High Tibial Osteotomy and Tibial Plateau Leveling

Post here if you are new to the board and not sure where to post your question. Or if your question or comment is of a general nature. The KNEEguru may move it later to a more relevant section if necessary.
User avatar
David_69
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 23
Joined: Mon Jan 12, 2004 8:55 pm
Location: Kansas
Contact:

High Tibial Osteotomy and Tibial Plateau Leveling

Post by David_69 »

Hello,
Can someone tell me about your experiences with these two proceedures. I went in for 2nd opinion on my knee and these proceedures were suggested to help my knee and push back the joint replacement.
It was also suggested to get a Loader Brace prior to the surgery just to see if I feel a benifit as the surgery would work in the same manner as the brace?
Thanks
09/83 Rt. Mobile Medial Meniscus No Repair
06/84 Rt. Partial Medial Meniscectomy 75%
07/94 Rt. Partial Medial Meniscectomy 25%
06/97 Rt. PCL Recon./ Microfracture
11/97 Rt. Medial Meniscal Transplant
11/98 Rt. Scope Lysis of Adheasion
04/07 Rt. Sciope Remove Loose Body
glasgowgirl
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 22
Joined: Mon Aug 27, 2007 3:16 pm
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by glasgowgirl »

Hi David,
I am recovering from High Tibial Osteotomy at the moment.
You can probably find my original post about it as I posted a message on here looking for advice. There's a bit more detail on it than I'm planning to write here just now.
I had the HTO because I am too young to have a partial knee replacement (I'm 30) and this procedure should buy me some time before I need to start down that road of replacement and revision. It was also done to re-align my knee, which is how it was described to me and is how I tell everyone else as it is quite complicated!
I would recommend it.
It has really helped my pain and reduced it tremendously. I have a dodgy other knee too, so I'm finding it a bit difficult to reap the full benefit of it at the moment but I can notice a significant difference.
I think my recovery has been okay. I had it done on 24th May and was non-weight bearing for 6 weeks and then on crutches for 12. I'm now not using them in the house and only taking one when I go out. Normally, I think I would only have been on them for 6 weeks walking. My surgeon was a wee bit concerned so I got an extra 6 weeks! I've still not gone back to work, but I guess that it depends what your work is whether this would be true for you. I can't go back until I can walk properly.
I've to have the metal plate removed in December and then I'm hoping I can forget about this knee and worry about the other one!
Hope this helps!
Are you in the UK, by the way?


User avatar
David_69
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 23
Joined: Mon Jan 12, 2004 8:55 pm
Location: Kansas
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by David_69 »

Hi,
I am in Kansas, just about smack middle of the USA.
I will take the time to read your origional post, but I will toss out a bit of information. We too are trying to 'buy time' with my origional knees. I am 40 and have had 7 surgeries on my right knee since I was 16. My last surgery was in April where my current doctor removed a loose body and cleaned up the joint a bit. My doctor thinks that the advances in the injections such as Synvisc will be my best hope to get me through to the age where I can get a total joint (mid 50's).
With his blessing I went to see another OS and this ne OS is suggesting both proceedures for me. All my damage is on the medial side of my joing and I am walking bow legged now. I cant tell I can just tell that I dont have the same fluid motion walking with my left leg as with my right. This is putting additional strain on my Fibular Collateral Ligament. In addition to this I have been told that the alignment of my femur and shin bone is off and is causing additional issues.
For the longest time I felt the sensation of my joint sliding front to back while walking down inclines. I also had the pin point pain where the Fibular Collateral Ligament connects but I couldnt explain why I was having the pain. One other thing is sometime when I flex my knee it feels as if it is under pressure, where I couldnt bend past a 90 degree angle because the discomfort as if I am pulling everything past lits limits.
So I am waiting to see my local OS once he receives the letter from the other OS on his findings and suggestions. I was told of the pain, the 6 weeks non weight bearing and the PT that would be involved. I was told up to 6 months PT.
I am a little concerned about the healing of the bone and infections, time in the hospital, the time off of work. I have a office job where I sit most of the day so I think I could return fairly quickly.
Thanks again for replying and I will go and read your earlier post. If I have any other questions I will post them here.
David
09/83 Rt. Mobile Medial Meniscus No Repair
06/84 Rt. Partial Medial Meniscectomy 75%
07/94 Rt. Partial Medial Meniscectomy 25%
06/97 Rt. PCL Recon./ Microfracture
11/97 Rt. Medial Meniscal Transplant
11/98 Rt. Scope Lysis of Adheasion
04/07 Rt. Sciope Remove Loose Body
User avatar
kneedy8
Regular Poster
Regular Poster
Posts: 131
Joined: Wed Apr 18, 2007 1:06 am
Location: Ontario, Canada
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by kneedy8 »

Hi David:

Just had a HTO done Sept 12th. The hardest part for me so far has been the non-weight bearing. See all my posts under arthritis..changing the forces through the joint.subject HTO uncoming. Since surgery I started a thread under the post-op section. Theres lots of info on my first thread, as I too had many questions. If you want to know anything else just let me know. Good luck!
User avatar
David_69
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 23
Joined: Mon Jan 12, 2004 8:55 pm
Location: Kansas
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by David_69 »

Hello Cat,
It is great to hear from a someone else from the Sunflower state. Thanks for the wishes and I wish you luck on your proceedure/decision.

Dave
09/83 Rt. Mobile Medial Meniscus No Repair
06/84 Rt. Partial Medial Meniscectomy 75%
07/94 Rt. Partial Medial Meniscectomy 25%
06/97 Rt. PCL Recon./ Microfracture
11/97 Rt. Medial Meniscal Transplant
11/98 Rt. Scope Lysis of Adheasion
04/07 Rt. Sciope Remove Loose Body
User avatar
David_69
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 23
Joined: Mon Jan 12, 2004 8:55 pm
Location: Kansas
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by David_69 »

Hello Kneedy8,
I looked over your diary on your surgery. So it doesnt sound as if the pain was too bad! How long did you have to stay in the hospital? I am waiting for the letter from the OS who gave me the second opinion to send his findings to my regular OS. Then I think I will have to have a sit down with my regular OS and get his opinion on the comments.
I spoke with Carl my PT today to find out if he has rehabed any HTO's, and in his opinion he thought that a HTO would be a little extreme he thought I should consider a Uni. I know my regular OS down played the efectiveness of a Uni many times and he'd even said since my last surgery in April that my biggest benifit would come from any improvements to the shots. Well the last series of Synvisc did no improvement in August and I had the all synthetic stuff last year and it was no better than a cortisone injection.
So are you to stay NWB for 6 weeks? Did you have to be on a CPM machine after surgery, since? DO you know how long the surgery lasted? One of your lasts posts you stated that you are to still use the cryo pak, is that the case still? How long a day do you use it?
Did you have an option to try an Unloader brace prior to surgery? I was told that the Unloader brace would simulate the same benifits from the HTO surgery. So if the Unloader helped the surgery would most likely help.
One last question for now, are you still off of work?
I hope that I dont bother you will all of the questions.
09/83 Rt. Mobile Medial Meniscus No Repair
06/84 Rt. Partial Medial Meniscectomy 75%
07/94 Rt. Partial Medial Meniscectomy 25%
06/97 Rt. PCL Recon./ Microfracture
11/97 Rt. Medial Meniscal Transplant
11/98 Rt. Scope Lysis of Adheasion
04/07 Rt. Sciope Remove Loose Body
User avatar
kneedy8
Regular Poster
Regular Poster
Posts: 131
Joined: Wed Apr 18, 2007 1:06 am
Location: Ontario, Canada
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by kneedy8 »

David:

No problem with the questions..glad to help in any way. Gosh, I know I had many questions! ;) The pain for me was controlled..just make sure you get a nerve block. If you can take the pain meds you will have no problem. I was nauseous the first week from oxycontin so then switched to tylenol. Hospital stay was 2 nights. Was told I could go home after 1 night, but my blood pressure was too low and I was not able to get up without getting dizzy. Next day was okay.

NWB will be for 7 weeks as I do not see my OS until then. (This is the hardest part) Hopefully, at that time I will be able to partially weight bear. I did not use the CPM machine. Surgery was about 2 1/2 hours..I also had a scope. I used the cryo cuff all the time the first 2 weeks. It kept the swelling down and felt really good! Since then, I only used a cold pack 2 or 3 times a day, usually after I work at bending the knee.

I did not use the unloader brace...was going to get one, but by that time I was getting booked for surgery so did not bother. I am still off work and will be for a least 4 months. Many people do go back to work alot sooner if they have a desk job. I have a 30 minute commute and although a large part of my job is at a desk...I am also on my feet alot. There are alot of stairs also. I am sure once I can start weight bearing it will get alot easier. I may go back part time for awhile.

It is a tough recovery but, in I do believe it will be worth it....a better knee! ;D ;D I am told I will be able to go back to moderate sports also and I can't wait! ;D ;D
ceoshea
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 20
Joined: Fri Nov 17, 2006 2:52 pm
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by ceoshea »

Hi David:

I'm from Wichita, too. Do you still see Dr. Bruner? He's done my last three surgeries. I'm having ever increasing pain and suspect I'm rejecting my ACL allograft. I've gotten another opinion and am looking at an HTO within the next year.

Cathy
ACLR:  12/30/04
LOA and removal of hardware:  8/05
LOA:  6/06
LOA:  11/06
User avatar
Mandy
SuperKNEEgeek
SuperKNEEgeek
Posts: 1234
Joined: Mon Aug 02, 2004 12:23 am
Location: USA
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by Mandy »

Hi David~

I'm due to have an HTO in the near future as well. Right now I'm using the unloader brace, and really like it. Well granted it is a brace, and does get to be a pain having to deal with it every single day, but it gets rid of most of the pain I have due to the bad alignment and arthritis. My surgeon wanted to see if the brace really did some good for my pain and activity levels before jumping into surgery, as I've already had 5 surgeries in a matter of roughly 2-3 years.

I'm really thankful that the brace has allowed me to continue working out and building back my leg strength. It has also bought me some time until I can get things surgically fixed as I'm at college right now, in the middle of a very time intensive academic program. There would have been no way I could have had the surgery and been back here to school in a managable condition for me to complete my clinical rotations. The brace I'm wearing is a custom brace by Innovation Sports. I believe it's the CTi2 OA model. Came with a hefty bill, but thanks to insurance, I think I only ended up having to pay around $200. Not bad at all when the brace is $2500.

Anyways just wanted to say hi and wish you the best in your HTO. Take care
~Mandy
21 yrs old
12/04: plica removal (RK)
2/05: debridement, LR/TTT (RK)
6/05: debridement, LR/TTT (LK)
10/05: scar tissue removal/debridement (LK)
3/06: screw removal (both knees), debridement on TTT site (LK)
5/08: debridement, HTO, Maquet procedure (LK)
User avatar
David_69
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 23
Joined: Mon Jan 12, 2004 8:55 pm
Location: Kansas
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by David_69 »

Hello Cathy,
Nice to hear from a 'neighbor'.
Yes I have seen Bruner, since 1994 actually. He has done my last 5 surgeries. Each time we have had a surgery the same comment is made, "we are just trying to buy time"!
I really like everything he has done for me and my right knee. What really did it for me was that he examined my knee when I wasnt even a paitent of his. A friend of mine tore his ACL and Bruner did his surgery. One day while I was taking my friend to his follow up appointment with Bruner, he looked at me sitting in the chair and saw the 6 inch scar I have down the front of my knee. Bruner asked how was it, I told him it was giving me some problems and he went ahead and examined my knee while I was there.
Sorry to hear about the ACL. So your last three surgeries, how many before Bruner?
Bruner did my PCL and Medial Minscus transplant in 1997. My PCL is still holding up but the question is for how long.
Did you get your second opinion here locally or did you go elsewhere?
I went to Kansas City for my second opinion. I will go in to see Bruner next week to discuss it and get his opinion on it.
Keep me posted, if you like I can email you my email address.
09/83 Rt. Mobile Medial Meniscus No Repair
06/84 Rt. Partial Medial Meniscectomy 75%
07/94 Rt. Partial Medial Meniscectomy 25%
06/97 Rt. PCL Recon./ Microfracture
11/97 Rt. Medial Meniscal Transplant
11/98 Rt. Scope Lysis of Adheasion
04/07 Rt. Sciope Remove Loose Body
User avatar
David_69
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 23
Joined: Mon Jan 12, 2004 8:55 pm
Location: Kansas
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by David_69 »

Hello Mandy,
Wow, a HTO at 20? It sounds as if you have had some work done on both knees and will soon have more.
Thank you for the information on the brace. I tried looking up the braces on Google just to see what it brought up. I will go see my OS next week to discuss with him the second opinion I received just over a week ago. I dont see where he would have any issues with putting me in the brace, now the HTO just might be the sticking point.
So with the brace being custom, how long did it take for you to get it once it was ordered? The last brace I bought was a custom Breg brace back in 1997.
So what do your activity levels consist of?
I gave up on running and jumping long ago and when I tried to take in racketball or something simular it just didnt work out, too much sudden stopping. Now the only things I do are walking, bike riding (streets no offroad) and swimming. I will go out and mow the grass one day and be laid up the next.
I would like to be kept posted on your HTO, as I dont know where I actually stand on getting it done. I will know more next Tuesday.
Take care and keep up the work in school!
David
09/83 Rt. Mobile Medial Meniscus No Repair
06/84 Rt. Partial Medial Meniscectomy 75%
07/94 Rt. Partial Medial Meniscectomy 25%
06/97 Rt. PCL Recon./ Microfracture
11/97 Rt. Medial Meniscal Transplant
11/98 Rt. Scope Lysis of Adheasion
04/07 Rt. Sciope Remove Loose Body
ceoshea
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 20
Joined: Fri Nov 17, 2006 2:52 pm
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by ceoshea »

Hi David:

Glad to hear from you too. Dr. Jansson did my ACL recon in December 2004. I had an allograft and partial meniscectomy and have had constant problems ever since. I switched to Dr. Bruner looking for a doctor with a more pleasant personality. Because I've had constant tibial pain since my first surgery, first he removed my hardware. Six months later I still had the tibial pain, lack of extension and patellar pain, so he did another surgery to remove a cyclops lesion and debride. Five months later I still could not straighten my leg, had clunking and grinding, so he debrided again. I still don't have full extension and I still have tibial pain. I had another bone scan in May and my tunnels and tibia are light up indicating some sort of immunological activity. Dr. Bruner suggested I get a bone stimulator to see if that would close up the tunnels and heal the tibia. He does not want to do any more surgery on me and feels my knee is straight enough. I'm having more pain than ever, can't walk for more than 20 - 30 minutes for exercise and am really worried that I'm rejecting my allograft. So I decided to call Dr. Noyes in Cincinnati for an appt. I saw him last week, and I was shocked to learn that I have lost 50% of my knee joint on the medial side. Dr. Noyes also thinks I'm rejecting the graft and recommended I get a biopsy from a tumor orthopedist to definitively rule out a low level infection. Then I'll need to see Dr. Noyes to have the ACL removed, a bone graft from my hip to fill in the tibial tunnel, and then 6 months later an HTO and revision ACL reconstruction. All this to stave off a TKR for 7 or so more years (I'm 48 now).

Dr. Bruner is a great guy but I think my knee issues are more complex than what he'd like to deal with. He's always super nice when I see him, but I really need to see an orthopedist who has seen lots of cases like mine. I hate to travel so far for surgery because it's so expensive and so disruptive for my family and job but I don't want a TKR before I need to. I haven't told Bruner's office yet that I got a second opinion. I need to make an appt. and talk to him in person.

Did Dr. Bruner diagnose your bowlegged condition? Until Dr. Noyes told me that the xrays he took showed the bowing in my knee (and he could see it when he watched me walk), I had no idea I had this problem. I just saw Dr. Bruner in August and he's never said a word about any of this. I'll be interested to hear what he thinks of the HTO your second opinion doc is recommending.

Take care,

Cathy

ACLR:  12/30/04
LOA and removal of hardware:  8/05
LOA:  6/06
LOA:  11/06
User avatar
Mandy
SuperKNEEgeek
SuperKNEEgeek
Posts: 1234
Joined: Mon Aug 02, 2004 12:23 am
Location: USA
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by Mandy »

Hi David!

Yea I hate having worse knees than my own grandmother right now. :P Kind of crappy when alot of the people I intereact with through the day don't really understand how frustrating this all can be, but thankfully I've found an amazing core group of friends and professors that are understanding, but don't feel sorry for me because that would be worse. As far as the brace goes, I had the OS appointment on a Tuesday, and met with the guy to fit it right after the appointment. I was back at the clinic exactly a week later. It actually came in before that, but being at school, the next Tuesday was the only break in my schedule for me to go pick it up. Before I even got it, I was told it would take 7-10 days typically.

My activity levels vary. I wore the brace the entire summer and didn't have troubles going for 6-8 miles rollerblading. I'm doing clinical rotations right now for my degree and I find I'm able to get through the day a little easier having it on. When I'm not in class, I do find times to go workout at the gym and I usually do a full hour of biking which doesn't seem to bug me all that much. I'd LOVE to get back to playing hockey, but I know I'll never be at the same competitive level I was once at before all of this knee stuff. Just can't see myself putting my body through all that again. Not exactly sure of my OS do let me back to hockey either. She sometimes gives me the "what the heck were you thinking" look when I told her some of the things I've tried doing (running, for example!).

As far as I know I'm just going to keep wearing the brace as much as I can, although its getting a little old having to deal with every single day. PLanning on seeing the OS during Spring break and go from there I guess. So as it looks, I'll most likely be crutching around and hopped up on narcotics for my 21st birthday...oh joy. :P

Take care, and keep in touch!
~Mandy
21 yrs old
12/04: plica removal (RK)
2/05: debridement, LR/TTT (RK)
6/05: debridement, LR/TTT (LK)
10/05: scar tissue removal/debridement (LK)
3/06: screw removal (both knees), debridement on TTT site (LK)
5/08: debridement, HTO, Maquet procedure (LK)
User avatar
kneedy8
Regular Poster
Regular Poster
Posts: 131
Joined: Wed Apr 18, 2007 1:06 am
Location: Ontario, Canada
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by kneedy8 »

Mandy:

FYI - Steve Izerman from the Detroit Red Wings had an HTO done and went back to playing professional hockey for a few years. A guy I know also had it done and he is skating and playing hockey again - something he thought he'd never be able to do. Think positive! ;D
User avatar
Mandy
SuperKNEEgeek
SuperKNEEgeek
Posts: 1234
Joined: Mon Aug 02, 2004 12:23 am
Location: USA
Contact:

Re: High Tibial Osteotomy and Tibial Plateau Leveling

Post by Mandy »

thanks kneedy! i remember reading that somewhere and thought that's what he had done, but wasn't positive. thanks much for the words to keep positive. who knows if i'd be able to get back to hockey. just besides the knee stuff, i've had numerous other injuries that were never taken care of correctly when they happend, so i'm still left with quite a bit of pain when i'm on the ice.

we'll see though. i just might have to bite the bullet and get back to the game that i just love. hope recovery is going well for you!
~Mandy
21 yrs old
12/04: plica removal (RK)
2/05: debridement, LR/TTT (RK)
6/05: debridement, LR/TTT (LK)
10/05: scar tissue removal/debridement (LK)
3/06: screw removal (both knees), debridement on TTT site (LK)
5/08: debridement, HTO, Maquet procedure (LK)
Post Reply

Return to “GENERAL KNEE QUESTIONS and comments (good for new threads)”

Who is online

Users browsing this forum: Amazon_[Bot], Georgie and 0 guests