whilst I make a decision.
I'm 53 and very active. I ski, play golf, dance and enjoy hiking long distances.

I want to make the right choice for my lifestyle. Has anyone had to make a similar choice?
I've also heard the Osteotomy is very painful and you can be out of action for up to 9 months recovering from trhe precedure.

Look forward to hearing from someone.

Mike

[Scooby]

Hi Mike

I had an HTO and microfracture with external fixator 10 months ago.  I am 39, a keen hockey player and was told HTO was the best option for me to enable me to get back to sport and to avoid having knee replacement as I was too young.

I did find it painful, but I think this was due to the external fixator (metal rods coming out of your leg, a bit like scaffolding!) which I had on for 3 months, rather than the bone break.  I did not have any internal pins or screws, which I gather can be a cause of some of the pain.

My knee has not recovered properly, although MRIs show that the microfracture has filled in the defect in cartilage and the osteotomy site has healed well, but I now have pain under my kneecap, which I think has got worse since they have realigned my leg.  Seeing the consultant again Friday to see where we go from here.

I would make a list of all your questions and ask your consultant about pros and cons of each op, including returning to activities.  I was told that it could take up to 18 months for the knee to get back to normal.  Its also good to have a good look around this site as these are the people that have been through these procedures!

Let me know what you decide!

[Contractorarsenal]

Hi Scooby,

Thanks for your input.
I will definitely take up your advice and write down all the questions on the pros & cons of the two offered procedures.

Good luck seeing your consultant and I hope your pain free very soon.

Mike

[mmrocker13]

A) get more than one opinion

B) keep your own bits as long as you can

[Contractorarsenal]

Hi,

I've opted for the HTO. Chatted to a number of people in the know and they all talk very highly of my OS, so it's all systems go for mid July or earlier if I can get a cancellation.

Thanks for your advice.

Mike

[bigal177]

Mike  i take it you are an arsenal fan , me too ,i am 8 months post op from a hto,my surgeon was mr O,leary from royal berks hospital,i cannot recommend him highly enough
 i had my op 0n 21st 0ctober,2010 and was back at work on 15th december , i work as a carpenter ,so it was slow to start with and not pain free ,
pain  after the op was really bad as i did not  a syringe driver for morphine as others had ,so it took a lot to get my pain under control .
any questions ,feel free to ask ,

berst regards  Alan

[Contractorarsenal]

Hi Alan,

Yep, I'm a season ticket holder although my friend is using it up to Christmas.
We can't be far away from each other. I live in Yateley.
My OS is Lt Col Peter Hill based at Frimley Park Hospital.
My op is scheduled for 2nd August unless he gets called away to Afghanistan.
It's brilliant that us civvies can use military surgeons. This guy has been described to me by fellow doctors as a genius so, hopefully, I'm in good hands.

I'm thinking about buying a Cryo Cuff icing system. Did you use anything?
Did you have a plate fitted or an external fitting?
Did you have to wear a brace?
Maybe my OS is giving me worse case scenario but he's saying I might just be able to play golf after 6 months but it will be painful. How close are to being fully fit?

Good to hear ffrom you and lets stay in touch.

Mike

[bigal177]

 Hi Mike
i just used bags of pees on a towel ,but the cryo cuff sounds good .
i will be honest i am only just thinking of going back to the gym now ,as i am only just fully fit in my opinion ,
the first real walk i managed was around a lake close to me ,it was about 3/4 of a mile it took it out of me but was a real milestone for me .
I had the internal fixed plate ,but have not used a brace as my surgeon said my muscles would make render the brace useless,as i have large legs ,
i feel the operation was a real success ,but it has high lighted how bad my left leg is ,not sure if i have made it worse by favouring  my left leg during my reccovery
i have spoken to my surgeon regarding a hto on this leg ,but  i have to wait until i am 12 months post op before they will look at it
 take care  Mike  stay in touch

[Contractorarsenal]

Hi Ala,

I'm glad the operation was a success. The road to full recovery is long, and very painful at the start.
It seems that our American friends receive a Cry Cuff and a Continuous Passive Motion (CPM) machine for their recovery.
No chance on the NHS!
The Cryo Cuff, second hand on Ebay is about £70.00 and to hire a CPM is £230.00 for two weeks.
I'm really considering shelling out the money if it speeds up recovery and reduces the risk of DVT.

I've been having a leg sports massage and been given a list of exercises to do prior to the op in the hope that my legs will be strong and this will hopefully reduce the recovery period.

Let's hope you don't need another HTO.
I'm self employed but have a very understanding business partner who is and has been able to run the practicable side without me.
It must of been hard getting back to work after only two months?
Have you had any problem, pain or discomfort with the plate and has your OS told you when it will be removed?

Keep in touch

Cheers  Mike

[bigal177]

 hi mike 
i have had no problems with my plate and screws although it is swollen around that area compared to my other knee
on the work front i carried out the work i was  capable of and just moved up from there .
if you want to chat or meet here is my email as i only live in Winnersh ,Wokingham
[email protected]
just send me your phone number and we can arrange something as i may be able to give you some pointers ,
regards
Alan

[WonkeyDonkey]

Hi Mike and Alan

I have been offered a HTO by my OS after having an arthroscopy to find grade 4 OA amongst other things! I have done lots of research into this procedure, finally looking at my OS' own website.
I have weighed up all the pro's and con's but I want my life back, so have opted to have this op in November, when I can actually spare the time to recover properly.
I only live in Blackwater, so was surprised to find other people in my own area having had this procedure. I am actually under Mr Adrian Wilson in Basingstoke and was told that if I had lived in other areas I would not have even been offered this procedure. I am feeling positive about my op even though it is some way off, so was looking for people who had been though it. I will be having a plate and screws put in and hope I it is successful.
It would appear that you both seem to have had good experiences, but has the pain gone away? Are there any tips you can give me to prepare for the op and for the recovery period?

Regards
Pat

[Contractorarsenal]

Hi Pat,

Alan and I are hoping to meet up on Tuesday for a chat.
You are more than welcome to join us.
Please contact me on [email protected] and we can swap phone numbers.

Cheers

Mike

[aaronbuxtonnz]

Hi
My name is Aaron and I live in Nz. I am 38 years old and 7 months post operative after HTO and wish I had total knee replacement done instead of the HTO. I have now been told that in february next year the plate and pins have to be removed as the pins are too long and are grabbing on the soft tissue on the inside of my leg which is creating the pain on the inside and the outside of the leg and under the kneecap. Even though Xrays show that the HTO cut line has healed well, it still generates alot of pain.
I know there have been alot of success stories but if I can recommend anything to you, it would be to opt for a total knee replacement.
I have also given my previous surgeon the boot and have gone to a sports surgeon as he seemed to be a lot more fussy than a standard orthopedic surgeon and it was the sports surgeon that picked up that the pins were too long.
 As I said, it has been 7 months now and I still cannot resume my sports or chase my 2 year old son around. I cannot kneel and I cannot bend my knee all the way back.
I hope this helps. All the best in your surgery and I hope it goes well for you

[Turtlebug]

Aaron:

I'm sorry to hear that you're having so much trouble after your HTO.  If the cut line has healed enough, is there any chance that the hardware can be taken out earlier? 

I know you mentioned a knee replacement, but the downside is that they don't last forever - esp. since you are young you may be looking at another one down the road (hopefully 20+ years, but...).  From my understanding, the HTO is to hopefully address not only rotational issues, but to delay a knee replacement in "younger, active" individuals.

I had a tibial osteotomy a few years ago and my kneecap points one way and my foot points another.  The pain I have is definitely worse than before surgery and it's not just knee pain, it extends all the way down my tibia.  I can't sit or stand for very long and walking
any distance is a thing of the past now.  It seems as though if I walk with my foot straight, it's uncomfortable, and if I walk with my kneecap pointing straight, my foot points out, and it isn't much better.

I agree with you in that there have been alot of success stories posted here, but I would not recommend it until a last resort.  But, I guess it is surgery and there are no guarantees.....

My only option now seems to be a knee replacement, but I'll live with what I have for now as I am afraid a replacement will make things worse.

I hope that when you do get the hardware out that it will provide you with relief from the pain you are experiencing.

Good luck and keep posting on your status (and hopefully progress!)

[kevin3004]

Hi Mike,
I am 54 years old played sport all my life and had microfracture (mfc) on the inside of my right knee 2 years ago.
At the time I was on the FA list of referees and officiated up to conference league level. I went into theatre for what I thought was a minor repair to my cartilage and came round from the op to be told I had no cartilage whatsoever, bone on bone, so the OS did the mfc.
I got back from the surgery with a lot of PT and was refereeing 9 months later, sadly over the past few months I have began to struggle and visited the OS who did weight bearing full length x rays and has offered me the same option as you i.e. HTO or PKR as the inside of my knee is almost bone on bone again.
He says the outside of my knee (lateral) seems OK so I would be a candidate for either.
I was just wondering how things went with your HTO and do you think you made the right decision?
By the way I’m in the UK and a Wolves season ticket holder
Cheers
Kevin 

[WonkeyDonkey]

Hi Kevin3004

Mike has a post op diary on here,

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=56935.0

which I followed to see how he got on, but have actually met up with Mike and Alan, who has also had a HTO, where we discussed all our options and Alans experience. Mike had his HTO back in August and seems to be recovering well, and when I last saw him was very impressed by the way he was walking. I have since had a HTO open wedge myself and am about 26 days post op. I found that by finding out as much as I could before hand, I went into the op with as much knowledge as possible.

I am keeping a post op diary as well.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=58048.0

So far I would recommend it, as you keep all your own bits and at 49 I was told I was too young to have a knee replacement. Not all areas of the UK offer the HTO, so it is now an operation that is coming back into fashion. I was lucky to have the OS who features on KG with his article on Osteotomy in the information section.

If you want to ask any questions, please email me.

WD

[kevin3004]

Hi Kevin3004

Mike has a post op diary on here,

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=56935.0

which I followed to see how he got on, but have actually met up with Mike and Alan, who has also had a HTO, where we discussed all our options and Alans experience. Mike had his HTO back in August and seems to be recovering well, and when I last saw him was very impressed by the way he was walking. I have since had a HTO open wedge myself and am about 26 days post op. I found that by finding out as much as I could before hand, I went into the op with as much knowledge as possible.

I am keeping a post op diary as well.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=58048.0

So far I would recommend it, as you keep all your own bits and at 49 I was told I was too young to have a knee replacement. Not all areas of the UK offer the HTO, so it is now an operation that is coming back into fashion. I was lucky to have the OS who features on KG with his article on Osteotomy in the information section.

If you want to ask any questions, please email me.

WD

Thanks WD, I see my OS next Tuesday so I will let you know how that discussion goes.
Cheers
Kevin

[bigal177]

good luck with your decision kevin
i am also in the HTO club and am on waiting list for another HTO on my left leg ,in my case
its a no brainer 1st op and recovery have gone well for me
HTO is buying me time and also evening out wear on my joints as i have bowed legs
so when i do have knees replaced i should have even wear
any questions please feel free to message me
regards
Alan

[goonerbryan]

hi mike,
           l'm at recovering from my second HTO,had my left one done 2 years ago,non weighting for 2 weeks off work for 5 months[HGV delivery driver],it seems to have done the for know.my right leg the recovery seems alot more painful and slower,this time l was non weight bearing for 6 weeks watch seems to have made the muscle,hamstring etc alot weaker.Still getting alot of pain at the side of the knee watch is no where near where the pins and plate are,would be gutted if the op hasn't worked.Thinking he should have gone for the PKR.
                                      Bryan

[smartdriver]

Still getting alot of pain at the side of the knee watch is no where near where the pins and plate are,would be gutted if the op hasn't worked.

Bryan,
How are you doing?  Unfortunately, even though it was still an HTO, each leg will recover differently.  I've also had 2 HTO's and in terms of recovery, they were totally different - it was as though I had had two different types of surgeries.  The second one (right leg) took alot longer to heal. I definitely have had more pain in my right leg as well.  It has gotten to the point where I can't really walk long distances comfortably (like I used to) since the medial side of my knees really bother me - especially if I walk on any type of incline.

I've got an appointment with another OS next month, so it will be interesting to hear what they have to say.

Hopefully your pain will subside soon..  Hang in there!