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Author Topic: Tibial derotation surgeons  (Read 3447 times)

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Offline theturningpoint

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Tibial derotation surgeons
« on: May 31, 2019, 09:21:14 PM »
Hello,

Not sure if I am posting this in the right place but I would like some help in finding successful experienced tibial derotation surgeons and also their prices if you know them. I think I would prefer distal due to less complications but would do proximal if the surgeon recommends and I wouldn't end up with a knee replacement.

I have had a problem with my right leg for about 10 years but chances are it was always rotated even as a kid it's just that it either became worse or it affected me more later on. I used to play football a lot for 10 years+, not sure if this would have had an affect or why would I only have problems with my right side. My left knee has noticeable "osgood schlatter" but it hasn't given me many problems except now the knee is very loose because I lived with a bad right leg for very long. I had a small limp (leg difference?) for many years and recently over the last 2-3 years I have had ankle problems on my left, then a loose knee and then a labral tear in the left hip which seems to be about 90-95% better now without surgery or anything, I am still worried about my loose left knee. My right knee may have osgood schlatter but it would be far less prominent than the left leg. During the last 10 years I have had right hip, right knee and right ankle pain but I used to forcefully rotate the right foot to a neutral position as recommended by a physio a long time ago. Ever since allowing my right leg to be where it wants to be I have had ZERO hip pain, only on few occassions knee pain for example when trying to exercise or stretch and a BIG problem with my right foot because it is basically facing to the right. I feel like I have zero strength or opportunity to grow muscle in the lower leg and now struggle to walk, stand on my right leg and even sit. When I sleep I have to sleep on my back to allow the foot to remain how it naturally should be, I can never sleep to the side because the heel does not touch the bed, it stays lifted up and is very tiring.

So my options at the moment are to not be able to walk or stand on my right leg and keep it externally rotated OR rotate it inwards and have hip and knee pain again, also back pain. This is why I think derotation osteotomy may be the solution for me. I can never put both my legs close together, my left leg used to be very very straight, very aligned, it is less so now due to adapting to my right leg but hopefully that is temporary. My right leg looks bowed and rotated, if I force the internal rotation it looks more bowed with a bigger gap between the kness, if I let my foot externally rotate my heel touches my left foot and there is still the gap between the knees.

I have had plenty of scans in the past, mri scans show that my knees are still in good condition with no arthritis (for now), x rays show a bowing of the right leg, less of the left. And most recently CT scan to find rotation values.

Femurs:
Right: 33.5 degrees internal rotation.
Left: 40.2 degrees internal rotation.

Tibias:
Right: 55.2 degrees external rotation.
Left: 41.5 degrees external rotation.

Also the scan showed almost 1cm length difference in the tibias, left being longer (which I already knew).

When I had this CT scan the imaging crew told me to "lift up my foot" because it was facing to the right too much for their liking, I told them but this will make my knee and hip hurt. They said don't worry its just for a few seconds. Is it possible that my right leg is actually more rotated than those numbers because of this? Also, how good/bad are those numbers anyway?
« Last Edit: May 31, 2019, 09:24:13 PM by theturningpoint »

Offline vickster

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Re: Tibial derotation surgeons
« Reply #1 on: May 31, 2019, 11:52:09 PM »
What country are you in? How far are you prepared to travel? I don’t know how easy it’ll be to find an experienced surgeon as this isn’t a common surgery. Research surgeons perhaps who’ve actually published on the subject if possible?

In the primers in the learning portfolio there’s a who’s who in knee surgery which
might offer some names

https://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-cosmetic-lower-limb-lengthening-realignment

https://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-osteotomy-knee-pain-angular-realignment

What about the surgeons who’ve ordered the scans?

Good luck  :)
« Last Edit: June 01, 2019, 12:03:06 AM by Vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
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Offline theturningpoint

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Re: Tibial derotation surgeons
« Reply #2 on: June 01, 2019, 09:50:19 AM »
Thank you for that vickster. I live in England and am looking specifically for tibial derotation surgeons, there doesn't seem to be many out there. I am willing to travel far as long as they have a proven track record and do not charge a crazy amount. Even in London the regular osteotomies can be done for £5000 or less, how much more are derotation osteotomies generally?

I have contacted the Sanders clinic because they specialise in this, are they reliable?

Offline vickster

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Re: Tibial derotation surgeons
« Reply #3 on: June 01, 2019, 10:13:10 AM »
If looking for NHS treatment, Have you consulted the specialist orthopaedic hospitals in Stanmore, Birmingham, Oswestry?

Osteotomy is major open surgery, I’d think It’d be more like 10k+ privately with appointments, rehab? £4-5k is more like a simple arthroscopy in London with a top knee surgeon

Have you consulted Prof Wilson in Basingstoke? He’s probably the U.K. expert in osteotomy, at least for varus or valgus. But he’d presumably be able to make a recommendation if needed.

Sanders clinic in the US? I reckon you’d be lucky to get change from 50k in the US
« Last Edit: June 01, 2019, 10:37:15 AM by Vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline theturningpoint

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Re: Tibial derotation surgeons
« Reply #4 on: June 01, 2019, 10:20:43 AM »
If looking for NHS treatment, Have you consulted the specialist orthopaedic hospitals in Stanmore, Birmingham, Oswestry?

Osteotomy is major open surgery, I’d think It’d be more like 10k+ privately with appointments, rehab? £4-5k is more like a simple arthroscopy in London with a top knee surgeon

Have you consulted Prof Wilson in Basingstoke? He’s probably the U.K. expert in osteotomy, at least for varus or valgus. But he’d presumably

Sanders clinic in the US? I reckon you’d be lucky to get change from 50k in the US

I had a consultation a few years ago regarding osteotomy in London and was quoted 5k but he also said you don't have osteoarthritis so wouldn't recommend.

"The cost of the procedure to the NHS is around £4,000, while privately it is £6,000 to £8,000."

But I am not looking for regular osteotomies anyway because I do not think they would work in my case, without rotating my lower leg I would still have hip problems again caused by the position of my leg.

Offline vickster

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Re: Tibial derotation surgeons
« Reply #5 on: June 01, 2019, 10:43:43 AM »
I don't think I can recall anyone in the U.K. posting on here about having had such a surgery, might be worth a trawl with the search function

I think there was someone in France a few years back, a Dr Dejour maybe although he is more a PF specialist

https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-david-dejour

And as you say Dr Sanders produced this article for the site
https://www.kneeguru.co.uk/KNEEnotes/articles/general-articles/2014/rotational-deformity-miserable-malalignment
« Last Edit: June 01, 2019, 10:50:04 AM by Vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline vickster

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Re: Tibial derotation surgeons
« Reply #6 on: June 01, 2019, 11:05:04 AM »
I was thinking of this poster in France, looking back through his posts, he had surgery under a Prof M in Montpellier

https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=63830.0
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline theturningpoint

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Re: Tibial derotation surgeons
« Reply #7 on: June 01, 2019, 11:56:04 AM »
I don't think I can recall anyone in the U.K. posting on here about having had such a surgery, might be worth a trawl with the search function

I think there was someone in France a few years back, a Dr Dejour maybe although he is more a PF specialist

https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-david-dejour

And as you say Dr Sanders produced this article for the site
https://www.kneeguru.co.uk/KNEEnotes/articles/general-articles/2014/rotational-deformity-miserable-malalignment

It is odd, a lot of people are born with or develop rotational problems. There are plenty of articles out there about kids that undergo surgery but who exactly are the surgeons? I am having a lot of trouble finding names of surgeons that specialise in this

Offline vickster

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Re: Tibial derotation surgeons
« Reply #8 on: June 01, 2019, 12:25:28 PM »
RNOH and other ortho hospitals must have paediatric specialists as will the large Children’s  hospitals presumably.

How old are you?
Who have you consulted with before? What did they suggest/offer?
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline theturningpoint

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Re: Tibial derotation surgeons
« Reply #9 on: June 01, 2019, 12:32:40 PM »
RNOH and other ortho hospitals must have paediatric specialists as will the large Children’s  hospitals presumably.

How old are you?
Who have you consulted with before? What did they suggest/offer?

27, almost 28 and I have lived with this problem for too long because no one listens.

I have been seen for "bow legs", have been told that my hip would also require surgery now because my "leg has damaged it" and multiple cuts in the tibia/fibula to correct it. Then they say it isn't worth doing because it is too much and I would be in worse condition after the surgeries. Basically a bunch of nonsense.

There is nothing wrong with my hip, I have zero hip pain or hip problems when my lower leg is externally rotated an excessive amount, the problem is 100% in the lower leg but no one wants anything to do with it on the "NHS" which is why I am asking here for private doctors who know what they're doing

Offline vickster

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Re: Tibial derotation surgeons
« Reply #10 on: June 01, 2019, 02:18:04 PM »
Most NHS Consultants have a private practice and vice versa although there are a few senior experts who now practice privately only. So you need to find the right surgeon regardless of where he or she has their primary practice. Some do only work in the NHS, these will be hard to consult for an opinion.

Where do you get the knee/leg pain? Have you had full hip imaging as well as lower limb?

Who have you actually seen? It’s not a matter of knowing what they’re doing but recognising exactly what the issue is.

My OS is excellent but I’ve no idea if he does derotational osteotomy (just the usual HTO or DFO). He’s also pretty conservative which imo is a good thing. You want a surgeon who will say that the potential risks outweigh the potential benefits and isn’t gung ho. Too many incidences of people on here who have been damaged by overzealous surgeons (mostly in the US it seems) by people desperate to relieve their knee issues (when surgery may not actually be the answer)
« Last Edit: June 01, 2019, 06:28:11 PM by Vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline theturningpoint

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Re: Tibial derotation surgeons
« Reply #11 on: June 02, 2019, 09:50:55 AM »
Most NHS Consultants have a private practice and vice versa although there are a few senior experts who now practice privately only. So you need to find the right surgeon regardless of where he or she has their primary practice. Some do only work in the NHS, these will be hard to consult for an opinion.

Where do you get the knee/leg pain? Have you had full hip imaging as well as lower limb?

Who have you actually seen? It’s not a matter of knowing what they’re doing but recognising exactly what the issue is.

My OS is excellent but I’ve no idea if he does derotational osteotomy (just the usual HTO or DFO). He’s also pretty conservative which imo is a good thing. You want a surgeon who will say that the potential risks outweigh the potential benefits and isn’t gung ho. Too many incidences of people on here who have been damaged by overzealous surgeons (mostly in the US it seems) by people desperate to relieve their knee issues (when surgery may not actually be the answer)

This isn't about just the knee, my knee pain is reduced when I externally rotate my foot far out. This is about becoming disabled, about not being able to use my right leg to stand, walk, do exercise, nothing. Most of my problem is from the ankle and tibial bone either hereditary or disease from lack of vitamin D etc. I have great hip problems if I do not keep my leg externally rotated but if I do I have a lot of trouble walking or standing.

The NHS first wanted try high tibial osteotomy but I told them this may not work for me, then they checked my knee and said I don't have osteoarthritis yet so osteotomy shouldn't be an option anyway. They done the full leg ct scan and said I have problems with my hip too which is wrong because the lower leg causes the hip problems. They said I would need multiple cuts in the lower leg and hip surgery but refuse to do it because I would be worse off and said I should limit the amount of exercise for the rest of my life and never do sports again. I don't believe a word they say and want to see a private doctor to correct my lower leg. This isn't a simple high tibial osteotomy job.
« Last Edit: June 02, 2019, 10:07:40 AM by theturningpoint »

Offline The KNEEguru

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Re: Tibial derotation surgeons
« Reply #12 on: June 02, 2019, 10:12:01 AM »
Mr Mohi el Shazly https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-mr-mohi-el-shazly is experienced in derotation in the UK. Further afield Dr Robert Teitge is a renowed expert. https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-robert-bob-allan-teitge
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Offline vickster

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Re: Tibial derotation surgeons
« Reply #13 on: June 02, 2019, 10:13:50 AM »
Maybe you need an ankle rather than knee specialist?
I saw this specialist (regarding an injury claim following an injury to my tibia), seemed very knowledgeable and thorough. Might be worth a private consult (has clinics in Birmingham and London).

https://www.thefootandankleclinic.com/profile/mark-herron-mb-chb-frcs/

Good luck :)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline theturningpoint

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Re: Tibial derotation surgeons
« Reply #14 on: June 02, 2019, 11:51:16 AM »
Mr Mohi el Shazly https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-mr-mohi-el-shazly is experienced in derotation in the UK. Further afield Dr Robert Teitge is a renowed expert. https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-robert-bob-allan-teitge

Thanks! Do you know how much Dr. Teitge usually charges for this surgery? Also how do I email him, they only seem to have a phone number.
« Last Edit: June 03, 2019, 12:19:06 AM by theturningpoint »