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Author Topic: NickiAnn's Crazy Derotational Osteotomy  (Read 31451 times)

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Offline NickiAnn

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NickiAnn's Crazy Derotational Osteotomy
« on: November 08, 2011, 08:47:48 AM »
It's two in the morning.  I've just thrown up everything I've ever eaten.  I'm riding out my osteotomy pain on two extra strength tylenol.  My baby is screaming.  I must be crazy...

My name is Nicole and I just had a tibial and femoral derotational osteotomy.  I also have an eight week old baby.  Before surgery I was in a period of knee pain remission and was not experiencing any pain.  I think I might have mental health issues.  Just kidding.  There is a method to my madness, and I'm glad I bit the bullet and had my leg "spun."   If readers out there are interested in how I came to this nauseous moment in time, they need to know my history, so, a little about me.

My twisted legs have shadowed my entire life starting in kindergarten.  On the first day of school the gym teacher had our class lined up in two teams to run relay races.  I was as excited as every other kid until I started running.  Halfway to my mark, I became aware that the other team's runner had already lapped me, and the baton had been passed.  My team was screaming at me to run straight.  I had no idea what the other kids were talking about, but I did figure out at the age of five that something just wasn't right with my legs.

Flash forward three years--I have undergone a hundred hellish gym classes when my gym teacher tells my mom that I was having trouble participating in gym and that I should see a doctor.  My mom promptly took me to a local ortho who said that my legs were just "made a little different" and that we shouldn't worry about it.  So we didn't.  At least I tried not to, but not being able to participate in team sports was a constant thorn in my side until my teen years.

Come high school, I had resolved myself to not being a sporty person, and I developed my identity in different ways.  I stopped worrying about my legs, but even though I wasn't athletic, I loved the outdoors, walking, and exercising.  In my twenties I spent a lot of time walking at local parks, but being so young, walking really wasn't enough exercise, so I tried to incorporate a little light jogging, just to enjoy the feeling of my heart rate rising.  Big mistake.  This is when the real pain first reared it's head.

For anyone who's interested, I will continue my story tomorrow.  As for now, my little guy is screaming his head off and I'm going to crutch over and make sure he's not killing my mom.  Sleep tight everyone.
1997 Diagnosed with miserable malalignment
Nov. 2011 Left leg femoral and tibial derotational osteotomies
July 2012 Right leg femoral and tibial derotational osteotomies

Offline NickiAnn

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #1 on: November 08, 2011, 06:52:35 PM »
So, to continue my story in the light of day.  In my twenties I tried to do some light running, just for the fitness aspect, and within two weeks my knees were protesting.  I had sharp pains under my kneecap, mainly the inward facing side.  I also started feeling a sharp pain in the front of my hip joint.  I interpreted this as tight hip flexors and spent a good deal of time fruitlessly trying to stretch the pain away.  It didn't take long for me to realize that at the age of twenty one I shouldn't feel so much pain from simply miixing a little jogging with my daily walk.  Plus, at twenty one I was a thin, young thing (those were the days!), so it wasn't as if I was putting any abnormai pressure on my knees.  I soon noticed that any high impact knee bending activity--tennis, aeroibics, etc., set off the pain.  It was time for me to investigate further.  I saw a knee specialist in my native Detroit; he took one look at my legs and (I'lll never forget this) fell back in his chair, threw up his arms, and said that I had the worst case of miserable malalignment he had ever seen.  In fancy terms I had femoral anteversion and tibial torsion.  My femur twists inwards so that my knees point in when I stand with my feet straight.  My tibia twists outwards so that when I walk my feet point out.  Not a good combination for happy knees.  While the knee specialist found my legs fascinating, he also was quick to admit that a problem as complex as mine was far beyond his realm of expertise, but he knew that several surgeons at the Detroit Medical Center were experimenting with new techniques to fix my problem.  That's when I was referred to an orthopaedic office staffed by Dr. Jeffrey Mast and Dr. Robert Teitge (whom so many people on this board have seen regarding rotational issues).  Dr. Mast did a CT roational study and found that both my legs had over double the amount of normal rotation in both the tibia and femur.  Any knee pain I might experience, Dr. Mast explained, would not be fixed by tampering with my knee.  The only real fix was a derotational osteotomy of the femur and tibia--both legs would need to be done.   The whole process would take two years. 

My family and I chewed on this decision for weeks.  Ultimately, while straight legs sounded good to me, the surgery, I decided, was too risky and too painful.  I resolved to do everything I could to work with my knees, not against them.  I began walking as much as possible on soft, unpaved trails.  I learned how to swim.  I never, ever ran.  Overall, I did pretty well, which brings me the summer of 2010.  At thirty-four years old I was thinking about starting a family, working, and trying to take my evening walks.  In June, I tried to burn off a little winter flab by taking good, vigorous walks after work.  Within two weeks I was hurting, day, night, at rest, and in motion.  I couldn't sleep on my stomach because my kneecaps were too sensitive.   I had a vacation to France planned that I considered cancelling.  With how I felt, I wondered how I could take care of a baby.  I spent the fourth of July in bed with ice on my knees and wailing "why me?"  I was more depressed than I had ever been in my life.  By August the knees were a bit better and I had a period of remission.  In October my husband and I took a beautiful hike in northern Michigan which set off a new round of pain that lasted approximately a month.  I decided then that it was time to take steps to safeguard my future quality of life.  I scheduled an osteotomy with Dr. Teitge for November 2011.  What about the baby?  Well, I reasoned I had plenty of time to have one before surgery, and infants have got to be easier to take care of than two year olds, right? 

Long story short, my bright-eyed baby boy was born in August, and I began taking steps to make the surgery happen, though I often thought of cancelling.  In particular there were days when I would be peacefully nursing my little guy when I couldn't imagine putting myslef in such a vulnerable position.  But, when I shut off my emotions I figured it could be done.  My mom is well enough to help with my son, I could hire a nanny to relieve my mom.  I began freezing breastmilk for the little guy (sorry to any male readers who are squeamish about these things, but it's nature's way!).  I began quizzing my pediatrician to find out what medications I could take while breastfeeding, and on the morning of November 3rd at three in the morning I woke my little guy up for a last cuddle and feeding and I headed off to the hospital.

In the OR I was still having last minute thoughts of jumping off the guerney and running out the door, but at that point they had put a little happy juice in my epidural and everything seemed a-ok.  I had finally done it; there was no turning back.
1997 Diagnosed with miserable malalignment
Nov. 2011 Left leg femoral and tibial derotational osteotomies
July 2012 Right leg femoral and tibial derotational osteotomies

Offline Lottiefox

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #2 on: November 08, 2011, 08:52:53 PM »
NickiAnn!

This is brilliant! You are awesome - not even a week out of surgery and you're writing amazingly lucid information.  ;D Look forward to reading how things are going for you. Which leg has been "de-rotated"? As someone with mild rotational issues and prematurely unhappy kneecaps I understand the syndrome. Sometimes these darned legs just aren't given to us right......check out Wenikio's post op diary too. She has one leg done earlier this year and then hardware removed too and is doing amazingly. I think she is about to have the other leg done soon!

Keep up the great work and take care

Lottie xx
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline NickiAnn

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Re: NickiAnn's Crazy Derotational OsteotomyMy
« Reply #3 on: November 09, 2011, 05:19:35 PM »
First off, Lottie, thank you for the positive feedback.  The outcome of my choice is still not 100 percent clear.  It's way too early to tell, but, as we all must do, I think I made the best choice availablle with the information I have.  So, for all those out there considering this surgery I will try to tell you a bit about my hospital stay, so that other twisted guys and gals have some information on which to base their decisions.

Aside from thinking I might jump up and run out the door at any minute, the pre-op process is a snap.  I was given a little happy juice, then the epidural was inserted.  I was not very nervous about this because I did have an epidural for the final stage of my labor in August, so I knew that it isn't painful.  I was fully awake and aware for this one too, and, once again, it was barely noticeable.  I was wheeled into the OR , said a few hellos to the staff, then the next thing I knew I was awake and the surgery was done.  At no point was I given general anesthesia.  Instead, some serious relaxant was put into the epidural so that I wouldn't be aware of the passage of time.

The nice thing about having an epidural for surgery rather than general is that I woke up quite lucid and without any nausea.  I was also pretty numb from the waist down, which is a good thing considering that every bone in my left leg had been broken and rotated.  My family was very anxiously awaiting my arrival as I had been in surgery for seven hours!  My husband, as is typical of most men, was particularly concerned about the state of my boobs--since the little guy eats every three hours, my husband thought I might have been in danger of exploding!  As it turns out, they didn't explode, but I might be the first osteotomy patient that has ever pleaded for a breastpump while being rolled out of the OR.

Regarding the pumping, I will just say that pumping while numb from the waist down and taking narcotics is interesting.  My poor sister got quite a show as I did not have the energy for modesty.  We did take care, however, to shield the teenage kid who picked up the linens in my room from such a traumatic sight.  Had he gotten an eyefull of that he probably would have been freaked out for weeks.  For anyone who's wondering, my little guy certainly is not getting any of this narcotic tainted milk.  The pumping was for maitaining production only!

My epidural stayed in for the first day post-op.  It kept me fairly comfortable, but I am always uneasy with epidurals as I'm afraid that if I lean back too comfortably I will cut off the dope supply.  The biggest problem , however, was that the epidural did a much better job numbing my right, non-operative leg than my left leg!  I had a decent hot spot of pain near my left hip.  Apparently, I might have some little anatomical quirk that keeps the pain medication from fully affecting the left side, as the same thing happened during labor.  The other big problem with the epidural is that it so fully numbs the pelvis that you can't pee while on it, and the doctor doesn't like to leave in a continuous catheter after surgery as it can introduce infection.  So, several times during the night the nurses brought in a bed pan and told me to at least try.  Since I like to be a good team player, I felt like such a failure because I tried and tried, but nothing would happen.  I finally begged to be temporarily catheterized to get some relief.

Post-op day two was much better.  Initially I was afraid that removing the epidural would cause a major increase in my pain, but the opposite occurred.  I was put on a morphine drip, and that hot spot on my hip finally got some relief.  Honestly, it was  blissful.  Wasn't sure if morphine would work for me, but it turns out that I find it quite lovely.  I would even go so far as to say that it was a very pleasant day.  Now, my readers need to remember that I am a new mother.  I have been unable to lie in bed for more than three hours continuously in 8 weeks.  The opportunity to lie there, feeling nicely detached, all wrapped up in warm blankets while chatting to my sis and husband was actually luxurious, spa-like even.  All I kept thinking was, "This is nice.  I should have gotten an osteotomy ages ago..."

Third day post-op I started on percocet which treated me quite nicely, at least for a while.  If you read the first entry in my diary, you can probably figure out that the percocet turned on me.  The nurses and occupational therapists got me out of bed and started me "walking" down the hall on a walker.  I did pretty well moving my leg forward and rolling my foot from heel to toe, though my range of motion was pretty limited.  At night I slept in the CPM or continuous passive motion machine, which I found very soothing and comfortable.  It gently bent and unbent my leg at the knee, keeping the leg from stiffening,  and making a lovely shooshing sound that I still miss. 

Now the good stuff.  What does the untwisted leg look like?  I was always so curious to know how it would look, so let me relieve the curiosity of my readers.  It looks like an overstuffed kielbasa.  Just kidding, sort of.  It is very straight.  Dr. Teitge was meticulous, and I am happy to know that my kneecap is perfectly square in the middle of my perfectly straight leg.  For the first time in my life, I lie in bed and my foot points up instead of turning outwards.  However, I would be lying if I said I took pleasure in looking at it just yet.  I am very swollen.  The incisions are big, particularly the one that runs from the middle of my hip down my thigh.  I don't let my mom see it because I think it would upset her too much.  However, while huge, they look thin and neat.  It's my understanding that Dr. Teitge is very careful to make sure the sutures are as minimally scarring as possible, so we will see. 

What can I do?  Well I think I am making good progress.  I can roll my foot gently as I walk on my walker.  I can stand on my good leg and raise my untwisted leg a few inches off the ground, both with my leg bent and my leg straight.  In bed, I can gently scooch my leg from straight to bent at a 45 degree angle. 

What can't I do?  I can't get my utwisted leg in and out of bed without using a strap to hoist my foot up or down.  Standing, I can't really lift my leg very high without a lot of pain in front of the hip.  A straight leg raise is totally out of the question. 

Why does it hurt?  So many muscles and tendons need to readjust that the resident who helped with the surgery couldn't possibly name them all.  It's just gonna hurt for a while, everywhere, end of story.

Overall, though, it has not hurt as much as I anticipated.  At no time have I been in agony, though I do miss my traitorous friend percocet.  Nothing has relieved the pain quite like it, but on my first day home from the hospital my system had enough of it, and I was as sick as the proverbial dog.  That was my night of nothing but extra strength Tylenol, which didn't quite cut it.  Now I am experimenting with combos of Ultram, Tylenol, and Motrin, with the hope that I can soon phase out the Ultram and resume feeding baby the good stuff. 

I am now on the slow road to recovery and will keep everyone posted!

1997 Diagnosed with miserable malalignment
Nov. 2011 Left leg femoral and tibial derotational osteotomies
July 2012 Right leg femoral and tibial derotational osteotomies

Offline NickiAnn

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #4 on: November 10, 2011, 02:38:30 PM »
One week ago today they were rolling me into the OR for my osteotomy.  1 week of recovery down, at least eight more to go before I feel more or less normalish.

At one week post-op I can't really say that I have dramatic improvement.  My pain is manageable, but my leg hurts, that's all there is to it.  The swelling is still pretty gross and the incisions still sting a bit. 

The worst part of it all is trying to sleep at night.  It's not so much that it hurts too bad to sleep as that I can't get my leg in quite the right position.  Generally when we sleep we move about to get comfy, but this leg is dead weight.  When I wake up in the night, it feels all stiff, just like I need to move it and roll over, but I can't.  I have to get out the strap, loop it around my foot, and try to reposition my self.  It's completely annoying, and I would say it is definitely the most unpleasant part of the whole process. 

The other big news to report is that I almost fell yesterday.  I tried to crutch downstairs for a change of scenery, and got a little overconfident.  I lost balance and came down pretty hard on my untwisted leg.  Ouch!  I think I definitely irritated a few things, but I'm hoping I didn't knock anything loose.

Regarding pain management.  I have decided to reintroduce percocet to my life, but at much lower levels.  I take one to two throughout the night.  This is the morning after and so far I'm not sick, so maybe I can tolerate smaller amounts.  I woke up and took a motrin, which seems to be a good pain reliever for me.  I will try to make it on the Motrin today and see how that goes.

My only hesitation is that I think Dr. T's resident said Motrin could inhibit bone healing somewhat because it is an NSAID and bones need to be somewhat inflamed to stimulate healing.  I'm pretty sure that Dr. T okayed it, though.  The only reason I'm a bit unclear is that when the nurse and I discussed the Motrin I was dealing with percoset induced nausea and half of what she said sieved right through my brain.  I guess Tylenol is really the pain reliever of choice once one graduates from narcotics, but for me Tylenol has never so much as said "Boo!" to any pain I've ever had.  Though I know Tylenol is a major component of Percocet, I have determined that it's the narcotic portion of the Percocet that kills pain.

Whoa, feeling a little woozy.  It's almost as if someone had broken my whole leg then stitched it back up... ha! ha!  Best to take it easy for the rest of the day. 

Will post again when I have something interesting to report.
1997 Diagnosed with miserable malalignment
Nov. 2011 Left leg femoral and tibial derotational osteotomies
July 2012 Right leg femoral and tibial derotational osteotomies

Offline Lottiefox

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #5 on: November 10, 2011, 04:43:25 PM »
Hi NickiAnn,

Good to read more information - very interesting descriptions. I smiled at your comment that morphine is quite lovely; I have only had a smaller osteotomy on my foot but I too found post op morphine to be quite lovely at making the world a fluffy, pain free place..until I threw up too! I'm in the UK so am not 100% sure of the names you have for meds, but I was on ibuprofen after my op and had been worried it might interfere with bone healing but my surgeon seemed to not be worried about it, he said evidence was limited and that most studies had only been done on rats....all I know is that I had a solid fusion at 3 weeks, 2 weeks ahead of schedule and can now jump on my foot with no problems. (apart from my knees, but that's a different matter!!).

One week is just nothing in terms of recovery from an op like this. Even for little fusion I didn't feel anywhere near normal for over 5 weeks and I am still seeing swelling reduce some 7 months on plus nerve regeneration; I have had some nerve complications etc. You have, literally, had your leg sawn in half and turned around!

Keep us posted and go steady on those crutches!!

Lottie xx
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline wenikio

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #6 on: November 10, 2011, 07:54:26 PM »
Hey Nicole,

Your entries are a pleasure to read! Sounds like you're chugging along well :) I hear you on the sleep problem. Dead weight is right- nights were miserable with just snippets of sleep here and there when my body just gave out from exhaustion. Plus narcotics will make your sleeping wonky (something to do with the kind of sleep they prevent). I'm glad you're able to tolerate at least some percocet now. Tylenol isn't super effective for me either, and yes, NSAIDs (like motrin/advil) inhibit bone healing. You've got the complicating factor of breast feeding, though so I'm sure Dr. Teitge has factored that into allowing it. It's not a black and white issue. For a variety of reasons I think controlling my pain was difficult, and I was on at least some percocet for somewhere around 6 weeks. I'm glad to hear you're seeing improvement much quicker!

Man, I'm totally jealous of the CPM. That's one thing I wish I'd had for the nights! I understand the importance of active movement during the day, but that passive movement is critical for nighttime comfort. My poor husband was up every 1-2 hours to help me flex and extend to combat the horrible muscle spasms. Have you had much of that?

Pain aside, isn't it kind of funny trying to lift up your knee while standing? It felt like a total disconnect between my brain and leg. You never really think about having to move a body part- mostly it just sort of happens, you know? It took a while for my dead leg to show any signs of understanding the brain signal and even twitch. Ah the simple amusement of a drug addled brain!

Knowing how I felt, I'm excited for you to see and feel the results of your newly straightened leg! I was so impatient for the swelling to go down so that I could get a good look at it, and then I was super impatient to get the hardware out so that I could really use it! Now I'm dying to get the other fixed so that I can see and use both! Can't discount the emotional part either- the validation alone that I wasn't crazy to think something was still wrong with my legs after 7 knee surgeries was a relief. Knowing that most of the lifelong barrier to long term physical activity is/will be removed is exhilarating. Keep reminding yourself about that and psyching yourself up for it :) I know it's a slog and probably seems impossible to imagine three more surgeries after this one, but being 50% there please know that the freakishly large & barbaric surgeries are worth it. I mean really, they are barbaric, right?

PS- I'm pretty sure you're Superwoman for having this surgery with a baby and toddler. My hat's off to you! :)
'97-'02  -  4 Left knee surgeries (plica removal, meniscal tear, LR, & TTT) & 3 Right knee surgeries (plica removal, meniscal tear, & LR)

3/11 -  Left fem. & tib. derotational osteotomies, TTT, LPFLr

12/11 - Right fem. & tib. DRO's, TTT, M&LPFLr's

Offline NickiAnn

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #7 on: November 10, 2011, 11:04:29 PM »
Wenikio,
OMG!  I don't have a baby and a toddler, just a newborn!  That would kill my mom!  I don't think I was being clear.  I was in quite a pickle last year because I didn't know what to do:  have all my surgeries then try for my first baby at age 37 when I might be running up against the biological clock, have my baby then wait a couple of years and do the surgery (which would leave my poor mama chasing a toddler); wait until all my childbearing years were over, get the kids in school and have the surgery; or try for a baby while awaiting surgery then heal up before he hits the terrible two's.  As you can see, I chose the last option.  Hoping that all this surgical process will be a memory by my baby's second birthday.  Then, the door is still open for baby number two.  So, that's how I came to be the only breast pumpin' woman in the bone and joint ward!

I know what you mean about the shin pain.  That's one of my most tender spots.  If it's any comfort, Dr. T says that full recovery doesn't happen for a year and that the surgery won't be a distant memory until you're two years out.  So, we still have a ways to go!

Lottie, Motrin is indeed ibuprofen.  Good to know you healed on it as it works so well and is safe for breastfeeding.  I'm hoping that by only taking it during the day and using percocet at night I will avoid the trap of not healing on NSAID's, though it's probably all a matter of dose and individual body chemistry.  I wish medicine were more clear cut; life would be so much easier that way.

1997 Diagnosed with miserable malalignment
Nov. 2011 Left leg femoral and tibial derotational osteotomies
July 2012 Right leg femoral and tibial derotational osteotomies

Offline schinz

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #8 on: November 11, 2011, 05:05:09 PM »
NickiAnn...I wanted to thank you so much for sharing your story.  I know it must have been a very hard decision for you.  My daughter is 13 years old and being seen by the head of orthopaedics at Johns Hopkins in Baltimore.  Her situation is unique in that there is no current pain with her malignment.  Her left femur is twisted at 45-48% and her right femur is twisted at about 40%.  However, her tibias are not twisted, therefore, she has been able to be mostly without pain.  She plays at a high level of compettive softball, playing 65 games a season.  she has had some knee pain, but it was relieved with physical therapy.  The big issue with her, since her tibias are basically normal, is her intoeing.  She has a dramatic intoeing gait and leans slightly forward when she walks to allow her hips to accomodate her rotation.  Her doctor said the primary indications for him to reccomend surgery are knee pain not relieved with physical therapy <which hers was relieved> or the patient wants them fixed.  He looked her in the eyes three times and asked her three different ways if her legs or the way she walked bothered her.  She told him three times..."no."  So here I am left worrying about the long term effects down the road and making myself psychotic about the "way" she walks whe i just feel like there is a fix.  As a parent, I feel like I am letting her down not insisting we get them fixed, but wondering how I would live with myself if there was catastrophic side effect after "making" her get them fixed.

I guess I just wanted to thank you, as I sit here now with tears in my eyes <again>, for taking the time to let us all know your experiences and that it "can be done."  Thank you.  Rick

Offline NickiAnn

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #9 on: November 12, 2011, 01:42:53 AM »
Rick,  Your message really touched a cord, and I called my mom in to read it too.  Ironically, just today we were having a talk, and my mom was expressing regret at not having insisted that I have the surgery at age 21. However, I have no regrets, and I told my mom just that.  I simply wasn't ready to do it at 21.  I didn't feel bad enough, and I had no way of knowing how I would feel in fifteen years.  It wasn't until last summer that I began feeling that I could no longer live around it.  In the interim, I had many nice walks, hikes and travels.

The bottom line is that I'm pretty uncomfortable while recovering, and this surgical process is a long road.  I had to be in a frame of mind to really want to commit to changing my legs.  And, as you said, you can make it work.  My timing may seem odd, but it is working.  Mom is enjoying her new grandson.  I have a nanny to give her a break (I had to hire a nanny anyways for when I go back to work.)  My sister has been over to help with her nephew and has enjoyed our little sleepovers as we are calling it.

In no way do I hold any anger at my mom.  She was supportive and caring and tried to help me find information, but I had to make the final call, both fifteen years ago and now.

Now that I am a mom too, I know the agony of trying to do the right thing for your child's health.  Your daughter is lucky to have a parent who cares so much about her and her future.  Luckily, time is on her side, and she has the luxury of many years to make her decision.  I'm glad that she is able to enjoy athletics in the meantime, and that her gait is not causing her any distress.  Sounds like she is a very well adjusted and outgoing girl.  Whatever she decides, I'm sure she'll have the strength to get through it and the support of her family.  Feel free to write anytime!

Nicole


1997 Diagnosed with miserable malalignment
Nov. 2011 Left leg femoral and tibial derotational osteotomies
July 2012 Right leg femoral and tibial derotational osteotomies

Offline wenikio

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #10 on: November 12, 2011, 02:58:27 AM »
Rick, I second Nicole here and my heart goes out to you. Surgery, especially these kinds, are a big deal. If she's doing fine like Nicole, your daughter will be able to do things that make her happy and fulfilled. If and when the time comes where she's having problems or it's becoming clear that long term joint damage is inevitable, then you can revisit the subject. Kind of the whole "if it ain't broke, don't fix it" thing... even though it sounds likely that it will "break" in the future, you know? Plus, the more time goes by, surgical and rehab techniques will evolve.

But please don't think I'm saying not to do it! Like you, we made decisions as a family when I was a young teenager with what information was available. A crystal ball sure would have been helpful, but we have to muddle through right? :p I had some of the proposed surgeries and passed on others. Your daughter is lucky to have you fighting for her in the same way that Nicole sounds lucky to have a mom who ultimately supported what she felt was the right path in a situation with no clear answers. I was desperate for a fix, and I know my parents had misgivings about some of the surgeries and forbade others, but I love them and am so thankful for their support and guidance. I know they didn't let me make a clearly wrong decision and that's really all we can expect of them, right?

I had a lot of pain from the beginning, so I wish I'd known about and done the derotations much sooner, but better late than never. It's a rough surgery though, and I can't see personally going through it without fully agreeing that it was necessary at that moment in my life. I've gone back and forth about getting my other leg done and was seriously thinking about not doing it, but as I've gotten more active again, I see the need. What is your daughter's opinion after that doctor visit?

Nicole- well, you're still at least mostly Superwoman for doing it with a baby :) Yeah, I got the same assurance regarding time as well. I still notice improvements weekly now and I'm nearly 8 months out from the derotations/2.5 months from the hardware removal. There's definitely room for improvement, but I'm not stressing about it because yeah, we've still got a ways to go! Besides, I'm much better off than I was going into surgery, so it's a win :)
« Last Edit: November 12, 2011, 03:03:38 AM by wenikio »
'97-'02  -  4 Left knee surgeries (plica removal, meniscal tear, LR, & TTT) & 3 Right knee surgeries (plica removal, meniscal tear, & LR)

3/11 -  Left fem. & tib. derotational osteotomies, TTT, LPFLr

12/11 - Right fem. & tib. DRO's, TTT, M&LPFLr's

Offline schinz

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #11 on: November 12, 2011, 04:28:40 AM »
Thanks to both of you.  I feel like Iam the only one who almost mentally goes nuts watching my daughter walk with such an unsightly gait.  When I know there is a fix and that we are just not doing it right now, it almost literally makes me insane.  I have gotten myself to the verge of depression and can't find a way to make myself feel better about the whole situation.  People like you two help me realize that this can be fixed at any time and maybe it is better my little girl enjoy her activities and sports, since she is in no pain, now; and get them fixed later.  Thanks so much and please keep sharing your experiences.
Gratefully,
Rick
« Last Edit: November 12, 2011, 12:51:04 PM by schinz »

Offline belle9

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #12 on: November 12, 2011, 08:46:01 PM »
hi, enjoying reading your post - its like hearing my own life story!
 i've had problems since about age 12 and after several OS opinions had given up hope of ever finding someone to take on my case. I didn't have any of the early surgeries suggested as i wasn't convinced that the OS knew what he was doing and was managing to do daily activities fairly well despite the pain.  In 2010 however, aged 26, i found myself having to use crutches permenantly to get around and decided i needed help.  A long story, but i finally found and got an appointment with a top uk surgeon in this field and underwent my first de-rotation osteotomy of my right femur and tibia in april 2011.  Its a big undertaking as i'm sure you'll all agree, but i'm hoping will all be worthwhile.  I'm now 7months post op and have gone back on the waiting list to have the other leg done early next year when i will also have the plate removed from my right tibia as its causing pain.  I've had both my femur and tibia de-rotated distally which i think its pretty unusual - i wasn't quite sure but got the impression you have all had them at the proximal end of the bones? Am i right? do i make sense?
having gone through this surgery i think you are amazing going through this 8 weeks after giving birth (and somewhat crazy!).
Good luck with your recovery!  I am still walking with one crutch partly because i have a degree of nerve damage to my foot and partly because my left leg ( still to be corrected ) isn't very stable. Will be keeping a close eye on this thread x x x
*Mal-alignment issues due to torsion or both femur and tibias
*Derotation osteotomy of right distal femur and distal tibia 12/04/11

Offline crankerchick

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    • Derotation osteotomy & TTT Post-op diary
Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #13 on: November 13, 2011, 02:17:33 PM »
Hi NickiAnn, glad to see you were able to have some time to start a post-op diary. It really does help most people here to post and share and get feedback, plus it is helpful for the next person in a similar situation. I'm also glad to hear that things are going relatively ok so far.

Your story is helpful to me because I am in a similar situation right now with my right leg. I know the benefits of the surgery from having had the left leg corrected, but also know the down time that goes with doing it, and I was at a point last year where I didn't feel like my right leg bothered me enough to have the downtime from life and sactivities. I was ready to run and jump and bowl and shoot baskets and just generally get on with life and even start a family. I don't regret that decision at all, but here i am a year later and i'm still thinking about the right leg because it does seem to be getting worse lately and i find myself feeling like I should stop being selfish and just get it over with! now is just not a good time for surgery for me, though. Your story is just a reminder that just because the surgery feels inevitable, and I know it is likely in my future, there's nothing wrong with doing it later if i am managing right now.

In the spring, when the time should be more appropriate, i will once again have to decide on fixing my leg or trying again that whole move on with things that have had to be put on hold. Thankfully for me, you are posting this diary to share your experience of recovering and taking care of your son, so thanks for that. ;D

Hope each day is getting a little easier and a less painful. Surgery sucks but the outcome tends to be worth the blood sweat and tears when it's done for the right reasons and at the appropriate time.

I know for me, as a kid, I didn't know what was wrong with my knees, i just knew they hurt! I still played sports and had a good time, I just had pain too. My mom felt bad when I saw drmark 2 years ago and learned what was wrong with my legs after all those years. But I still feel like things work out the way they are meant to. In the end I found a great doctor who knew how to fix me and I got my left leg fixed at the time when it bothered me the most and was making simple day to day activities incredibly difficult. I can't see having the surgery if it isn't bothering a person enough to keep them from enjoying life and their activities. That is exactly why i haven't fixed my right yet, because it does hurt no doubt, but isn't as bad as my left ever was and i just want to be selfish and live life and that leg isn't stopping me...at least not yet anyway. It just isn't possible to know if the deformity will eventually bother a person to the point of surgery, so I don't see the harm in waiting it out. At least the deformity is known, and if things do decline, we know how to fix the problem!
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 NickiAnn

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Re: NickiAnn's Crazy Derotational Osteotomy
« Reply #14 on: November 14, 2011, 08:34:17 PM »
Wow!  It's fun to log on and see so many comments.  Makes me feel less alone during the recovery process.  Lottie, you had an osteotomy in the foot area?  Which bone and what's the theory behind an osteotomy on that part of the anatomy?  Having broken my fifth metatarsal a few years ago, I can understand that the foot is very tender and takes forever to stop swelling.

Belle, I'm so sorry you had to use crutches to get around.  I never got to that point thankfully.  Yes, my osteotomy is at the proximal end of the bones, though I'm not totally sure why.  The only thing I can think of is that doing the femur proximally allows the hardward to insert deep into the head of the femur.  Next week when I see my OS I will have to ask him why they do it the way they do.  He will probably be interested to hear about the different protocol in the UK.

Very fun to have readers from the UK.  Ladies, I have to ask a question that has been bothering me for years, and I hope you won't think me too ignorant.  When I meet someone from England, should I refer to them as British or English?  Enlighten a poor American!

Crankerchick, glad my diary is helping you somewhat.  I certainly looked to yours quite often before making this big decision.  There really is no good time for these surgeries, and the biological clock makes it trickier.  As of now, I plan on doing the second leg in July because I think it will make crazy if my  legs don't match.  However, I'm still early in the recovery process and I could change my mind once I fully understand what I'm in for!

So, in my second week of recovery I have achieved a few milestones.  First, I have worked out the best pain relief for me.  In the day, I take motrin, which is very effective.  At night, I figure I should take a break from the anti-inflammatories and I take one percoset to lull me to sleep.  On this schedule, my mom and hubbie feed baby at night when mommy is on her funny drugs.  That way by morning I'm ready to feed the little guy from the source, which brings me to my second milestone.  I am nursing baby again, at least during the day.  I could feed him at night as well, as my pediatrician has assured me that normal doses of percoset will do no more than make baby a little sleepy (some women are even given percoset while nursing to ease pain from childbirth), but we have decided to err on the side of caution and keep baby off the hard stuff.

Other milestones--I have managed to flip onto my stomach to sleep at night.  Only problem, sometimes I get stuck there.  The  other night, my husband heard me grunting and woke up to find me flailing about trying to flip back onto my back and had to offer an assist.  Also, I can now slide my untwisted leg from straight to bent without helping myself along with my strap--I rock!     

Now some frustrations--The strength is slowly returning, but still I am frighteningly weak.  If I place my hand on the muscle when I clench my quardriceps as hard as I can, I can barely feel any movement.   Even though I'm doing well, I find I'm like a kid in the back of the car saying, "Are we there yet?"  Then I look at my wrist and realize that the hole where the IV was is still bruised.  If my IV spot hasn't healed yet how can I expect my untwisted leg to feel better?  Well, I can't!  I'm just impatient! 

The back of my ankle is scary bruised.  I'm hoping it won't get worse because it's pretty ugly.  Also, there is a spot deep in my hip on the rear facing side that is sore, sore, sore.  When I raise my leg a bit to exercise the muscle, I feel sharp, pulling pains in that spot.  Not sure if it's the muscle over the plate or the tendons stretching in strange ways.

I am also missing getting down on the floor and playing with baby.  Granted "playing" pretty much entailed him frantically kicking his legs while I kneel over him insanely squealing, "kicky, kicky, kicky!"  But, it was fun nonetheless.  Just keep reminding myself that the worst will be over by Christmas.  A literal blip in my life overall.

It's a gray, gray November day in Michigan.  I hope others are enjoying sunnier afternoons.
1997 Diagnosed with miserable malalignment
Nov. 2011 Left leg femoral and tibial derotational osteotomies
July 2012 Right leg femoral and tibial derotational osteotomies















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