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Author Topic: double rotational osteotomy - misalignement symptoms, other options....  (Read 144 times)

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Offline Lakeswim03

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Hello all,

Firstly I am so pleased to have found this forum, and already benefited from such a useful resource so thank you to all of you who have posted!

I am at a crossroads in needing to decide whether to go forward with a double derotational osteotomy.

I have been having a lot of pain in my knee when I bend it or stand( more details below)

I have consulted many Drs in different places and have tried their recommendations without success.

I have found 2 Drs (in the same practice) who recommend double derotational osteotomy and both are highly regarded surgeons in this field.

However I am resident in a different country in Europe, and the Drs here do not agree that I need this type of surgery, they believe it is a very "heavy" operation with no guarantee that it will resolve my issue and a strong chance it will make things worse as they think there is another issue causing it but are not able to offer other solutions............

 
My situation is:
- early 40s female, only had issues for the last 3 years
- severe pain in left knee under and around bottom of kneecap

- as a result of pain I have difficulty walking, going up / down stairs and weight bearing of even a few extra kilos. In terms of impact on life this means I do not leave my apartment very often apart from to go to work, and I have pain when standing to do cooking/washing up (I have to sit down after 10 mins) and also when doing short walk to collect groceries, take rubbish out etc

-pain is only when walking, standing and squatting (no pain when sitting / lying), pain is like a grinding of kneecap against bone and gradually appears the more I use my knee (first steps are usually pain-free), sometimes (usually after bending/squatting down) the pain only appears the day after exertion.

- leg is perfectly stable and no kneecap dislocation

- Pain started 3 years agon about after trauma to knee (felt strange immediately after), then I did a hike 2 days later and the pain started the following day.

- Before this I was very active, running, hiking, skiing, swimming etc, active also in childhood/teen years/20s and early 30s, no problems doing sport

- Due to inactivity during 3 yrs I have gained 50% extra weight, I realise this is really not helping my problem so I'm trying to address this by strict controlled diet (3 kg lost already!)

- I've had over 9 months of Physio with 3 different Physiotherapists>did not help and sometimes made pain worse (ie too painful to walk for week after)

- Tried rest, bracing, taping, stretches, orthopedic insoles, NSAIDs, icing, hyaluronic acid injection into joint, nothing helped

- MRIs show nothing very abnormal, just some inflammation of tendon, but this would not explain level of pain

- Rotational CT scan shows:
Left
Femoral torsion 26 degrees
Tibial torsion 30 degrees
Right
Femoral torsion 21 degrees
Tibial torsion 32 degrees
No patella alta in either.

I can see that many posters have far more torsion than this, and mine in my left knee is considered borderline. Also the fact I've only had this pain since my mid-thirties was also raised by my Drs here that this points to the issue not being malalignment.

I had an idea that I would ask for an arthroscopy as this is a much more minor op, with the hope that this would show if I had misalignment issues (through wear marks?) and also they could see if there is any other problem visible, but as my MRI is ok, my Drs this side are hesitant even to perform this.

I really feel stuck and my current condition means I really cannot do much, I cannot live autonomously, finding work in my field when my current contract ends will be challenging if not impossible. I also feel the rest of my health is deteriorating due to the lack of movement, and I am too young to only have this sort of quality of life for something which (I hope) is correctable......

I would love to know if anyone has had "borderline" torsion and still gone ahead with a rotational osteotomy which has helped them, or any links to research papers on this level of torsion, and equally of course I would be interested to hear from anyone who has a similar sounding issue to mine, or if an arthroscopy/scope has helped pinpoint a similar issue / justify further surgery.

Thank you for reading if you have managed to get this far!


Offline The KNEEguru

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Re: double rotational osteotomy - misalignement symptoms, other options....
« Reply #1 on: August 17, 2020, 10:51:27 AM »
There is a wide variation of opinion amongst surgeons around the world when it comes to osteotomy. And only a very few do de-rotations. So I think it likely that you will receive the full spectrum of opinions, which must be incredibly distressing to you.
In Europe you might speak to Ronald van Heerwarden - https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-ronald-j-van-heerwaarden , who is very well thought of when it comes to osteotomy.
One of the world experts on derotations - but unfortunately not in Europe, is Bob Teitge - https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-robert-bob-allan-teitge - but perhaps he may be prepared to give you an opinion?
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Offline Lakeswim03

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Re: double rotational osteotomy - misalignement symptoms, other options....
« Reply #2 on: August 19, 2020, 06:27:34 PM »
Thanks a lot for your reply.
  Yes I understand that relatively few surgeons perform this type of op, which explains partly why the majority don't have enough knowledge to recommend it.
Also the data on derotational osteotomies on cases like mine where the degree of torsion is very slight must be rarer still.
I have not found any evidence of my level of torsion being operated on in this way (with either good or bad results!) which is why I'm hoping for some extra info on this.
I'll update with any findings.