Issues after HTO

[MTLover]

I had a tibial osteotomy (HTO) due to some pretty severe pain on the lateral/outside of my knee.  Right after the surgery, things seemed OK, but going through rehab, months of PT, aqua therapy, etc., and trying to strengthen my leg, the more I did, the worse it felt. 

The pain, essentially, is now on the medial/inside of my my knee instead of the outside.  My knee and leg feels worse than it ever did before the HTO.  There's a very distinct pain where the bone was cut (on the medial side) along with pain down the tibia, almost to my ankle.

In addition, my upper leg and hip area on that same side is starting to bother me as well.  I can't seem to find a comfortable "position" to keep my leg in when I walk.  If I walk with my leg straight, then my hip feels like it is turning inward.  If I walk with my foot pointing out about 45 degrees, then my hip doesn't bother me but my knee can't take it for very long.  When I ride a bike, my knee doesn't stay "straight",  it tends to move inward.  Even if I try to use the elliptical, when I am on the step down (push cycle), my operated knee goes inward towards my other knee.  It just seems very unstable.

Has anyone else experienced anything like this?  I would have thought that after this amount of time that everything would have been healed.

Thanks

[MTLover]

I found a different OS to go to - unfortunately, he really didn't know what to do - other than offer me a cortisone shot.  But, the majority of the pain isn't in the knee joint - it's at the bottom of my kneecap and all the way down the tibia, along with medial side pain on my knee where the bone was cut.  I get a sharp/burning pain with every step.  So, I'm not sure if a shot would help with that or not.    I really don't want to start getting cortisone shots if there's something else going on that could be fixed.  Or maybe I should continue searching for yet another OS?

[vickster]

Which country are you in?  Maybe someone can recommend an OS, or at least you could look at the surgeon list for your country/region in the Information Hub ^^^  I amy be wrong, but I thought an HTO was normally used for medial (inside pain) due to bow legs and femoral osteotomy for lateral due to knock knees (outside pain - this is a possible future option for me with lateral)

Have you seen a pain specialist?  Maybe it's neurological/nerve related rather than bony/orthopaedic?

Good luck

[MTLover]

I amy be wrong, but I thought an HTO was normally used for medial (inside pain) due to bow legs and femoral osteotomy for lateral due to knock knees (outside pain)

Vickster:  I hadn't heard of this before, but now at least for me it would make sense based on how my knee/leg feels.  I am in the US.  I did call some pain management clinics in the area.  They asked me alot of questions, but at the end, they all said pretty much the same thing - what I am experiencing, they didn't feel it would benefit me so I couldn't even get an appointment.   

My knee gives out occasionally now where it didn't before I had the surgery.  In addition when I sit with my legs out straight, my non-surgery leg/foot is straight, whereas the one I had the HTO on, the leg goes to the outside and my foot is at about a 45 degree angle.  If I try to put my leg straight then my femur/hip tends to feel like it is being forced inward. 

So, even though yes, I have the pain on the medial side to deal with, I'm not sure now if what I am experiencing should have been fixed with a femoral osteotomy in addition to/instead of a tibial osteotomy???

[MTLover]

So, I feel as though I've gone back a few years as far as progress and how my knee feels  - the pain behind my kneecap is back 

I've now developed a "snapping" sensation on the medial side of my knee when I walk, or do anything that requires bending of my knee.  It is actaully quite painful and of course, the more I walk, the worse it gets.  In addition, my knee joint now feels as though it is catching on something - esp. when I go down stairs. 

Not sure what else can/should be done at this point?

[mmrocker13]

Close wedge? What kind of hardware? still there? How long has it been since yoru surgery? What kind of PT did you do?

It can take quite awhile for stuff to settle down--and, obviously, not that you are loading the OTHER side of the knee, it will need an "adjustment" period, as well. Could be you are doing too much too soon for that part of the joint.

Honestly, pain behind the knee sounds like "runner's knee"--overuse which may be compounded by poor core (ham/quad/glute/low back) strength, imbalance between ham/quads, or VMO inadequacies causing patellar maltracking.

When you change the alignment of your leg, everything else is going to have to readjust--from the top down. some of this will do it on its own. Other stuff needs a lot of PT. And everyone will have stuff shake out differently.

[MTLover]

mmrocker13:  The hardware's been out for over a year.  Before surgery, I also had alot of pain behind my kneecap, so that hasn't changed as I had hoped, so even though it sounds like runner's knee, I just don't feel as though I'm overusing it.  I went to 6 months of PT and still do the exercises they gave me on my own-they all focus on the areas you mentioned-quad/ham/low back and glutes.  Even if I walk on the treadmill for 30 minutes, by night time and the next day, the pain is so bad I can hardly put any weight on that leg.  The best I can describe it is instability.  Even just standing, my knee wants to "give out" and go inwards toward my other knee.  I also have a horrible snapping sensation on the medial side as well-especially  if I turn or do any type of rotation movement.

[Scooby]

I had an HTO nearly 18 months ago and am experiencing some of the things that you are.

I had an opening wedge HTO using an external fixator.  Prior to this op I had medial pain and some pain behind the kneecap.  I still have medial pain but in a different place and like you, my knee now wants to point toward my other knee.  If I do a squat, my knee does not line up with my toes but goes towards the other knee quite badly - it didnt do this before!  I have now been told that I have squinting patellas, something to do with the way my hip joints are or something?  I have managed to return to hockey but every few weeks, because my knee doesnt bend straight, it seems to bend the wrong way sideways, then injuring the lateral side of my knee.  I am desperately trying to find a way to get my leg to be "straight" although I thought that was what the HTO was supposed to do!  It also feels as if my one leg is now longer than the other and therefore my one hip is higher and I am starting to get pain in my hip area too.

Fortunately for me I can walk ok and can run but with some pain, but would still like to get it all sorted out!

Hope you have managed to find some pain relief somehow.

[MTLover]

my knee now wants to point toward my other knee.  If I do a squat, my knee does not line up with my toes but goes towards the other knee quite badly - it didnt do this before!  I am desperately trying to find a way to get my leg to be "straight" although I thought that was what the HTO was supposed to do! 

Scooby, that is exactly how my leg is!

It's been quite a while since posting last - but nothing has changed    Still can't walk on the treadmill for more than 10 minutes before my knee feels like it is burning.  Riding a bike also doesn't agree with my knee - and it doesn't matter if it's an upright or recumbent bike.  And the worst is that I've still got the snapping sensation on the medial side of my knee - starting about half way down my kneecap and going down a few inches.

I've been doing exercises from PT and nothing that I do seems to help the pain or even build strength up in my leg.  I've been going to the OS and finally I was told that due to my age I may as well tough it out and wait for a knee replacement and that right now, there is nothing wrong with my knee   I guess that was a nice way of telling me that I'm old.....  I wish doctor's could experience the pain that we do because I feel that sometimes they think that I'm lying to them when they can't find any "reason" for the pain.

[mmrocker13]

The medial pain sounds very similar to pes anserine bursitis--it can cause considerable pain, snapping, etc. on the medial side.

If your hardware is out, have you had an MRI at all done since the pain returned? Can you see a different PT? Perhaps one who specializes in athletes? You might benefit from a strength and muscle balance assessment.

It's amazing really, how it only takes a small thing to throw the whole kinetic chain out of balance...sometimes it can be a real process  to try and figure out where it's coming from, and you definitely have to be an advocate for yourself--sometimes to the point of being a PITA. Hopefully, you will get some answers!

[MTLover]

The medial pain sounds very similar to pes anserine bursitis

If your hardware is out, have you had an MRI at all done since the pain returned? Can you see a different PT?

So, I've been to a few more OS's and PT's.  Two of the PT's said that, in their opinion, my leg is out of alignment and that they really can't help me - that I need to go back to my OS.  The PT's that I've seen all specialize in athletes/sports performance.

The OS's that I've seen only look at the x-rays and no matter how hard I try to convince them to "treat" me, they've told me that I really need to go back to the original OS who did the surgery.  The OS who did the surgery said that my leg is "perfectly" aligned and there is nothing wrong.  None of the OS's will approve an MRI.  It's as though the other OS's don't want to get involved or say anything potentially negative about what another surgeon did.

One OS I saw is also a physical therapist.  Even he didn't have any other answers, but he took a quick one second look at the x-rays I brought and didn't even bother to look at the last MRI results that I had.  He said he could do a cortisone shot, but I should really go back to the surgical OS as he is the only one that really knows what was done.

I've asked about the pes anserine bursitis, but everyone has said "no, that's not it".  So I guess that's the only diagnosis that Ive really gotten.

In the meantime, my knee is feeling worse as I go up/down stairs or walk any distance.  It will start to ache as I sit for longer periods of time (I've got a desk job).  But I'm still doing my exercises and pool therapy.  I can't even think about doing any kind or running/jogging.  Biking is good for about 10 minutes before my knee starts to ache - again all on the medial side.  I've also started to get burning pain down the front of my leg and in my knee too.  It feels as though someone is trying to rip my kneecap off - especially at the bottom of my knee.

I just wish in hindsight that I hadn't gone through with this procedure.  My family and friends tried to get me to wait and not rush into things.  And now they're all saying the typical "told you to wait". 

As with others on here, my leg is worse now than it was before surgery and I wish I had my "old leg back" as I was alot more active then than I am now.

OK, enough rant for the day.....

[neos2300]

Hey MTLover, im really sorry to hear about the troubles you've been experiencing over the past years. I know this is late but how is the knee doing now? Have you been able make any improvement since your last post?