Proximal Tibial Osteotomy - Arthrex iBalance instrumentation/implant

To let us know how you are getting on for the first days and first few weeks after your operation or injury. We would be interested in knowing about pain levels and meds, dressings, using the CPM machine, swelling, icing regimes, mobility, exercise regimes, bathing and travelling issues, etc.
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jmkuphal
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Proximal Tibial Osteotomy - Arthrex iBalance instrumentation/implant

Post by jmkuphal »

I underwent a left leg high tibial osteotomy on my left leg November 9th, 2022 at the Mayo Clinic in Rochester, Minnesota under Dr. Michael J. Stuart. In addition I had the medial meniscus cleaned up in two places where it was torn and some clean up of a 12mm cartilage defect. More on that later. Will document the how the procedure went and recovery after a little history.

In 2016 after several years of right knee pain, I elected to have this procedure completed on my right leg. I have a separate log documenting this event, but it was a difficult recovery due to complications with Complex Regional Pain Syndrome. Long story short, by the grace of God I recovered from the surgery, the complications, and ended up with several years of pain free knees which allowed me to return to all the activities I loved. Running, hiking, biking, downhill skiing, lifting weights, squatting, etc.

In late 2021 I started having medial left knee pain which I immediately knew was the same condition I experienced on my right knee. I knew the time would come when I would need to have the same procedure completed on my left leg and here I am. I delayed surgery as long as possible due to the busy year I had and underwent the surgery in November.

This would be a bigger correction then my right leg (11mm). My left leg needed a 13mm correction. The max correction using the Arthrex implant is 15mm I believe. I highly recommend the arthrex wedge implant because there is no hardware to remove post op (ie; plates and screws). The implant remains in the leg, the bone grows around it and it is comfortable and does not need removing. You essentially avoid two surgeries and recoveries.

The surgery was conducted successfully as out patient and I went home same day.

Day 1-7 was much much easier then my surgery in 2016. 2 days after the surgery, I immediately began Range of Motion (ROM) exercises which was differential to my 2016 surgery where they didn't allow me to bend the knee for 4 weeks due to meniscus repairs made. Because this time they simply cleaned up my cartilage and torn meniscus, I was able to start moving right away. What is the same is no load bearing for 4 weeks minimum and then only partial until 6 weeks and verification of bone fusion. In 2016 I had horribly agonizing blood rushes and was heavily medicated for 4 solid weeks. This time the first week I thought I was out of the woods and even weening off pain medication. My leg color was also not nearly as red and I controlled swelling with a cryotherapy unit that automatically circulated ice water through a sleeve and came on at timed intervals. This made a huge difference in swelling and pain.

Day 8-13 - I am currently on Day 12. Right on cue my blood rushes I had previously experienced hit me and I was back on pain medication to deal with it. I am taking Tramadol (100 mg) at 7:30 AM and then another dose in afternoon around 3:30 PM to deal with this pain in the day time. The tramadol does not make me as drowsy or out of it. At night I take Ambien for sleep and nearly every night I wake up at 2-3 AM in horrible pain and take 5 mg of Oxycodone to deal with the breakthrough pain. I am hoping by week 3 this will begin to resolve.

Blood Rush Trick - The blood rushes feel like someone is burning my leg with a blow torch. Horribly unbearable to the point of nearly passing out. I cannot make it to the bathroom because standing up and crutching is so painful. What I found is if I wrap my leg over the compression sleeve I am wearing very tight with an ace bandage before donning my rigid leg brace, I can slow down the blood rush and the pain becomes more tolerable long enough to get to the can and back. Otherwise, I just have to medicate heavily to tolerate.
Not everyone experiences these blood rushes. I seem to with every surgery I have ever had. They are horrible. I will say, the swelling and bruising this time around is way better and my leg appears at this time to be spared the red hypersensitive CRPS I had last time around. I am in much better shape then I was at this point in 2016 and ROM exercises have gone very well. The most painful times for me are waking up in morning and around 2-3 AM when I wake up and my leg is pissed of because it hasn't moved. I have to exercise it and take medication to get back to sleep.

I am excited to have this behind me and get back to life. I am in a much better mental state this time vs. 2016. I knew what to expect and we were much better prepared.

Cheers,

Joe Kuphal
Will ski again someday!

Joe
jmkuphal
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 21
Joined: Thu Dec 22, 2016 11:11 pm
Location: Minnesota
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Re: Proximal Tibial Osteotomy - Arthrex iBalance instrumentation/implant

Post by jmkuphal »

3 Weeks Post Op yesterday. Brief update. Been only taking Tylenol for last several days. Like clockwork my worst time for pain is right before bed and I wake up at 3:00 AM with discomfort for an hour or two before falling back asleep. Usually have to exercise the leg with basic ROM exercises to calm it down...think it just gets very stiff and painful when I sleep and not moving, etc. The worst of the pain is behind now though. It is a tolerable but annoying ache in the bone and just knee ROM stiffness, etc. I may start doing some upper body exercising this week for my sanity and to move.

I have started putting a little weight here and there through my leg. I am supposed to wait for week 4 for that, but...I am impatient. Nothing major just a little bit here and there. It feels good. My calf near the ankle is extremely tight, been stretching that alot. I think everything has to get used to new position within the leg and given the Osteotomy adds a little overall length, I am sure the muscles and tendons need to adjust. I remember similar with my right leg in 2016.

The color of the leg is looking good. Still some localized burning and skin sensitivity just below the osteotomy site but not my whole leg like last time.

I am crutching around quite often now around the house. It is nice. Navigating the stairs well, but have had a couple scares where one crutch caught carpet. Stairs are no joke and would not be worth a fall, so always take them slow and methodical no matter how good you get at them. All in all things are progressing nicely as far as I can tell.

If you are reading this, I hope you are doing well in your journey and or post op recovery.

Cheers and God's blessing.

Joe

Will ski again someday!

Joe
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