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Author Topic: Made decision to have HTO...now what?  (Read 5871 times)

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Offline jjhug76

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Made decision to have HTO...now what?
« on: March 20, 2012, 12:27:53 AM »
Hello.  My name is Jamie and I'm a 35 year-old female whose life has been turned upside down and inside out by arthritis.  I'm hoping my nightmare will end with the recovery from this surgery.

My journey (nightmare) began about a year ago. I began having uncomfortable pain in my left knee down to my ankle about a year ago. It wasn't terrible so I ignored it for a few months until it got worse in May of last year.  I went to my primary physician who said I had tendonitis from working out too much.  She told me to rest for a week or so.  I did. Got back into my workout routine and the pain was horrible. My knee was buckling.  I went to the ER in June.  Same thing-tendonitis.  Gave me a steroid shot and stabilizing brace. No improvement. So I went to see an orthopedic doctor who took one look at my knee and said the ligament that goes down the center of my leg from my knee was off center to the left and pulling my kneecap to the left when I bend my knee.  He gave me a cortisone shot and by the next day, I felt like I had a bionic knee!  It was wonderful!!

By mid-September, the shot wore off and I was back to being in pain-even more so!!  Back to my ortho who gave me another shot of cortisone and said if it didn't work we'd have to explore other options because I'm too young to be getting these shots like this.  A week later there was still no improvement.  Back to my ortho who said the next step is visco injections but he didn't think they'd be effective on me so he sent me to physical therapy.  Physical therapy failed.  Next step-surgery (lateral release).  I was in law enforcement and since we were so short handed I tried to tough it out until after the holidays.  However, my supervisor saw me wearing a brace 10/19 and sent me home saying I wasn't allowed to come back to work until I was 100%.  On 10/25/11 I had the lateral release.

While doing the surgery, my surgeon was shocked to discover I have grade 4 osteoarthritis in my left knee.  So he performed a debridement, as well as three microfractures.  One week post-op he took the stitches out and advised me of the severity of the arthritis.  10 weeks of physical therapy (my therapist terminated me 2 weeks early because there was no improvement and this became quite expensive for a single mother).  I ran out of leave at work in January so I tried to get my doctor to release me back to work.  He said he wanted me to see another specialist because I was no better off than I was before my surgery.  The surgeon he referred me to said he couldn't help because of my age.  He said although my case is severe, I'm just too young for a replacement.

Last resort, my original surgeon did tried five Hyalgan injections, which didn't help.  I ended up having to quit my job on 2/13/12 because I now walk with the an off loader and a cane and that's unacceptable in law enforcement.  So here I am now, a single 35 year-old mother of two with no prospects.

I went back to the specialist out of frustration and he referred me to a wonderful surgeon that I'll just refer to as Dr. G.  He reviewed my arthroscopy photos, xrays, mri's and pathology reports and advised me that a high tibial osteotomy is my only option and that I have an 80 year-old knee.  I asked him how soon as we can do surgery and he replied April 2.  I advised him my medical insurance expires at the end of this month because I had to quit my job because of all of this but that I did apply for Medicaid.  He said he doesn't accept Medicaid but because of my circumstances and the severity of my case, he'd go ahead and do the surgery anyway.   ;D  I couldn't believe it!!  I still can't believe it.  He said he's not just in this for the money, he enjoys helping people and enjoys practicing medicine.  I'm in tears just typing this.

I was so excited a the prospect of returning to some form of "normal" again.  I go back to see him tomorrow for measurements and a full xray of my hip to my ankle (he suspects I also have arthritis in my hip for some reason).  This has been such a rollercoaster experience and has turned my life upside down.  I've never been unemployed.  I've never NOT been able to take care of my kids so this is so stressful and scarey. Luckily, my kids are teenagers so they don't require me actually taking care of them physically and will be able to help me out. 

A few questions...does this surgery require an actual overnight stay at the surgical facility??  And I've read about an extender for a toilet...however, I'm not sure how that would work.  My downstairs bathroom is TINY...if you sit on the toilet, the sink is literally in your face.  Any suggestions???  How bad is the pain?  For real?  Ive read about people going in to shock from the pain and being rushed to the hospital via EMS.

Any help would be great.  Thank you!!!

Jamie


Offline captainruss

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Re: Made decision to have HTO...now what?
« Reply #1 on: March 20, 2012, 02:07:24 AM »
Jamie,

I am not sure about your type of surgery as mine was different.  There are many types of pain medication and pain relief.  I would first suggest you google the "Intractable Pain Patients Handbook" and print it.  This gives you ideas on how to speak with someone about the pain and what to ask for.  Pain is your enemy.  If you are in pain, someone is not doing their job.  There are blocks, epidural's, PCA (Patient Controlled Anesthesia) where you push the button every 6 minutes for pain relief.

Your Dr. G sounds excellent.  Ask him for his cell phone number.  Ask him to put it on your chart in case you have trouble with pain the nurse can telephone him immediately and get an order for something different.  I don't know of many docs who do this, but my last OS does and it was absolutely necessary.  Little things.....my nurse on one of my operations tried to unhook the PCA at 4 a.m.  I was not leaving until noon, eight hours later.  It literally  takes them 3 minutes to remove the I.V. and shut off the PCA.  Why should I suffer for eight hours when it is that easy to unhook.  The orders were to remove it prior to my release from the hospital.  It said nothing about making me suffer for eight hours.  Anyway, she changed her mind when I started calling my doctor with my cell phone.

The other big point is after surgery.  An ice machine or cryocuff is very important.  Ice is very helpful with pain and swelling.

The only dumb question is the one you do not ask.  Be patient, there will be someone with specific knowledge about your specific condition.  They will give you their impressions/experiences.  If you need someone to talk with, I am here.

I have been out of work for two years now.  My church has tried on several instances to assist me.  I have politely resisted because of my pride and I am not desperate just yet.  Their are many different non profit groups that will help.....Let us know if things get difficult.  Your insurance should offer COBRA?  I don't know if that is an option.  Did you work with a police union??  Was you knee work related??  Are you sure??  Was your condition aggravated by your job?  Couldn't your union request "light duty"??  I don't know how many years your worked for them, but there must be a job in the Police Department where you can use your experience (dispatch) etc where you don't use your knees?? 

I can't tell you why these things happen.  I am told there is a reason.....and after problem after problem after problem seems to really take your breath away....I know it is tough with teenagers.  I fortunately have someone.  Do you have any family close??  I do enjoy posting on this forum as it helps to speak with people and I have found people such as yourself that have it tougher than I do.  This makes me buckle down and try harder.  One day at a time. 

Russ
80 Shattered patella 5 surg
09  TKR 
09  MUA
09  MUA
09  Knee infected??
10  TKR  Scar Tissue
10  2nd OS  Diagnosis Infection
10  TKR with antibiotic spacer, no joint
4/11  TKR
11  TKR PT
11  TKR
11  TKR  AF diagosis
12/11  HO diagnosed
2012  Intractable Pain
2012  OS split
amputation possible?

Offline captainruss

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Re: Made decision to have HTO...now what?
« Reply #2 on: March 20, 2012, 02:23:38 AM »
Jamie,

I am not sure if you are in the U.S. or not, but at 35 you are young enough to go back to college or continue college.  I am taking college classes online and getting financial aid.  It is to pay for books, tuition, rent...etc. 

I would be in serious trouble without this idea.

If you need advice on this, let me know.

Russ
80 Shattered patella 5 surg
09  TKR 
09  MUA
09  MUA
09  Knee infected??
10  TKR  Scar Tissue
10  2nd OS  Diagnosis Infection
10  TKR with antibiotic spacer, no joint
4/11  TKR
11  TKR PT
11  TKR
11  TKR  AF diagosis
12/11  HO diagnosed
2012  Intractable Pain
2012  OS split
amputation possible?

Offline jjhug76

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Re: Made decision to have HTO...now what?
« Reply #3 on: March 20, 2012, 10:49:24 AM »
Russ,

My condition isn't work related unfortunately.  If it was, my job would have offered me light duty.  That's the only way to get light duty in my line of work.  I was in corrections and the DOC doesn't give a damn about their people where I live.  In fact, when I did come back to work the first thing they did was try to punish me for taking FMLA for the first surgery (but of course tried to make it about something else that occurred almost three years ago).  So, I had no choice but to quit before they fired me for not being "fit for duty".

I've actually been in school and had to take a break because of my last surgery.  I'm one year from my bachelor's degree.  Unfortunately, my financial aid doesn't cover living expenses because the FAFSA is based on my previous year's income.  Luckily, I've only been in law enforcement for five years and did have a career prior to.  It's just a matter of recovering from this surgery so I can get back to work.  Until then, it's going to be tough.

I don't have much of a support system.  Luckily, my mom doesn't work and will be staying with me while I recover.  That's the extent of my support system.

What is a cryocuff?  And how long was your hospital stay??

Thanks for the info and help!!

Offline WonkeyDonkey

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Re: Made decision to have HTO...now what?
« Reply #4 on: March 20, 2012, 04:21:41 PM »
Hi jjhug76

You have done the hard bit by making the decision to have the HTO. I am 18 weeks post op of an HTO and my life is getting better every day, it can make a huge difference. It is not an easy recovery and you have to put in a lot of physio, but I no longer have the pain and can do things that I had put on hold for a good couple of years. I have been back at work since 13 weeks post op, although 3 weeks were part time. I look after children so needed to be safe to lift etc.

Below is a link to my post op diary, if you want to have a read

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

I was very lucky and had the OS that features on this website and wrote the osteotomy course, but I personally would recommend the operation and it feels great to be getting my life back.

If you have any questions please feel free to email me, as I know how I felt in your position.

WD

Offline captainruss

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Re: Made decision to have HTO...now what?
« Reply #5 on: March 20, 2012, 08:37:04 PM »
Jamie,

First, there are always people who are willing to help.  I know the last thing on your mind is becoming involved with more people who take up your time that is spent taking care of your kids (more of a job than working) but church's and non profit groups help out quite often.

I read that you were originally diagnosed as a result of "working out too much"??  Are you not required to meet height/weight/physical requirements as part of your job with DOC?  I guess the point I am making is this should be looked at from a different angle.  The physical stress of doing your job and/or the physical stress meeting the fitness requirements of the DOC could be an avenue to explore.  Anything that aggravates the condition and is in any way related to work makes this a work "aggravated" condition.  As an employer, I found some very creative conditions that were tied to work and permitted an employee who was miles away from work when his/her condition was caused to get paid.  

Financial aid is based on your previous income, but if you speak with a financial aid specialist at your college, they have been known to issue waivers.  You are unemployed with multiple depends and no income.  Again, the emphasis in our current political climate is to encourage people to go to school and not on government assistance.  This normally refers to healthy people, but the rule can be bent to possibly help in your situation.  

I have been told that I will not be able to climb ladders, crawl around under marine diesels any more, so I need to finish my degree.  I read the paragraph on what you can spend it on and it is pretty wide open.  If you could finish your Bachelor's degree you are much more marketable.  I am taking online courses so I don't have to hobble around campus.  A note from your trusty OS gets you excused from on Campus tests...etc. .....I only suggest this because I am struggling  thru classes yet also putting food on the table.

My surgeries were each different.  First, never rush to get out of the hospital.  While in the hospital you have access to immediate pain medications.  I often rushed to get out because of the $150 a day my insurance charged for me to stay.  I am now to the point where I don't care after eight surgeries....I am more concerned with getting healthy.  You need the doctor to write you scripts for pain meds, etc prior to leaving the hospital.  Find out before surgery if the hospital has a pharmacy and arrange with your doctor to have that pharmacy fill your scripts prior to leaving.  This eliminates the need for a trip in the car or out with the kids.  Make sure you have crutches, walker, cane, etc also procured before leaving the hospital or better yet prior to the day of surgery.  The key (for me) is ice.  The hospital put this ice pad on my knee and it was attached to a cooler the filled with ice which pumps cold water around your knee.  This to me was a must have.  A cryocuff is similar but it also applies pressure to the knee.  I have never had a cryocuff.

You need to find out about PT that will be prescribed after surgery.  Normally, you have PT sessions in the hospital prior to leaving.  You must be able to get out of bed and move...mostly to the bathroom.....but walking is important.  If you are having outpatient PT, I would try to ask about the different outpatient PT clinics close to you.  I actually visit them and picked my therapist.  I have had more than 100 pt appointments in the last 2 years....so having an "excellent" therapist is vital.  Mine, Kristy, is very dedicated.  She actually spent in excess of 2 hours each day between my exercises, deep tissue massage...electric stimulation, ice....she is my source for gel ice packs.  I paid $20 each, but this should be ordered on a script by your doctor prior to you going into the hospital.  

Always write down all of your questions/needs prior to your appointment.  This way you don't forget them.  

Being prepared prior to surgery is vital...especially if you don't have local family to assist.  Your OS is most likely willing to help with all of this.  

Just my opinions.  Please don't look at my case and get nervous.  I am in the less than 1/10th of 1% of all TKR's that have serious complications.  I have good reasons to encourage you to get multiple opinions and to speak up about your pain.  I think you will get further posts assisting in the knowledge you will need.

Russ
80 Shattered patella 5 surg
09  TKR 
09  MUA
09  MUA
09  Knee infected??
10  TKR  Scar Tissue
10  2nd OS  Diagnosis Infection
10  TKR with antibiotic spacer, no joint
4/11  TKR
11  TKR PT
11  TKR
11  TKR  AF diagosis
12/11  HO diagnosed
2012  Intractable Pain
2012  OS split
amputation possible?

Offline Forevergimpy

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Re: Made decision to have HTO...now what?
« Reply #6 on: March 20, 2012, 09:24:29 PM »
Jamie
 Sorry to hear you're in need of an HTO, but glad you have an action plan. I had a TTT back in 1995 and I must say I don't regret it for a minute. The recovery was not easy but I honestly do not even remember a lot of the particulars. I was admitted overnight the day of surgery and was sent home with an immobilizer and NWB for a few weeks and what felt like forever in PT. However, it did work wonders for me.

It's great your mother will be able to stay with you for a while to help out with the house and your kids. Your bathroom issue does sound to be troublesome - can you sit on the toilet with your leg straight in front of you? If not, you may need to think about purchasing (or renting ?) a free standing toilet seat until you can fit in the tiny space?

As for the pain, I remember it being significant at times, but well managed with pain meds and ice.

Good luck to you!
Right Knee:
1993 Plica removal
1994 Lateral Release
1995 TTT & chondroplasty
1996 HW removal & debridement
2005 Meniscus trim & chondroplasty
5/17/12 Meniscus trim & ?

Offline lululocket

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Re: Made decision to have HTO...now what?
« Reply #7 on: March 21, 2012, 11:45:10 AM »
Hi Jamie,

Like some others here, I have had a TTT. I don't know much about the subtle differences with an HTO, but my understanding is that a TTT is very similar in terms of recovery because the tibial tubercle is being moved. The reasons for moving it in my case are to do with dislocations rather than arthritis, although I had some damage starting too.

I just wanted to reassure you that even on a budget, there are lots of small steps you can take pre-surgery to help your recovery. It really is the small things that matter! My insurance in the UK covered the time in hospital and my physio (PT), but that is about it, and I've spent almost nothing on other measures. Just ice packs and  tray for in bed.

I started typing but decided it was worth another thread!
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=59074.0

Lulu

2003 RK dislocation
multiple sublaxations (10+), both knees
2007 LK dislocation
03/2010 TTT on RK
03/2012 TTT on LK

Offline jjhug76

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Re: Made decision to have HTO...now what?
« Reply #8 on: March 22, 2012, 01:01:29 PM »
Thank you for all the kind words and information.  I'm waiting for my doctor's office to call with the surgery date.  I'm on pins and needles right now.  I feel so fortunate.  I stopped by my physical therapist's office the other day (I'm still making payments on my therapy from my last surgery) to straighten out my account and they offered to do my PT for $20 a visit after my next surgery.  In Florida, Medicaid only covers PT if it's an outpatient hospital setting, which means me driving 120 miles round trip to have PT at the facility that's doing my surgery.  I'm so grateful and appreciative that not everyone is in the medical field for the money.  I'm not used to catching a break in life so to have a surgeon that'll do my surgery for free and therapist that will see me for so little is such a weight off my shoulders.  I'm truly blessed.

Offline jjhug76

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Re: Made decision to have HTO...now what?
« Reply #9 on: March 22, 2012, 01:16:37 PM »
Wonkey, I read in your blog that you did in fact use the stairs in your home immediately after your surgery.  How difficult was this??  I ask because after my last surgery, I camped out in my living for about 6 weeks because I was terrified of my staircase (very narrow spiral staircase).  I hated being in my living room so this time I planned on temporarily switching rooms with my daughter (she's on the first floor, I'm on the 2nd) but she's not happy with this at all.  The first floor bathroom is a full but the 2nd floor (mine) has a very small shower and toilet-no tub.  How feasible is it for me to to stay in my room?  Or is switching rooms with my daughter the better idea??  How hard was it getting up and down the stairs?  And would it even be possible with a very narrow spiral staircase??

Offline bigal177

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Re: Made decision to have HTO...now what?
« Reply #10 on: March 22, 2012, 08:10:22 PM »
Jamie 
  i am pleased that you have a plan now, i too have had a HTO
i am waiting for my left leg to be done also ,hopefully i will then be even  ;D
personally i found the first week  very painful but everyone is different.
i have not regretted the op and have great results ,that have been slightly dampened with my left knee
allso grade 4 athritic  so i am waddling all over the place and hurting my hips too
one thing that i personally feel is that you have to learn to walk again as you are weight bearing in different places
so it does affect muscles etc
best wishes
Alan

Offline WonkeyDonkey

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Re: Made decision to have HTO...now what?
« Reply #11 on: March 23, 2012, 04:53:36 PM »
Hi Jamie

I was shown how to go up and down the stairs whilst in hospital by the physio's. mind you the stairs in hospitals are never like those at home. My stairs have carpet and a bend at the bottom, so not the same at all. i was in hospital for 4 days and then tackled my own stairs.
I used both crutches to get up the stairs, although it is a little scary to start with. I had either my son or husband walk up behind me to start with. I mastered it after a while, and made sure that I put the crutches at the back of each stair to get the best support. I was NWB for about 2 weeks and after that PWB, which made getting up the stairs easier.
I stuck with going down the stairs on my bottom for weeks as I found that is more scary on crutches than going up. When I was PWB I practiced on the last couple of stairs before taking the plunge and coming down the whole flight.
I was trying to only come down once and up once during the first week or so, and then could manage more often, although I have a downstairs loo so once down I was ok.
One of the best items I used was an office type chair to assist in the bathroom. I found it easier to use to get in and out of the bath, to sit at the sink to clean teeth, wash hair and wash, and just to take the weight off when doing hair etc. Another item I have grown attached to is a cryo cuff, it made icing so much easier once you know what you are doing.

You need to master being on crutches as soon as possible as this makes life easier. See if you can get some before your operation to practice on. I didn't but wish I had done so. Also make sure you have plenty of pain meds indoors, just in case.

If you have any further questions just shout.

WD

Offline neoma

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Re: Made decision to have HTO...now what?
« Reply #12 on: March 26, 2012, 04:20:43 PM »
Hi Jamie
I had a high tibial osteotomy with opening wedge in August 2010. I was a long recovery and a painful one, but definately worth it.
I am so glad I made the decision to have the surgery. I don't have any pain in that knee now, although the re alignment has meant changes to my ankle etc so I have had to work hard regaining fitness.
I am now on the waiting list for the plate and screws to be removed and hopefully that will sort out the shin pain. :-\

N

Offline Grandhoux

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Re: Made decision to have HTO...now what?
« Reply #13 on: May 08, 2012, 07:44:49 PM »
Hi, Jamie, I'm 3 months post HTO in France and have been given the all-clear to walk without a crutch although I tend to take walking stick on longer outings. I'm a bit 'heavy' (95 Kg ... all muscle ;)) which doesn't help and was the reason I had to wait for the full 3 months before walking without a crutch. I get a fair bit of pain but nothing Ibuprofen won't shift. I also take Glucosamine, I'm convince it helps, and calcium and vitamin D as I don't eat much dairy food.

My main pain is around the area of the plate and four screws where there is still bruising. I think it's me, I don't get on well with hardware and I'm pretty sure I'll have to have the metalwork out next year. Compared to the tibial plateau fracture surgery and the broken femur this was a walk in the park. I had a rather large wedge inserted, about 1/2 inch of opening with artificial bone as my leg was bent by 15 degrees. It is a painful operation, but with two anaesthetics (local and general) it wasn't too bad.

I'm walking a lot better already, less limping until it gets tired, then it's a bit sore but I think that's the hardware again. The pain seems to drift around my lower leg and knee but I can kneel to work, walk up stairs and carry things. I'm gardening, plumbing and digging holes so it can't be that bad. I'll see my physiotherapist in a couple of weeks and ask if he can give me any improvement, if so I'll get a prescription from my GP.

I'm pleased with my HTO, hope yours goes well.

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?