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Author Topic: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12  (Read 22786 times)

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Offline natenix

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I just had a derotational tibial osteotomy on Wednesday with Dr. Sanders.  Following is a little of my pre-surgery history.  I hope this journal can help others as much as I've been helped by individuals who've posted on this site.  I've always considered myself an athlete, I reallly loved to play all sports and up until I was 26 other than a chronic case of shin splints, I had almost no leg problems.  At 26 however after partially tearing my A.C.L. in a freak way, my legs began to sort of unravel. My knee Dr. in Georgia scoped my knee and when I awoke from surgery he told me my A.C.L. was 80% intact and that he had used his awl to poke holes in the bone to see if the 20% would scar down.  After a few weeks rest, I began rehabbing at my local gym all was going well but as I was doing a calf strech on a stair, I really badly strained my left achilles tendon.  This really hampered the biking I was doing which was helping my knee and really set back the rehab.  Before my achilles got completely better my right big toe began giving me big problems then my right heel (I would often be limping around and haven't showered standing up for the past 3 years because of those heel problems), this was followed by my right and left hips.  I actually had what is called a femoral osteochondoplasty with labral repair on my right hip Feb 2011 followed by the same procedure on my left hip in April 2011, my hips had begun acting up as I was still trying (3 years later) to rehab my knee and other body parts from these various injuries.  Following the hip surgeries I was very hopeful that the time spent in bed and rehabing very aggressively was going to deal with all these injuries and set me on the right course.  Unfortunately that wasn't the case.  The hips seemed to do great but the toe, heel and knee were still causing problems.  Ultimately after spending 1000's of dollars trying orthotics and other various things, both a physical therapist and a Dr. in Georgia confirmed to me that the problems I was experiencing were due to excessive tibial rotation.  This was devastating news at first because it felt like at 30 for the first time I felt I was finding out I'm deformed and also because it felt as if there was nothing I could do about it.  I was pointed initially towards Dr. Lonnie Paulos but ultimately through this website I discovered Dr. Mark Sanders who runs the Sanders Clinic in Houston and Gainesville Texas.  I drove out from Georgia and met with Dr. May 1st, he confirmed that I was both very Varus (bowlegged) and that I had 46 degrees of external tibial rotation on both my right and left legs.  Dr. Mark proposed that I have both a high tibial osteotomy where they cut right below the knee and a distal osteotomy where they cut right above my ankle and that he would correct both the varus deformity and the rotation issues.  I just had both of these done this past Wednesday and hope to update tomorrow what the past few days have been like, but I'm exhausted now so more for next time.


Offline natenix

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #1 on: June 02, 2012, 07:04:10 PM »
Surgery Day

As I'm a few days out I will just recount a little of what I remember from these days.  I arrived at North Texas Medical Center at 6 a.m. Dr. Sanders had one patient in front of me and so it took quite a while before I ultimately went to surgery.  I think went back around lunch time and they finished me up around 3.  I remember being pretty scared about the epidural and spinal, thing is I can't even remember this part, whatever they gave me beforehand sure did the trick.  I was pretty awake by 5 or 6 this day but in almost zero pain, the epidural was really working well.  In fact almost too well I really didn't start getting much feeling in my toes till around 12.  I mainly just remember a friendly nursing staff keeping my cryocuff changed and being up most of the night trying to move my toes and feet as much as I could to regain feeling. 

Offline natenix

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #2 on: June 02, 2012, 07:21:40 PM »
Post op day 1

One of Dr.'s orders was to try and drink gatorade till your urine was clear.  Well I couldn't ever seem to get my urine clear but when they came to empty my catheter bag it did have 5500 cc of urine in it.  I think that was close to the record.  I had them bring me pitcher after pitcher of water all night long.  Anyways this morning Alan the the PT as well as his assistant Bert helped me start getting range of motion.  We just did about 4-5 simple exercises and they didn't get me walking on my leg this day because they were a little worried that my unoperated leg was too wobbly from the epidural.  I was able to achieve about 130 degrees of flexion in my knee, Alan also seemed to be pleased with how my ankle was flexing.  He's an encouraging guy and a really good therapist.  My hemoglobin levels were looking good, didn't look like I was going to need a transfusion and they changed my bandages today (it was wild to see my leg and I could already tell it was much straighter than before).  I took some pics, maybe I can post them sometime soon.  Dr. Sanders has done a good job emailing and calling me in response to questions whenever I've had any.  Throughout this day I've regained much feeling in my legs and while I'm not in a ton of pain my operated leg definently feels cold constantly from the cryocuffs.





Offline crankerchick

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #3 on: June 04, 2012, 05:56:50 PM »
Hi Nate! Glad to see you were able to get a post-op thread started. Hopefully folks will see it over here in the >300 posts section, or perhaps a mod will move it to the <100 posts section for now, so more people can see it and be helped by your experience.

I do believe you are the first to post on here with both a varus and rotational deformity. Your distal and proximal approach for the surgery I think is also a first here (I could be mistaken, I don't come here as often any more).

So I'm glad to see you are posting and sharing your experience. Yours sounds very similar to mine, except for the epidural part. My legs weren't numb after my surgery and I could use them just fine. Dr. Sanders making me do cannonballs shortly after waking up is a testament to that. Speaking of cannonballs, how do you like them? Torture eh?! :-)

I had my surgery on a Tuesday and was on my way home by the following Monday, so I'm guess that perhaps you are too. If you've left already, or for whenever you leave, just want to say best wishes for safe travel. The traveling sucks, but getting home will feel so much better than being in the hospital and in the hotel.

Glad to hear you like Alan and Roberta. They are awesome! Favorite PT ever, and I've seen my fair share in 20 years of knee problems. Just be sure to do everything Alan says and don't hesitate to ask questions if you aren't sure about something. Everyone there is really nice and helpful.

Glad to hear you didn't need any blood. I didn't get any either, but I did have one fainting episode that landed me a bonus day in the hospital. I was only supposed to stay 1 night but ended up staying 2.

Curious to hear how moving around is going for you. Congrats on the great range of motion! You're doing awesome!
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 natenix

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #4 on: June 08, 2012, 02:55:11 AM »
Post Op day 2

Nights arenít terrible,but I donít sleep more than about 2 hours at a time.  Mainly because my knee hurts from keeping those towels under my heel and letting it hang with nothing but air beneath.  I just wakeup when its no longer bearable, do a little PT and then it feels better and back to sleep.  I am paranoid that my foot is going to lose circulation, it is sooo cold and everything is so swollen and funky feeling down there that  every once in a while I have the nurses feel my toes to make sure they feel my pulse and that I can feel their finger.  They say the pulse is strong and that helps with the anxiety.  Began walking today.  I was eager to do it though a little nervous.  I think Iím mainly afraid that I am messing up the bones and that they wonít heal.  Ultimately though if Iím going to trust doc to do the surgery, then Iím going to trust Alan and Dr. through this part too.  I have to put this walking boot looking thing on my leg before I walk, itís got a high heel on it so when Iím standing my operated leg must be slightly bent because my sneaker doesnít have nearly as high of a sole.  I made it down to the nurses station walking.  It was a cardio workout as walking heel toe like they want me to actually is much more of an upper body workout  than they way Iíve walked on crutches in the past.  Iím thankful for that though.  I need the workout.  They want to keep me one more night in the hospital, Iím fine with that as long as my insurance covers it.


Offline natenix

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #5 on: June 08, 2012, 02:56:00 AM »
Post Op day 3

Alan got me up and we walked a couple times today.  Gaining confidence here. Interestingly enough though this was the first time IĒd felt a little dizzy and my eyesight a little blurry.  My hemoglobin levels had dropped a little bit, but still at 11 so they say nothing to worry about, you donít need a transfusion till you are like a 8 or something.  They changed my bandage again today, still bleeding a little in one spot.  I said goodbye to everyone and dad and I headed to a hotel.  It was a trial run in the back of the Subaru Outback, we are going to make the trip back to Georgia in this thing on Monday and Tuesday so we were figuring out how to make it as comfortable as possible.  Back at the hotel pretty boring really.  Doing office stuff for work, PT, watching golf and resting.  Thankful that Iím not in too bad of pain. 

Offline natenix

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #6 on: June 08, 2012, 02:56:39 AM »
Post Op day 4

Pretty boring day layed in bed at hotel pretty much all day doing exercises on the hour and keeping things iced.  Iíve thought of a few questions for Dr. for when I see him tomorrow, my main concerns are:
  This popping I feel/hear around my ankle is that my broken tibia popping?  That wouldnít seem to be a good thing.
On the Xray I saw that they broke my fibula too but didnít use anything to fix it (no screws plates etc..) will this be a problem?
I will find out tomorrow.
By the way Iíve got full range of motion as far as I can tell in my knee and my ankle is probably like 98% there if not there.  Pretty encouraging for 4 days out of surgery!!!

Offline natenix

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #7 on: June 08, 2012, 02:57:18 AM »
Post Op day 5

Saw Doctor today then began the trek back to Georgia.  Dr. said that the xrays looked good, he was pleased with my range of motion and said it is a lot higher than what most patients who use other Drís for osteotomies would have at this point.  Iím thankful for that. He had get in several different positions and my dad could observe my operated leg was now much straighter than my unoperated leg.  I was so pleased with everything that I went ahead and setup my appointment to do the left leg in November.  I know that I have a long road ahead with this leg, but I believe that Dr. Sanders has some serious surgical skills and Iíve been very pleased with everything up to this point.  Found out I will get staples out at 3 weeks and xrays at 6 weeks (man I hope everythings healed by then!), and I can remove this big long super bandaid of a thing this thursday.  Made the 9 hour trip to Tupelo pretty easily considering.  I was laying in the back of my dadís outback with my leg elevated and the cryocuff on.  I would still do exercises as instructed and I had enough room to do most everything.  Was able to take my first shower tonight, great to do that!  Only tough thing really is Iím probably only getting about 6 hours sleep a night and not much if any in the day.  I know your body does much healing while you sleep so I hope to do better with this.  I am in enough discomfort that itís hard to sleep more than 2 consecutive hours so I just wake up do some quick PT (which helps with pain) and Iím back to bed.  Looking forward to when I can walk.

Offline natenix

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #8 on: June 08, 2012, 02:58:02 AM »
Post op day 6

Rode with my dad from Tupelo to just outside Atlanta Georgia.  Again Iíve been amazed at how little discomfort Iíve been in.  Going into surgery I thought that coming out I might experience the worst pain of my life and be stuck with that pain for weeks on end.  I imagined what it might be like being shot on the battlefield and having to live with the ache and throbbing of that for a while.  Iím so thankful that hasnít been the case.  Perhaps anticipating something that bad has made me notice less the pain that I do have. Whether itís this or the pain meds Iím taking (no narcotics), or just a great surgeon, Iím grateful for the fact that Iím not in a considerable amount of pain.  I know many people were praying for me so praise the Lord for this.  I made the 6 hour drive from Tupelo in the back of my dadís subaru outback with no problems.  After I arrived at my grandmas I rode the bike for 45-50 minutes!  It was a little bit of a slow go for the first minute and it wasnít a great cardio workout or anything because I canít have any resistance, but man it was nice to use my leg some!  I felt some discomfort in the ankle, my dad commented that I wasnít using my ankle on the operated side as much as the other so I tried to focus on using it more.  After I finished I used the cryocuff and did feel some pain in my achilles/heel cord for a while, but overall the bike was a good experience.  I did notice when I pulled back these white compression stockings after the bike ride Iím black and blue now almost all the way up to my groin.  Itís not painful in the areas above my knee but just noticeable.  sure it will go away with time.  All in all pleased with my progress!

Offline crankerchick

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #9 on: June 08, 2012, 03:07:50 AM »
Great posts Nate. Thanks for updating all of the days in between. What did Doc say about the fibula? I'm pretty sure the answer is you don't do any fixation on a fibula break as long as it is within a certain distance to the ankle, as yours is, but I'm curious to hear the answer nonetheless.

Elevating with nothing but air under the knee definitely isn't comfortable, but there is good reason for it, as it is meant to help you keep your extension, rather than have to work to get it back in PT.

I didn't sleep much through the night either, just like 2-3 hours at a time, but I was able to nap through the day. In fact, I just fell asleep randomly through out the day for a few weeks actually. If I sat on the couch to watch tv, I was out like a light!

I did a lot of pt also, just moving, exercising, stretching, trying to do leg raises, etc because it is true, it helps with the pain. I also rode the bike in sessions just to spread out the relief. Sometimes I would wake up and ride it through the night! LOL

Sounds like you are doing well and your post op days weren't too bad. I was expecting crazy pain too, but was very happy to find that my pain was never too bad or out of control. I mean it hurt, as surgery should, but it was definitely not what I expected at all.

Glad your ride back to GA wasn't bad. Try to rest at all costs. Michelle told me to make sure I slept or she would make sure I did. I'm pretty sure I wasn't interested in finding out what she would do to me!
« Last Edit: June 08, 2012, 03:10:22 AM by crankerchick »
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 natenix

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #10 on: June 08, 2012, 06:59:00 PM »
Crankerchick,

Thanks for all the encouragement.  Yeah both Dr. Sanders and Alan acted like no big deal on the fibula break, it will just heal itself.  I think it was a little disconcerting at first because I didn't know they were going to do that but I just trust Dr. so not worried about it now.  You mentioned in a previous post cannonballs being bad for you, interestingly enough they haven't bothered me at all.  I wonder if it was the TTT that made yours rough.  I've pretty much had full range of motion in that knee since day 1 cannonballs have been almost zero discomfort.  I did sleep with the pillow under the knee last night and slept better, I felt good about doing it because I've had full extension in that leg for 2-3 days now.  Sleep seemed to trump extension for at least one night.  I just made sure when I woke up in the morning to really work on extending it and throughout the day today I've been going without anything under it.  Swellings been going down some today which is nice.  How do you think I can move these posts to the less than 50? I am going to fiddle around with it but i have no idea.

Nate


Offline natenix

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #11 on: June 09, 2012, 03:08:50 AM »
Post op Day 8

Woke up this morning in considerable discomfort (first real bad discomfort since the hospital), leg felt really swollen, hadnít slept much and was constipated (Iíll spare the details but thatís taken care of now all those pain meds, vitamins and proteins must be what did it).  I think having to sit on the toilet last night for a while with no place to prop my leg was part of my leg issues.  The other thing was probably sitting up in the bed yesterday while typing.  Resolved to lay flat in the bed today and type with computer on my stomach.  This along with staying on top of the cryocuff really had me feeling good by the time I was on the bike around 2 today.  Removed this waterproof bandage that I left the hospital with and got my first real good look at the staples etc. they are healing nicely.  My grandma even commented on how good they looked which is a compliment to whoever stapled me up cause sheís a worrier.  Breaking the biking up now to 30 minutes 2 times a day.  Mainly just to give me more to do, the hour bike ride isnít really bothering it.  I want to see if Dr. is ok with 45 minutes 2 times a day.  Anyways thankful todays ending better than it began.

Offline missmyknee

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #12 on: June 09, 2012, 04:15:47 AM »
Hi Nate

I was reading your diary about your derotation. What caught my attention was your derotation site. I had a tib-fib derotation to the distal tib-fib back in 2001. Mine was done because I severely fractured my leg. OS #1 placed an IM rod down the tibia and plated my ankle but my leg was set 40 degrees externally rotated. I left that OS , got another opinion and had to have my leg rebroken. This is when the tib-fib derotation was done. Anyway, my OS left my fibula apart, freaked me out when I saw my xrays, there was so much space between the bone ends. I would feel the bones moving and clicking. My OS said the ends would grow together like a bone bridge and it was not a weight bearing bone. It took about 4 months to grow and looked kind of crooked for several yrs on xray. The bone looked like it had a knot, where it grew together. Years later, I had to have surgery to fuse my ankle and had that area of the bone shaved at the same time since it was causing pain.

Best wishes on your recovery,

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

drmark

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #13 on: June 09, 2012, 10:44:32 PM »
It doesn't matter how you break up the biking time.  Get in an hour per day
The less dope you take, the easier it is to keep up your "regularity"
I am sure it has happened, after at least 500 fibular osteotomies I performed for ununited tibial fractures, or in association with tibial osteotomy, I have never had a patient's fibula either not heal, or be symptomatic enough to treat on the specific basis
Over all, it sounds like you are doing quite well.

doc

Offline natenix

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Re: Nate's Derotational Tibial Osteotomy (Proximal and Distal) 05-30-12
« Reply #14 on: June 10, 2012, 07:12:19 AM »
Thanks Dr. Mark,

I haven't actually taken any percosets since they were giving me whatever they were giving me in the hospital (I think it was oxycodon at the hospital).  I have been taking all the other pain meds just like is prescribed in the "19 commandments" that Dr. Sanders office hands out.  I also been taking all the vitamins (Calcium, Vitamin C, a multivitamin) and according to the recommended doses.  I am curious how soon some of you other derotational osteotomy patients started coming off your non narcotic pain meds.  I am in little pain, but I enjoy that aspect and don't mind taking the medications a little while longer if it keeps me there.  My pharmacist buddies told me nothing to really worry about if I take them a little longer.  Missmyknee sorry about your experience with your fibula, doesn't sound like fun.  I hope I'm more in the normal category for Dr. Mark's patients on that.  Today was day 10, things are seeming pretty much the same so may begin posting a little less.  I did make it back yesterday to my wife's parents house where I will be spending several weeks.  They have a hospital bed and it's a good setup where I can do a lot of the office work I need to for my job while lieing in bed.  Biking's going good, very occasionally I will feel a funky knee pain while doing it.  Trying to keep the incisions clean and bandaged up well.  I am pretty paranoid about getting an infection so I try to take all precautions I can to stay clean and not contaminate the incisions.  I am getting around well, walking and putting about 20 lbs down on surgery leg, I really focus on heel toe walking.  I haven't been wearing the boot they gave me because dr. sanders had me walking around without it at his office so I figured around the house it'd be ok (I'm going to email and ask him about that) it just stinks having to strap that thing up when your in a hurry to go pee.  I plan on wearing the boot when I go out in public.  When walking my leg actually feels way better when I do use it than if I pick it up and scoot on the crutches, the latter makes blood pool in my leg the former feels like good PT and seems to really help the blood flow.  I am curious how soon I can get in a pool and start walking around, if I can up my biking to 45 minutes twice a day and if there are any other exercises I can add.  All in all things are good way better than I deserve but thankful for God's grace and a good doctor.

Nate