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Author Topic: Miserable malalignment derotational osteotomy UK NHS  (Read 690 times)

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Offline stillwaiting

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Re: Miserable malalignment derotational osteotomy UK NHS
« Reply #15 on: October 06, 2020, 11:04:41 PM »
hey tuggers.  sorry to hear about your situation.  I know someone who has had a derotational osteotomy.  The best advice is to speak with someone who has personal experience . It's a rare procedure.  I can give your her email if you want, I don't think she would mind and I will ask her of course if it's ok.  My only advice is to get multiple opionons and do one leg at once.  My email is [email protected] I'll have to charge you tho.  (jk)

Offline 3diwk

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Re: Miserable malalignment derotational osteotomy UK NHS
« Reply #16 on: October 07, 2020, 08:32:54 PM »

So your hip ROM is not the same as the torsion. The torsion is the twist in the bone. You can only see it looking down at the bone.  From the front your leg would appear perfectly straight. Thatís why you need a CT scan. But because you have a lot of hip internal rotation (40  is normal and very little hip external rotation it  is indicative of persistent femoral antetorsion - probably about 45 degrees (normal is 15-20 in a female)  And it sounds like you have about 50 or so degrees of external tibial torsion (normal is 27 in  a female)  So itís quite significant and not surprised youíre in a lot of pain! But if youíve had physio they should be focusing on increasing your hip external rotation range.

Itís not that uncommon actually. Whatís uncommon is having both. Lots of hip surgeons do femoral derotational  osteotomies, for example. Hope it goes well at Oxford. If youíre unhappy, I can definitely recommend a few surgeons in London on the NHS - but I suspect youíll get world class treatment in Oxford.


Offline Tuggers1994

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Re: Miserable malalignment derotational osteotomy UK NHS
« Reply #17 on: October 09, 2020, 09:15:57 PM »
The consultant I saw at Swindon said they do a lot of femoral derotations but he's not seen a tibia done there in the 12 years (if I remember rightly, was a long time) he's been there.

Physio has always tended to focus on my weak hip and glute muscles, only one ever tested my ROM in my hip and said I had femoral anteversion but never gave me any exercises for it. I think the reason my muscles are weak is walking with my feet straight for years and they have just compensated. I don't think my legs are particularly weak in their own right, the muscle balance is just different. If I use the muscles the physio says I should be using when I walk my feet shoot straight out sideways which is probably why I don't use those muscles.

I'm a bit apprehensive about Tuesday but hopefully I will finally get some idea of where we go next with this. Despite surgery being a daunting prospect I think I'll be more upset if they say they aren't bad enough for them to do anything with becuase that basically confines me to life on crutches if I want to do anything that involves more walking and it only gets worse as I get older. Any idea how much I'm likely to find out from an initial appointment? I know they won't have CT scans etc but I'm guessing they will have some idea? Will let you know if I'm not happy at Oxford, thanks. 
« Last Edit: October 09, 2020, 09:30:09 PM by Tuggers1994 »

Offline Lakeswim03

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Re: Miserable malalignment derotational osteotomy UK NHS
« Reply #18 on: October 11, 2020, 12:49:13 PM »
hello tuggers,
Thanks for your post, I am following this with interest, and I'm sorry you are having to suffer from everything which goes with needing this sort of operation, but it sounds like you are speaking to all the right people and doing everything you can to come to a good diagnosis & decision hopefully.
 Sorry I can't help with your questions, I hope someone else comes along who can, but I just wanted to say good luck and let us know how it goes on Tuesday.

Offline 3diwk

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Re: Miserable malalignment derotational osteotomy UK NHS
« Reply #19 on: October 13, 2020, 04:01:18 PM »
How did the appt go? I suspect theyíll want CT studies before recommending treatment? Hope it went well.

Offline Tuggers1994

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Re: Miserable malalignment derotational osteotomy UK NHS
« Reply #20 on: October 13, 2020, 10:29:27 PM »
I wrote an update but no idea what happened to it!

He has recommended derotations of both tibia but agrees with the consultant at Great Western that my hip ROM is normal.

He said my right leg will need doing with a frame as it is more twisted and the risk of compartment syndrome is too high but apparently there is the option to combine the frame with an internal rod so I would only need the frame for a few weeks and they could then remove it and put the pins in the rod. But I might just go with the frame on it's own for the sake of an extra 4-8 weeks.

He thinks my left leg will be ok with just the rod but the risk of compartment syndrome is about 10% which seems quite high to me. Is the rod what you had 3diwk?

He doesn't atm bothered about CT scans, I asked if I needed to get one done and he said no which seems a bit odd to me but I guess he knows what he's doing. I thought physio after would be pretty intense but it didn't sound like it would be but maybe it's different with just the tibias.

He's going to arrange another appointment nearer the time so I can ask questions and meet the frames team etc and we currently looking at early Feb for the first leg.

I'm so relieved to finally have some sort of plan, there's probably not many people that would be happy about having their legs broken on purpose!

Offline 3diwk

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Re: Miserable malalignment derotational osteotomy UK NHS
« Reply #21 on: October 13, 2020, 11:50:14 PM »
That sounds sensible - they know what theyíre doing, you can tell clinically with torsion but a CT is more accurate. My surgeon used a plate - but a nail is also good as itís minimally invasive. The nail/frame combo is also a good option. Either way itís quick healing and I actually think it heals faster with just the frame because you get much more  compression. Itís good you donít need your femurs doing. The recovery will be significantly quicker.

There is a risk of compartment syndrome and nerve damage - this is minimised significantly with the frame, and itís very rare (less than 1%). If they just did the nail then my surgeon released the nerve to reduce the risk. The key is being in a specialist hospital - I donít think itís as much as 10% but it is a risk and the frame/nail combo sounds good. I actually requested this but my surgeon didnít like using nails.


Offline Tuggers1994

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Re: Miserable malalignment derotational osteotomy UK NHS
« Reply #22 on: October 14, 2020, 05:51:26 AM »
I assume the risk of compartment syndrome increases with the amount they have to rotate the bone but I don't know what the cut off is and how close my left leg is to it, maybe that's why he said 10%. That's a question for my list!

He was happy to do my left leg first which although less twisted is the one that gives me most pain.

He doesn't like using plates but I guess they're all different!

Part of me is thinking I'll go with frames for both legs as I'm not sure about the nail although I do wonder if I'd be able to sleep with a frame and I do like my sleep! It's a shame most of the information online is scientific journals and reports which are not light reading!