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Author Topic: Femoral Anteversion  (Read 824 times)

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Offline schnops

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Femoral Anteversion
« on: April 24, 2016, 10:27:36 PM »
Hey everyone!
So a bit of history... I've had TTO's and VMO advancements on both of my legs and continue to have a lot of knee pain and instability. More recently I have been diagnosed with a labrum tear and impingement in my hip. I had a rotational CT done and found out that my femoral anteversion is 27 degrees. Does anyone know if this is enough rotation to warrant a derotational osteotomy? It seems like most people's have been 30+ degrees, but given my history and symptoms I wasn't sure if that made me a better candidate. If not, any other suggestions of what to try?

ANY help or advice would be greatly appreciated!
Schnops
TTO, LR, arthoscopy, medial tightening R leg -03/'13
Hardware Removal- 9/'13
TTO, LR, athroscopy, medial tightening L leg- 10/'13
VMO advancement, LR, trochleoplasty

Offline Leena20

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Re: Femoral Anteversion
« Reply #1 on: April 25, 2016, 03:43:30 PM »
Hi, I had my femur derotated last year. My anteversion was 39 degrees and my understanding is that usually they consider it pretty bad if its over 30. Having said that they brought it down to 14 which is in the normal range so still quite a difference from 27 to below 15. Also my other leg is in the mid 20's and I've had similar problems with both so now the surgeon is considering doing the procedure on that leg even though it doesn't meet the normal criteria for an op. When I look down at my non-derotated leg I can clearly see how it goes in and am pretty sure its causing at least some of the problems I've had. So just my opinion but would say its worth looking into further.

Offline schnops

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Re: Femoral Anteversion
« Reply #2 on: April 25, 2016, 07:18:47 PM »
Thank you so much for your reply!! Do you mind sharing what your symptoms were before the derotational osteotomy? I have both knee and hip symptoms and the torn labrum in my hip was a direct result of the malalignment, so I'm hoping this OS will consider doing the derotational osteotomy. And how long did it take after the surgery for you to feel semi normal? I'm a college student, so I want a realistic timeline of how long I'll need off of school and how long it'll take for me to be able to get around campus.

Thank you again! Really really appreciate it!
Schnops
TTO, LR, arthoscopy, medial tightening R leg -03/'13
Hardware Removal- 9/'13
TTO, LR, athroscopy, medial tightening L leg- 10/'13
VMO advancement, LR, trochleoplasty

Offline Leena20

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Re: Femoral Anteversion
« Reply #3 on: April 26, 2016, 12:48:18 PM »
No worries - I first found out about this surgery on kneeguru when trying to understand what on earth was wrong with my knees, so happy to answer any qus. I have never really had many problems with my hips but seemed quite prone to getting aches when attempting running or long walks. With my knees I had successive surgeries for fat pad impingement and patella tendonitis which just kept coming back until a surgeon wrongly took out the whole fat pad and left a horrendous mess of painful scar tissue. My new surgeon (one of the few people in the UK who understands this op) said at the conference he went to on osteotomies the speaker was listing the symptoms associated with malrotation and it went on and on and on....So as far as I know it can cause a whole range of issues.

As far as the op goes it was a pretty rough ride for the first two weeks but for me that was mainly because anesthetic and I do not agree at all and I felt really feverish. Memory is hazy but I think after a few weeks I could crutch to a coffee shop from the car and was back at work after 6 weeks with 2 days working from home (my office is small though so got in, sat down all day, got home and rushed to ice my leg). It was maybe 3 months before I could get around more normally, but check other peoples diaries on here as I was starting from a really bad position - constant pain sitting/standing let alone trying to walk! So far (6 months in) I am really glad I had the op. In some ways it was less traumatic than all the minor ones as unless you are really unlucky bones just heal back together whereas the five ops I had before didn't treat the cause of the problem and if anything left me worse off.

Offline schnops

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Re: Femoral Anteversion
« Reply #4 on: April 26, 2016, 01:52:14 PM »
Yes, it is so hard finding surgeons who actually know what to look for and how to treat it. I've had just about everything possible done to my knee and it just isn't working and has even made things a bit worse than they were. All the pain and rehabbing that would go along with a derotational osteotomy I feel like would be so worth it since you know it's going to fix your twisted legs. Everything else was just kinda putting a bandaid on the issue.

So after the op how long were you required to be on crutches? Was in non weight bearing? And there's no brace or anything right? I'm so used to those giant immobilizers after the knee surgeries, but seems like there's no bracing after this one. For the TTO's I took about 2 weeks off to recover then went back to school for half days and stuff. Hoping to get this done (if the surgeon even wants to do it!) this summer or during my winter break so I'll have much longer to recover before going back to classes.

Where/how big is your incision? What was PT like for the first few weeks or months?

Sorry million questions! Thanks again for all of your help! I have an appt with the surgeon that ordered the rotational CT next week so hopefully I'll have an answer as to whether or not I'm actually having this done.
Schnops
TTO, LR, arthoscopy, medial tightening R leg -03/'13
Hardware Removal- 9/'13
TTO, LR, athroscopy, medial tightening L leg- 10/'13
VMO advancement, LR, trochleoplasty

Offline Leena20

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Re: Femoral Anteversion
« Reply #5 on: April 27, 2016, 06:36:06 PM »
Hey I had to be on crutches for about 7 weeks. I think it was something like two weeks no/just a tap weight, then 30% weight baring for a bit and then 50-75% for the remainder. There was no brace at all so you can get going on ROM almost straight away which was nice. And having the op in the holidays definitely sounds good.
I have two main scars on the outer side of my leg above my knee (some surgeons operate at the hip), one about half the length of a pen and the other half of that. Also three arthroscopy holes but I can barely see them now.

The first few months of physio was mainly basic things like ROM exercises, leg lifts and leg extensions moving on to wall squats when I could fully weight bare. I added in a resistance band when things got easy and also bought a cheap exercise bike so used that whenever my leg felt up to it with a really low resistance. By 4 months I could go to the gym and start using some of the machines to help build up the muscle, though its still looking pretty pathetic!
Hope your appointment goes well.

Offline schnops

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Re: Femoral Anteversion
« Reply #6 on: April 28, 2016, 12:18:58 AM »
Do you know what your tibial torsion was? I just read the CT report and it says I have 31 degrees of external tibial rotation and 23 degrees of internal rotation of my right tibia. You just had your femur derotated, correct?

Thank you again for all of your help-seriously can't thank you enough!
Schnops
TTO, LR, arthoscopy, medial tightening R leg -03/'13
Hardware Removal- 9/'13
TTO, LR, athroscopy, medial tightening L leg- 10/'13
VMO advancement, LR, trochleoplasty

Offline Leena20

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Re: Femoral Anteversion
« Reply #7 on: April 28, 2016, 03:34:26 PM »
Ah yes my right tibia is rotated externally by 39 degrees and the left is somewhere in the 20s I think. At first the surgeon wanted to do both femur and tibia for the right but then decided that I would probably be ok with just the femur corrected. My foot does stick out a bit now and I know people who have had the tibia operated when its in that range, but he didn't want to risk any unnecessary damage to my leg given all the ops I'd already had. Took a while to adjust to the new foot position but so far its not causing my knee any problems to have it stuck out a bit and my knees are too bad to ever run so think it will be fine if I just want to walk/cycle. Not sure about your internal rotation. This is just from a website so might be wrong but gives an indication of what things should be:

'Normally, lateral rotation of the tibia increases from approximately 5 at birth to approximately 15 at maturity; femoral anteversion decreases from approximately 40 at birth to approximately 15 at maturity.'