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Author Topic: Tibial Tuberosity Transfer  (Read 2647 times)

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Offline Lucy

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Tibial Tuberosity Transfer
« on: February 11, 2004, 04:38:50 PM »
I am booked in for a TTT on 1 Mar with the same procedure booked for my second knee in May (haven't decided which knee to have done first!).  I feel remarkably ill informed as to how it will go.  I failed to ask my surgeon the dozens of questions I now have. Here are some of them:
- how long will I be off work
-How long will I wear a brace or plaster
-Will I have to have a later procedure to remove the screws
-Will I be able to weight bear when I am on crutches
-What will the scar look like
Will I be able to bend my leg imediately post op
-How much post op pain will I be in
Any answers gratefully received  
« Last Edit: February 15, 2004, 01:02:15 PM by admin »
L & R knee LRs in Feb & Apr 2002.  R knee TTT 1 Mar 04. L Knee TTT 10 May 04.  Very tired of post & pre op sore knees!!

Offline muskypike

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Re: Tibial Turberosity Transfer
« Reply #1 on: February 11, 2004, 05:17:41 PM »
Hi Lucy:

I had a ttt last year.  there are a ton of posts on here about ttt's do a search and you will find a wealth of info.  more than I have time to type.  but I will answer your questions......

how long will I be off work-------------  12 weeks
-How long will I wear a brace or plaster -------immobilizer 8 weeks
-Will I have to have a later procedure to remove the screws-------- only if screws start bothering you- there are only 2 screws  
-Will I be able to weight bear when I am on crutches-NO!!! your OS is mechanically fracturing your bone and a break takes 8 weeks to heal.  they are afraid you will refracture your tibia  
-What will the scar look like maybe a 4" incision  
Will I be able to bend my leg imediately post op-I couldn't bend mine for 8 weeks.  
-How much post op pain will I be in ---ask anesthesiologist for a femoral nerve block - it is an injection into the nerve in your groin area.  they will do it before you wake up from surgery you won't feel a thing,  it lasts for 24-48 hours,  it is great!!!  your pain will be intense when you go to get up from a prone position this pain is called -BLOOD RUSH- it hurts like hell.  but it only occurs if you get up quickly.  if you do stages with your leg it helps out greatly.  so if you lower your leg slowly from one height to the next it isn't so bad.  Also ice your knee, this also helps reduce the pain.  Most people are put on Oxycotin post op.  very strong pain med.  MAKE SURE YOU GET A SEAT FOR THE SHOWER AND A HANDLE THAT SECURES TO THE TUB to help you get in and out.  I bought a rubber maid step stool from wal mart for 8.00 it worked great. and was alot less expensive than buying a shower seat from the pharmacy.

Good luck and you can IM me if you have anymore ?'s

Ellen
GOLDWIATH1980. LR1992. MENISCUS TEAR 1992 1999 2003. SYNVISC INJ 2001, FULKERSON 2002 W/ PATELLA CHONDROPLSTY SYNoVCTMY & LR SCAR TISSUE REMOVAL4/03 STAPH INF4/03 BONE INFECTION 4/03 TKR 3/04 meniscus tear 7/04 LOA 9/04 RSD 9/04 LOA 1/05, and LOA in May, told by OS will need loa every 3 mos. ENUFF!!

Offline erinR78

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Re: Tibial Turberosity Transfer
« Reply #2 on: February 11, 2004, 06:52:43 PM »
Hi Lucy,

I'm having a TTT in 13 days (2/24), and I've been asking the same questions you have.  Based on what I've heard, I'm planning on being out from work for about 4-5 weeks, and might still only work Part-Time for a little while after that.  Fortunately, my work is sending me home with a laptop so I'll be able to telecommute for a while before short-term disability coverage kicks in.  You might ask your work if they can do something similar or send you home with "special projects" that you can do while sitting down with your leg elevated.

Ellen had a lot of great suggestions for you too, and here are some more that I've heard:

* practice with crutches before you have to use them.  It'll be a lot more difficult when you're in pain and drugged up so you ought to have some idea of what you're doing before then.  Especially if you have to navigate stairs.

* spend some time really working out your quad and calf muscles before surgery, this will help you recover later--you will lose some muscle while your leg is immobilized.  Elliptical trainer is good for this--better than the weight machines that have you bend your knees and lift a weight, b/c the weight machines can actually worsen your knee's condition if you have a "tracking" problem (meaning that your kneecap doesn't move along the femoral groove the way it should when you bend your knee).  If the elliptical trainer has "ski poles" for you to work with your arms too, even better--you can build up your arms for using the crutches.  Recumbant bikes are also good--be sure to move the seat back as far as you can for the best leg extension while you're pedaling.

* look into getting a stool that you can sit on in the shower while your injured leg is propped up on the side of the tub or outside of the shower.  You won't be able to get it wet until the stitches come out.

*  see about getting an over-the-shoulder style bag or satchel that you can use to carry things around in while you're on crutches.

* ask your doc about whether he/she intends to send you home with a portable cryo-cuff (neat invention that continuously feeds icewater to your knee while it's healing).  If not, pick one up on your own--if the doc will give you a prescription for one, you will probably be able to submit a claim for it to your insurance under the "durable medical equipment" portion of your medical insurance.  Same for the leg immobilizer.

* Look around for a "Gopher" or some other similar contraption that allows you to grab things from a distance.  You won't want to be doing a lot of bending or reaching if you can avoid it.

* Before surgery, make sure to set up everything you might need around your bed or couch or wherever you will spend the most time post-op.  Think about beverages, ice pads, books, pain pills, tvs/remotes, dvds, anything that can keep you occupied when you're not sleeping.  Be sure to have someone home with you for at least your first couple days post-op.  It also couldn't hurt to keep a phone (cell phone or cordless) within reach at all times, just in case you need it.

* think about wearing long skirts or baggy pants post-op--something you can get into and out of easily without much bending, particularly when you need to use the bathroom.  You may want to have a stool by the toilet to prop up your injured leg while you're sitting down, and it will be more difficult to do this with pants than with a long skirt.  Also, think slippers instead of socks, and slip-on shoes rather than lace-up shoes.

* you probably won't be able to drive for several weeks post-op, even if you have an automatic transmission, just because your injured leg will be fully extended--you probably won't have room to extend it and still reach the pedals.  So think about having a family member or neighbor close at hand who can help you run errands or take you to post-op appts or physical therapy.

I am having the TTT done at the same time as a lateral release, and it's my understanding that the lateral release is actually the more painful of the two procedures.  The TTT will hurt b/c of the incision and the bone break, but it's my understanding that the TTT will be more of an ache than a sharp pain, and goes away more quickly.

Ask your doc what TTT method he's using--mine will be the "Fulkerson" method.  Then go to webmd.com and start a search about "lateral subluxation" or search the name of the method the doc will be using, and you will be able to find all kinds of useful information there.

Spend some time reading these bulletin boards--TTT seems to be a VERY common procedure, particularly for women, and there's lots of good advice and feedback on this site.  Keep in mind, though, that a lot of the people who write about their experiences are writing because they had bad experiences---the people who got through the procedure with no problems are less likely to feel an urge to write about it.  So read everything with this in mind:  just because more people are writing about bad experiences does NOT mean that the majority of people who have this procedure done have had a bad experience.

Best of luck to you, and feel free to write ([email protected])--my surgery will be about a week before yours and I'll be happy to compare notes with you as we go along.

Erin
*anxious about surgery in Seattle*

Offline Leentje

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Re: Tibial Turberosity Transfer
« Reply #3 on: February 11, 2004, 09:15:15 PM »
Lucy,

I had a TTT a year and a half ago and will answer your Q's. But this was my recovery, everyone's recovery is different and every OS has a different post-TTT protocol. Just thought I'd share...

- how long will I be off work
I was off work 11 weeks. I am a nurse
 
-How long will I wear a brace or plaster  
I was in a full leg plaster 3 weeks.

-Will I have to have a later procedure to remove the screws  
I have 2 screws and OS  will only remove them if they bother me. I cannot kneel on hard surfaces and sometimes they are painfull, esp. when I jump.

-Will I be able to weight bear when I am on crutches  
I was able and allowed to weightbare with crutches 30%. When I was 3 weeks post-op I had my cast removed and and could be full WB.

-What will the scar look like  
I have a 13 cm scar from the top of my patella down my shinbone. Has healed well, it's a white line and only turn purple when it's cold. I had 16 staples in it which where removed 1/2 1 week post-op and the other 1/2 3 weeks post-op

Will I be able to bend my leg imediately post op
I was in cast so couldn't bend...  I whad full ROM back 5 weeks post-op

-How much post op pain will I be in
It depends. On a scale from 1-10 my maximum was a 4. This was on the screwsite!

Ellen and Erin have given you great advice! Write it down and be sure you're prepared in every way. Don't be too nervous, we'll be here if you have any more Q's!

~Helena Hope this helps!
Bilat patellar malalignment/PFdysplasia
00/06/83 L wrist #
11/12/00 L knee LR + chondroplasty
21/08/02 L knee TTT
02/03/04 L knee stretched PCL
11/09/07 L ankle dislocation/medial avulsion #
25/05/09 L ankle medial avulsion # AGAIN!
05/06/13 R ankle dislocation

Offline Sharon

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Re: Tibial Turberosity Transfer
« Reply #4 on: February 11, 2004, 09:59:13 PM »
Lucy,

Alot of those things depend on your doctor and the protocol that he likes to follow post-op. I know that my OS has tended to be less strict following these kinds of surgeries than some of the others. I actually had 2 TTT's, the first was a Fulkerson with a LR and the 2nd was pretty much a revision of the first. My knee still isn't good but I seem to be the exception-most people who have TTT's are so much better after the surgery. Anyway, as to your questions, this is the protocol my OS had me follow after the surgery.
- how long will I be off work-I wasn't working at the time of either of my surgeries so I really can't answer that for you
-How long will I wear a brace or plaster-I was in a full leg blesdoe brace for about 8 weeks-it was locked straight when I was walking for about the first 4 weeks and after that I was allowed to unlock it to walk
-Will I have to have a later procedure to remove the screws-I had to have the screws from my second TTT removed about 4 months post-op but only because they were starting to back out on their own and causing me alot of pain
-Will I be able to weight bear when I am on crutches-I was never completely non weightbearing, for the first few weeks I was toe touch weightbearing and once my OS saw on the x-ray that the bone was starting to heal, he allowed me to weightbear as tolerated
-What will the scar look like-mine is 5 inches long
Will I be able to bend my leg imediately post op-my OS had me on a CPM(continous passive motion)machine right after the surgery and in the first week I was only allowed to go from 0-30 degrees but after that he allowed me to increase 5 degrees every other day.  
-How much post op pain will I be in-I won't lie, it is quite painful but I also had a femoral nerve block and it helped quite a bit. I also had an epidural for pain during my night in the hospital and it was really good for the pain. I am very sensitive to morphine so I chose to have the epidural instead and I am very glad I made that choice. The blood rush that Ellen mentioned is pretty bad but I found that if you lower your leg a little at a time when you get up it's not as bad as if you just suddenly lower your leg to the floor. As for pain meds, I think I was on percoset following both of my TTT's-I may have been on vicodin after the second one but I'm not quite positive. Anyway, I hope this helps and if you have any questions feel free to ask away!

:)
Sharon

Left knee:
LR-5/99 & 9/01
Distal realignment and LR 7/02
TTT revision 6/03
screw removal/MUA 10/03
d/x with severe patella baja
7/05 patellar tendon replacement w/piece of quad tendon
4/07 OATS

Offline Lucy

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Re: Tibial Turberosity Transfer
« Reply #5 on: February 12, 2004, 09:02:13 PM »
Ellen,Erin, Helena, Sharon,

Thank you all so much for your incredibly helpful advice and information.  Having been through lateral releases on both knees a couple of years ago my 2 up coming TTTs have been really bothering me.  Although it sounds like it will be a difficult period coming up actually I feel much better about the whole thing.  Will post another entry if I think of any more questions, but will also post my progress as I go along after surgery.  

Erin will drop you an email nearer your surgery.  Hope it goes well and I will keep you up to date with my progress.

Once again many thanks

Lucy
L & R knee LRs in Feb & Apr 2002.  R knee TTT 1 Mar 04. L Knee TTT 10 May 04.  Very tired of post & pre op sore knees!!

Offline cat

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Re: Tibial Turberosity Transfer
« Reply #6 on: February 13, 2004, 03:47:53 AM »
Hey Lucy,
Looks like we'll be recovering at about the same time. I'm scheduled for a similar procedure March 2. We'll have to compare notes.
cat
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline Marie

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Re: Tibial Turberosity Transfer
« Reply #7 on: February 13, 2004, 08:26:28 PM »
Just thought I'd add in my 2 cents:

- how long will I be off work  --- 6 weeks for me, but about 10 weeks before I could do most things.  I work in a lab & have to be on my feet to do most things, so I couldn't really do that until I could walk without assistance.  Once you're less dozy from your pain meds & in less pain, you should be able to do office-type stuff anywhere from 2-6 weeks afterwards.  
-How long will I wear a brace or plaster  --- I was in a brace for 3 1/2 weeks and my OS apparently thought this was too long as he yelled at me at my 3 1/2 week appointment for still wearing it
-Will I have to have a later procedure to remove the screws  --- Mine will be removed approximately 12 months after the operation.  I'm skinny, the screws protrude, they hurt - they're coming out!!!
-Will I be able to weight bear when I am on crutches --- All depends.  I was allowed partial weightbearing immediately, full weightbearing at 3 1/2 weeks.
-What will the scar look like  --- They can be horizontal or vertical, and you may have a few different incisions.  The big scar can be anywhere from 2-12 inches, I think.  Mine is 2 1/2 inches & vertical.
Will I be able to bend my leg imediately post op  --- This is a question I didn't think to ask about, but wish I had.  We started agressive range of motion (ROM) therapy at 3 1/2 weeks, at which point I was already behind and am still trying to play catch up at 5 months post-op.
-How much post op pain will I be in ---  If your meds are adequately administered, you'll be fine.  For me, it was the most pain I ever felt in my life, but I was expecting that.  I don't think I had adequate pain management - staying in the hospital overnight the first night and possibly the second until they make sure you can be stabilized on prescription drugs is an excellent idea & I'd recommend that to anyone who is able to have a brief  hospital stay.

Otherwise everyone else has mostly said it all... take care & all the best!
Marie
« Last Edit: February 14, 2004, 02:07:13 AM by Marie »
24y/o - had subluxing right patella, frequent dislocations, osteoarthritis.
Sept26/03 - TTO, scope, LR, medial plication & microfracture (right).  
Slow ROM recovery (126).
My new PT is awesome!!!

Offline Emily

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Re: Tibial Turberosity Transfer
« Reply #8 on: February 14, 2004, 01:19:26 AM »
Lucy-

I had a a TTO in October... Here is how things worked for me, all OSs are different and protocols can very greatly with the same or similar procedures...

- how long will I be off work   I am a highschool student, and I missed 13 days of class. So I went back at about 3 weeks post op including weekends. I tried to go back earlier... but I had some issues with the elevator being broken ect... It all depends on what type of work you do and how much you can sit down.

-How long will I wear a brace or plaster  I was in a brace for the first 6 weeks after my surgery. It was locked straight for a week, and after that I could unlock it when I sat down. In order to get out of my brace for walking I had to be able to do straight leg raises with 5 pounds on my leg in all four directione (on back, belly, and both sides) and walk without a limp.

-Will I have to have a later procedure to remove the screws   Like other have said... I was told the screws would stay in place unless they bothered me. If I did get them taken out they said it's a really minor procedure... especially compared to a TTT!

-Will I be able to weight bear when I am on crutches  I was told to put as much weight on my leg as soon as possible. I started putting a tiny bit of weight on it the day after surgery, and put full weight on it I think the 4th day.

-What will the scar look like  
I have three scope holes which are just like 1.5 cm straight lines, a little scar from the drain, and the actual TTO incision is about 3 inches long down the front of my leg.

Will I be able to bend my leg imediately post op I wasn't aloud to bend my leg at ALL until I started PT two days after my surgery. They took off my brace and I was supposed to see how far I could get it. After that I did a tiny bit of ROM work every day. At one week post op they let me unlock my brace any time I didin't have weight on the leg.

-How much post op pain will I be in   It all depends. I didn't have a nerve block or spinal or any post op pain control things like that, but it still wasn't completely unbearable. The first week was the hardest, but I had lots of pain pills!

Good luck! Let us know if you have more questions, and keep us updated!

Emily
« Last Edit: February 14, 2004, 01:20:07 AM by KneePain326 »
Right Knee- 10-14-03- LR, TTO, Scope, Plica excision
               4-20-04- Scope, screw removal, scar tissue clean up

Left knee- subluxing, maltracking & malaligned-not ready to start treatmet..

Offline Dancer8880

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Re: Tibial Tuberosity Transfer
« Reply #9 on: February 17, 2004, 12:35:46 AM »
Hi-

I have a question, My doctor has suggested a Fulkerson procedure, and I am trying to do me research on this procedure.  But every time I do a search for this surgery it brings up information on TTT.  My question is, Is TTT the same as Fulkerson procedure?  If anybody knows, can you send me a note, I am really confussed! :-/
                                            Thanks ~ Dancer8880
Scope and LR on both knees at the same time June '02

Offline Marie

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Re: Tibial Tuberosity Transfer
« Reply #10 on: February 17, 2004, 03:51:19 AM »
A Fulkerson is a type of TTT (tibial tubercle transfer) or TTO (tibial tubercle osteotomy) where they move the TT anteriorly and medially, so it's also called an "anteriomedialization".  
;)
-Marie
« Last Edit: February 17, 2004, 03:51:57 AM by Marie »
24y/o - had subluxing right patella, frequent dislocations, osteoarthritis.
Sept26/03 - TTO, scope, LR, medial plication & microfracture (right).  
Slow ROM recovery (126).
My new PT is awesome!!!

Offline Michele

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Re: Tibial Tuberosity Transfer
« Reply #11 on: February 17, 2004, 04:30:38 AM »
I had a tibia Tubercle transfer a year ago. Are you having screws put in? Is it for patellafemoral syndrome?
My experience is this...
I had a two night stay in the hospital. The pain wasn't horrendous--but I was on major pain meds for awhile. I had to be off my feet for two weeks, and on crutches for two months. Please feel free to email me directly for any further info on my procedure.
Good luck!

Offline Donna

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Re: Tibial Tuberosity Transfer
« Reply #12 on: February 17, 2004, 05:10:32 AM »
Lucy,

My surgery lasted 3 hours.
Stayed in the hospital overnight.

I was off work for 9 1/2 weeks after my Fulkerson TTT. Had to be non-weight bearing for 9 weeks.

My incision is almost 9 inches.

I have 2 screws in my leg still.( Surgery was 22 months ago.) They don't give me too much trouble but do sting once in awhile and are tender to the touch. I cannot kneel on that leg.

I had a CPM machine for the first 4 weeks. My OS sent me to PT starting 1 week after surgery. Went for about 5 months 3 times per week.

Shower chair and hand shower wand were a huge help.
I also bought a raised potty chair.

I also had a Breg ice machine. It was great.

Pain is kind of bad the first few days but take your pain meds on a schedule and you should do well. The worst thing is the blood rush when you put the leg down towards the ground. This subsides agter 7 days or so.

Good luck!! If I can answer any questions let me know.

Donna


4/88 menis, chondroplasty,
10/01 menis, chondroplasty
2/02 microfrac,chondro,menis,
4/02 Fulkerson TTT, LR, microfrac,
2/03 open LR,fat pad removal, lysis,menis Still need more surgery.

Offline Kim

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Re: Tibial Tuberosity Transfer
« Reply #13 on: February 17, 2004, 05:31:44 PM »
Hi Lucy,

I know a bunch of other people have answered your question, but since everyone is different I'd thought I would give you my answers.

- how long will I be off work       I was off for 10 days   and came back full time after 2 weeks.  But then again I have a desk job.
How long will I wear a brace or plaster     I was in the brace for 5 weeks, but originally I was told 6-8 weeks.
-Will I have to have a later procedure to remove the screws            I had my screw removed 4 months later in the doctor's office and I had no pain and walked out of there.
-Will I be able to weight bear when I am on crutches  I was able to "toe touch" from the beginning
-What will the scar look like    I have 3 different scars, but you can only see really one
Will I be able to bend my leg imediately post op       It took me 4 months until I could really bend my leg like before the surgery, that was the hardest part.
-How much post op pain will I be in    The pain immediately after was horrible but after a couple of days it was fine

I hope this helps some!

Kim
4/12/02 Proximal Distal Realignment & LR on left knee

Offline yodalover

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Re: Tibial Tuberosity Transfer
« Reply #14 on: February 17, 2004, 08:50:05 PM »
 Wow, we all really have had different circumstances :)

I had a modified Elmslie TTT done arthroscopically

Here's my answers:

- how long will I be off work  

I was off work 12 business days... about 2 1/2 weeks.

-How long will I wear a brace or plaster  

I had a nerve block so I wore an immobilizer the first 48 hours until it wore off.   After I had that off, i just wore the ted stockings

-Will I have to have a later procedure to remove the screws  

I was told that unless there are problems, the screws would remain.

-Will I be able to weight bear when I am on crutches  

I was 100% weight bearing from the get-go.   It hurt at first of course, but I never had any restrictions.


-What will the scar look like  

i have 3 small 1/2 inch scars where they stuck in the instruments and one 2 1/2 inch scar running along my shin bone where they sawed the bone and tendon and moved it over.

Will I be able to bend my leg imediately post op  

probably not.   I sure couldn't... at first it hurt so much that there was no way i was going to bend it.   As the pain lessened, i've been able to bend it more and more... then when I did the at-home exercises and then PT,  i can now bend it to 140 degrees.  At 5 weeks, i'm almost 100% back to normal...just a bit of lingering pain.

-How much post op pain will I be in  
 
I was in tremendous pain (9-10) for the first 3-5 days.   After that,  it went to about 7-9 for the next week or so.   it's gradually getting better and better with each day and week...   at 5 weeks out, i'm hardly taking pain meds and i just have a small amount of discomfort.

-Paula
Left Knee - Modified Elmslie TTT with a lateral release and patella shaving - January 14, 2004
Right Knee - same surgery - June 9, 2004















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