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Author Topic: Tibial Osteotomy after injury  (Read 9440 times)

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Offline Grandhoux

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Tibial Osteotomy after injury
« on: November 02, 2011, 09:11:05 PM »
I have just visited my surgeon in France. 3 years after a Tibial Plateau Fracture which healed badly sustained in a traffic accident I was expecting to be offered a total knee replacement. Instead, to remedy the 15 degree 'bend' in my left leg and hopefully relieve the pain and swelling in my knee, I have been booked in for a Tibial Osteotomy in 3 months time. Has anyone any experience of a Tibial Osteotomy after an injury or more specifically, a TPF?

He told me it would be 1 month non-weight-bearing, 1 month half weight-bearing and a further month before I would be fit for work. How does this fit in with your experiences, any advice? Will I end up with new hardware ... I got rid of 17 screws and two plates last year!  ::)

Cheers,

Dave.
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline vickster

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Re: Tibial Osteotomy after injury
« Reply #1 on: November 02, 2011, 09:21:18 PM »
This chap had an HTO fairly recently - he has a post op diary running

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55737.0

Good luck with it :)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
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Offline Grandhoux

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Re: Tibial Osteotomy after injury
« Reply #2 on: November 07, 2011, 04:59:46 PM »
I'm getting very optimistic about the operation, looks like it could be pretty effective. At the moment I'm doing some pretty heavy lifting and carrying on my French restoration project. Mixing and laying concrete, moving oak beams and rocks etc. My knee is holding out and my leg is getting stronger but I'm getting more pain in certain areas. I'm sure this is because my leg is out of alignment (by 15 degrees!) and the stresses are all in the wrong places. The Osteotomy should sort that out.

As it's a 'closed' osteotomy I don't think there will be hardware involved, maybe some bone grafts but they'll have my own bone, not some French cow bone, to work with this time! The 3 months minimum recovery will be a bit of a pain, though. Knowing my luck this will stretch out to 4 or 5 months ... I may be pleasantly surprised, though! My first task is to get back to driving as we live 10 miles from the nearest supermarket, my wife doesn't drive and there are no buses! Fortunately I have an automatic car, pretty rare in France, and it's my left leg so I don't need it for driving though I'm sure I'll have to wait at least a month until I'm partial weight-bearing to even consider driving.

Another annoying thing here is the use of disabled parking spaces. I will need to park as close as possible to the stores and need to be able to swing the door out wide to get out; it's a pretty low car. Last year I was recovering from breaking my femur and parked in a disabled spot without a badge; the gendarmes fined my €140 even after I appealed. As a badge takes months of paperwork here I should be OK before I get it. I also need to drive 40 miles to the prefecture to apply! What the gendarmes are doing ticketing people in supermarket car parks (which don't even have a sign to say a badge is required) I don't know. They are renowned for being utter b******s and it's a well deserved!

Looks like I'll have to suffer!  ::)
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline WonkeyDonkey

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Re: Tibial Osteotomy after injury
« Reply #3 on: November 18, 2011, 10:51:49 PM »
Hi Grandhoux

I have just had a HTO a week ago, to correct my weight bearing due to grade 4 OA in my medial part of my left knee. I am keeping a post op diary if you are interested. My osteotomy was open wedge though, so I had a plate put into my leg. My op was because of an injury I sustained 2 years ago by lifting up a child and turning awkwardly, followed by two more stupid injuries on the same knee less than a year later.

I have followed other KG diaries and also did lots of research before I made the decision to agree to this op, including meeting up with two other KG's who have given loads of help, encouragement and support. KG's are all very supportive and you need to make sure that your OS have answered all your questions and you know fully what to expect when you have the op. My OS has written the osteotomy information on this website, so I felt I was in very good hands and have confidence in his skills and knowledge.

Good luck and if you want any more information, please email me and ask.

WD

Offline Grandhoux

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Re: Tibial Osteotomy after injury
« Reply #4 on: November 19, 2011, 10:20:14 AM »
Thanks WD, looks like the HTO is my only option at the moment. The knee/leg is getting worse the more I use it, especially for lifting and carrying. At the moment my leg is 15 degrees from straight but my OS agreed it appears to be getting worse. Obviously all the stresses are wrong in and around my knee so this needs to be addressed.

As for having a 'discussion' with my OS, it won't happen! He really isn't the type and then there's the language barrier.  ::) Fortunately he's a well regarded surgeon and it's a good hospital. We also live quite a distance from the nearest major city so the choice is very restricted. I just have to trust him! Reading about HTOs, it does seem to be the logical solution and I'm optimistic about the result. I don't think I'll need any hardware but will certainly be laid up for up to 3 months, compared to my previous injuries ... tibial plateau fracture then broken femur ... this is the blink of an eye!  :)

I'll continue reading through the HTO info although most or all seems to be to reduce the effects of arthritis and about opening osteotomies. A few horror stories there, too!   :-\
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline Grandhoux

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Re: Tibial Osteotomy after injury
« Reply #5 on: February 02, 2012, 02:07:16 PM »
I have to laugh about my OS here in France; a real 'charmer'! If i'm lucky i get one word answers from him, otherwise, nothing! After telling me he was going o ta wedge of bone out from the outside of my leg i.e. a closing tibial osteotomy I realised from where the incision was after the operation that it had to be an opening osteotomy with a wedge put in!

The operation went well last week, double anaesthetic (local plus general) as it's supposed to be a very painful operation and this worked well. It wasn't pleasant but was definitely better than previous operations for pain afterwards and now I'm back home. At the moment I'm just using codeine and paracetemol, not even prescription doses, just bought over the counter. I had my stitches out yesterday, just 8 days after the op, and my leg looked like a rolled joint of pork but with more bruising ... a lot of bruising. Also some strange single stitch incisions North, South and East of the main cut which I think come from some sort of jig arrangement used to get the opening gap right. They certainly knocked my leg about!

Yesterday I asked about the operation and he confirmed it was an 'opening' high tibial osteotomy not a 'closing' one. I then asked if he'd put a wedge of bone in it and he sais yes, I then had to ask what sort of bone as he hadn't taken any from anywhere else. He said 'I had a piece', so I asked him if it was cow, human, what was it? He just said 'artificial' and walked away! He is supposed to be very good but is known for being a bit weird ... or rude, whichever way you want to take it.

Anyway, my leg is now straight and where I was worried I would lose some length where the leg was already about 2 cm shorter he has confirmed that I gained length so both my legs are back to the same length pretty much; that's good! I just wish he was a little more communicative! I get an Xray on my next appointment in a month and so, hopefully I'll know a little more. It took some real interrogation to find out I had a plate and four screws in! As I say, I have to laugh!

So my only problem at the moment is that I think they took the stitches out too soon and last night it bled onto my sheets through the compression bandage. Of course, they didn't give me any dressings or closures to use so somehow I have to get my wife to the Pharmacist 10 miles away to buy some ... if they sell them! It's typical French after-sales service: non-existent and often downright rude! You never get used to it, unfortunately.

Dave
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline WonkeyDonkey

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Re: Tibial Osteotomy after injury
« Reply #6 on: February 02, 2012, 09:50:15 PM »
Hi Dave

Glad to hear your op went well, and you are now on the road to recovery. Now you have joined the HTO open wedge club. Hope you are using lots of ice to keep the swelling and bruising down, I used and stilll use a cryo cuff. Best thing ever and worth every penny! The bruising will go down but don't be surprised if it goes as far as your ankle first.

On my osteotomy, I had the iBalance HTO, which does not have a metal plate but has an implant.

Now you have both legs the same length, you won't need to walk along the curbs!! You can walk on the pavement like the rest of us!! Even if it is slowly.
When you look at your x-rays you will be able to tell how much hardware you have in your leg and also how much the bone is filling in. Good luck with this, as when I went for my x-rays my implant does not show up on them, so I got a bit of a shock.

Sorry to hear that the stitches have come out too early, do you have any tape that you could use, or plasters. Maybe it would be quicker to get some dressings delivered by post than try to get to a chemist shop that may not even sell them.

Good luck with your recovery, and if you have any questions, just ask. I also have a post op diary if you want to have a read.

WD

Offline Grandhoux

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Re: Tibial Osteotomy after injury
« Reply #7 on: February 11, 2012, 05:20:33 PM »
Thanks WD,

the swelling and bruising are going and the stitches are pretty much healed. I can't tell what's been done altogether as I have 3 small incisions North, South, and West of the main incision. I think temporary guide rods or something have been inserted, maybe something to open up the bone rather than chisels.  ??? The pain is getting better although it aches when the paracetamol and codeine wears off. The biggest nuisance is the brace I have to wear in the initial stages of healing and the non-weight bearing. Such a nuisance, but I've been there before!

One problem is that I can't wait to try out my nice, new, straightened leg but it's going to be at least another 3 weeks before I can put any weight on it at all. I won't be stupid and try it, I want this to work after all the pain and bother!  ;)
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline WonkeyDonkey

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Re: Tibial Osteotomy after injury
« Reply #8 on: February 15, 2012, 08:54:38 PM »
Hi Dave

It's good to know that the swelling and bruising is on it's way out. I have a small incision under my knee in the shape of an H (on it's side) which was used to put one of the tools in by. Keep up with the pain meds, as you will find a time when you will stop taking them. It's a great feeling when you have taken them for years.

Check out Mikes post op diary as he had a brace after his HTO, it may be of some help.

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

If you have a metal plate in your leg, then they are designs to be able to take the weight from day one, it is only that they like the bone to start healing that they make us NWB to start with. I was NWB for 2 weeks and then on to PWB for 2 weeks and then FWB after that. I am now walking around the house without crutches or a stick, and am trying to do away with the stick outside, but find it not so easy. Indoors there is aways something to hold on to if you have a wobbly moment, but out it is not so good. I need more confidence outside, my husband is always offering me his arm.

It is worth being good, as you have made the choice to have the op, and I am now nearly 14 weeks post op and life is much easier, no pain, no pills and even back at work with the children. I have been very good with my physio, and have walked most days since PWB and on two crutches, down to one crutch and then down to a walking stick. The walk has been a bit of a highlight in my day during recovery, but I can certainly recommend walking as part of physio. I started walking the block and then slowly increased it, as and when I felt I could walk further. I can walk 1 1/2 miles now and improving.

Keep up the good work

WD

Offline Grandhoux

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Re: Tibial Osteotomy after injury
« Reply #9 on: February 19, 2012, 11:40:14 AM »
I have very high hopes for this operation, I want to get back to hill-walking ... even if the hills around here are pretty flat! I can't wait to try out my new leg and start cycling, I think that's my first priority. Just by the house there's a converted railway line which is pretty flat and runs 10 miles in each direction. In one direction it joins on to other lines which make up a whole network of cycle and bridle paths so there's plenty to go for.

The bruising has almost gone now, they certainly went to town on mauling the leg about, though. Sleeping at night is really difficult particularly as I'm trying to avoid any codeine or anything stronger than paracetemol, it really affects me badly. I've always been a very restless sleeper and have been taking the brace off at night for the past 10 days; I don't know if I should, though! I find it impossible to sleep on my back as well so I'm just hoping that I'm not doing any harm. The sugeon gave me very little instruction about the brace, just said 'wear it' and 'no weight bearing'. It's very difficult when your surgeon tells you so little!

So, fingers crossed. I get XRayed and see the surgeon on the 29th February, 10 days, and I'm hoping it's progressing. The swelling is certainly going and all the incisions have healed, I just hope the bone is healing OK.

Dave
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline WonkeyDonkey

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Re: Tibial Osteotomy after injury
« Reply #10 on: February 27, 2012, 10:26:38 PM »
Hi Dave

Good luck with the xrays this week, try to have a look at them to see what you have in your leg. The bone will take 6-12 months to heal, according to your own speed of growth, so you should be able to see some bone growth when you go for your x-rays. It looks like clouds on the side of the bones. Luckily my daughter is taking a radiography degree and told me what to look for.

Sounds like you live somewhere that will encourage you out on your bike, with the converted railway line. I went for a walk yesterday, just under 2 miles, across a wooded area, and my leg was very stiff and aching this morning but is feeling better this afternoon, after yet another walk. It is my knees way of saying the muscles are working and need more time! It was a great walk, and I enjoyed just getting out and about in the fresh air!!

I have now been discharged from physio, but am still exercising and trying to walk further each day, so far this operation is a success and I do not have the pain that I did have, which is great.

Keep up with your recovery.

WD

Offline Grandhoux

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Re: Tibial Osteotomy after injury
« Reply #11 on: March 18, 2012, 11:05:53 AM »
Hi, WD

The bruising is pretty much gone now and I'm partial weight bearing ... although I keep putting a bit too much weight on the leg, I think. I was pretty optimistic and I'm sure I'll be pretty much pain free when I start walking but I've started getting pain on the inside of my knee as I use it more ... the place I was getting pain before!  :-[ I just hope this is temporary and that it will go in time and with exercise. Perhaps I'm doing a bit too much but I get stir crazy!

The bone is hea;ling OK, or it was at the end of February, and feels pretty good now as long as I don't twist my leg, then it hurts ... but that's to be expected. So far the operation has been successful in that my leg is now straight, the bone and incisions have healed well, it's just that damned knee pain. I've actually kneeled a little on the knee and that's fine, too, so fingers crossed. 
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?

Offline debbieo

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Re: Tibial Osteotomy after injury
« Reply #12 on: August 26, 2012, 09:36:32 PM »
Glad to read here and there==that things are working out good for you. It's been along time coming. Here's hoping your riding your bike and hiking some hills
Remember this, if things go this way---I hope not==often a tkr does not resolve the pain you might experience from a tpf. 
Wishing you the best in court and good health
Wonder Woman
tkr 9.14.09  tibia fracture 04
As Lovely as Aphrodite—as Wise as Athena and the strength of Hercules—she is known only as Wonder Woman, but who she is, or whence she came, nobody knows!  
I WILL NOT BE DEFINED BY WHAT I CAN NOT DO!
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=48797.0

Offline Grandhoux

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Re: Tibial Osteotomy after injury
« Reply #13 on: August 27, 2012, 10:36:18 PM »
Thanks, Debbie,

I hope not to go to court, that just drags things on. Here they try to settle things in an 'amiable' fashion. This means the insurance companies work together to keep payments down but the courts take ages and may not be any better! This is France!

A tkr is something I don't want but it may be necessary. As I'm just coming up to 58 the surgeon would like to wait at least 10 years. By that time I really hope to be back in Britain where they don't want to spend money on tkrs anyway! As for the bike ... I'll have to do it but it hurts my bum! I'm a hillwallker and I'm planning to start again gently. What worries me is going great guns for a couple of miles or more ... then the knee swelling and I can't get back! Looks like I'll be restricted to places with mobile phone coverage. There isn't any mountain rescue around here so I'll have to ring the Gendarmes ... they'll probably breathalyse me and chuck me in the back of a police van!  ;D

Dave

PS My limp has pretty much gone and I can walk down stairs pretty normally without holding the stair rail ... that is until I see the insurance doctors and for some reason the limp returns and there's so much I can't do! These TPFs are strange injuries!  ;)
« Last Edit: August 27, 2012, 10:49:13 PM by Grandhoux »
Accident in France 1st December 08. TPF, plate and 7 screws
22 weeks later, now only 6 screws!
11 months, slipped and broke Femur. Plate and further 10 screws in femur
16 months now only 15 screws, another came out!
2 years hardware removed.
January 2012 High Tibial Osteotomy to straighten leg.
tkr?















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