Miserable malalignment derotational osteotomy UK NHS

[Tuggers1994]

Hello everyone,

This is my first post on here but I've been lurking about for a while.

A bit if background:
For the last 20 years (I'm 26) I've been struggling with first ankle pain and then knee pain. The knee pain has now got to a point where I can walk for 10-15 mins and that's pretty much it. Driving, sitting in one position and standing for any length of time are all difficult.

I've seen the GP numerous times about this and was dismissed with growing pains when I was younger. As I got older I was referred to podiatry for insoles as I have flat feet and have had many referrals for physio which does nothing.

In a hope of getting the GP to take me seriously I saw a private orthopedic consultant yesterday and have finally been diagnosed with miserable malalignment, for which he has said I will need derotational osteotomy of my tibias at least and possibly femurs as well but he wasn't sure without further imaging. He wanted me to get a couple more scans done (MRI and rotational CT) and then see his colleague who is a 'rotational geek' in London next week to discuss a surgery plan (at about 15k per leg - which I don't have)

Now I have some sort of proof there is actually something wrong with the alignment of my legs I'm hoping the GP will take me seriously. Has anyone got any experience of having derotational osteotomy done on the NHS?

I have spoken to someone a colleague knows who had it done (in Bristol) and they had a Taylor Spacial frame as apparently it would be too much to derotate all in one go. From what I can make out this private consultant would cut and pin the bone and then you're up and about in a couple of weeks so now I'm very confused! I'm not keen on the idea of a frame as I think it will gross me out and obviously takes a lot longer but if that's the tried and tested way of doing things I'll go with it.

I've also spoken to my old physio and she said Basingstoke do a lot of this sort of thing - long shot but had anyone had surgery there to be able to tell me how they do it?

Sorry this has got so long, but if you made it to the end, thank you 😊

[Vickster]

Sorry to hear of your knee issues.

There’s a list here of surgeons who undertake osteotomies (not necessarily derotational), some will have an NHS practice, some may be private only.

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

Who is the ‘rotational geek’ in London? Maybe s/he has an NHS practice? Indeed, many surgeons do actually do both private and NHS and one you see privately may be willing to transfer you to their NHS list.  If you look them up on the private hospital website or the Bupa consultant finder, it’ll usually say if and where they have an NHS practice.

If you do need to go the private route, most hospitals will offer a payment plan to pay in instalments which may help with affordability.

Good Luck

[The KNEEguru]

Mike Risebury and Sam Yasen run an annual osteotomy course in Basingstoke and both have NHS posts. (https://www.basingstokeknee.org/).
Matt Dawson and David Elson do a sister course in the north and also have NHS posts. (https://www.northernosteotomy.co.uk/)

All have a great deal of experience in realignment osteotomy, but I imagine they also do plenty of derotations.

https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-mr-michael-risebury
https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-mr-sam-yasen
https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-mr-matt-dawson
https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-mr-david-elson

Professor Adrian Wilson was one of the founders of the Basingstoke group, but he is now Private only (London) where he is part of the London Osteotomy Centre with Raghbir Khakha and three European experts, where they are definitely experienced in derotations - https://os.clinic/the-london-knee-osteotomy-centre/

https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/professor-adrian-wilson
https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-mr-raghbir-singh-khakha

Mr Khakha has an NHS post at St Thomas's in London.

[The KNEEguru]

If you search from the searchbar above - 'derotation osteotomy' - you will find plenty of people who have researched and/or gone through this procedure. You can PM (private message) them if you have PM rights, which is easy to achieve - you need 20 posts but can build them up in the games room... (security system)

[Tuggers1994]

Thanks for the replies.
 
It was Adrian Wilson I saw and the 'rotational geek' is Ronald Van Heerwaarden but he doesn't do anything on the NHS.

I've put everything on hold for now as I have exams in a couple of weeks and things were moving a bit quick on the private front for me to get my head round! What I might do is get the worse leg done privately (which I think is actually the less twisted one of the 2) while the NHS referral hopefully plods on in the background. I have made an appointment with a GP so will see what they say about NHS referral and go from there.

[Vickster]

Can Adrian Wilson suggest someone with an NHS practice so your GP can focus the referral to the right hospital under choose and book?
I doubt your GP has a clue where to send you.
Where in the country are you?

[Tuggers1994]

Good idea Vickster. You're probably right about the GP not knowing where to refer me, I saw one orthopedic guy on the NHS and he didn't have a clue about rotational issues, he was only concerned with the ligaments in my knee which he said we're fine so he discharged me.
I have asked and they recommend his colleague Mr Raghbir Khakha who works from the BMI London Independent Hospital.

I think I need to see the GP armed with all the information I can.

I'm based in Wiltshire.

[Vickster]

Yes, even dedicated knee specialists have sub specialisms or specific expertise or interest.

I watched a kneeguru webinar recently with Mr Khakha and was impressed by his knowledge and delivery. Certainly he’ll be on my list when my current specialist retires (hopefully before I actually need a knee replacement!)

Good luck getting referred (he’s at Guys NHS I think?)

https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-mr-raghbir-singh-khakha

[Tuggers1994]

I've watched some of his YouTube videos and was impressed that someone 5 weeks post osteotomy could fully straighten their leg and bend the knee just over 90°. And no Taylor Spacial frame in sight  😊

Looks like you're right about Guys, I just copied and pasted what his secretary put on an email to me!!

Thanks for all your help, all the best with your hopefully far in the future knee replacement!