Pain discussion after high tibial osteotomy

snowboarding

I saw Professor Wilson in July 2017 after developing increasing pain in my left knee. I had previously consulted him for a torn ACL and, also had an arthroscopy to remove a bursa.

During the Appointment in July we discussed many treatment options including HTO (high tibial osteotomy) but decided to go with an injection to help with the pain and have a review in 6months. After 6 weeks however the pain had increased significantly and I was unable to complete a day at work without pain killers. Any other activities (snowboarding or mountain biking) were out of the question, so I returned to see Professor Wilson at the Hampshire Clinic.

Again we discussed the options including Stem Cell injections, and HTO. Prof Wilson thought that the best of course of action was an HTO, and having had this previously mentioned i had done a lot of research into this, and agreed to the procedure which took place 27 September 2017 at the Hampshire Clinic.

After my earlier discussions with Adrian and the research I did I was expecting a painful recovery, but am glad to say this is not the case. I woke up after surgery in some pain but this addressed quickly - a few hours later I woke up in my room, pain free and comfortable eating dinner.

On the recommendation of Professor Wilson I had hired a GameReady for a month post-op, this was put on me immediately after surgery. Unless I was doing physiotherapy it was attached to my left leg for the whole month post op, and I believe the GameReady helped with Swelling (I had virtually none) and pain relief. I never needed the higher level of pain relief (codeine) and was able to stop all pain relief (paracetamol) 5 days post-op.

My advice - if your considering an HTO - is to go for it. It is not as scary as the internet makes it seem. Trust an experienced surgeon like Professor Wilson. Have physiotherapy before the op if possible, as I believe this helped me a lot, because now at 6 weeks post-op I can complete 30 straight leg raises with no pain whereas pre-op I could only manage 15, due to pain.

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James (Hobbs) is 28 at the time of writing this. He came to me a few years back, having had a very nasty ski injury in Whistler. He was doing a season - was fairly advanced in terms of his skills - and had a nasty 'wipeout' and damaged the knee. He tore his ACL and damaged the meniscus and the joint surface.

When he first presented to me he was very unstable, so I was able to do a very nice ACL reconstruction and stabilise his knee, but there was clear, significant, damage to the joint surface and meniscus. I did a chondroplasty, to smooth off the damaged areas to the joint surfaces, and a meniscal repair but he sadly continued to develop further pain.

I know he has always felt very stable but he really began to struggle. He had very physical job, and we tried injections and bracing, but it got to the point where the pain was so significant that he felt he wanted to do something more.

Because of the alignment, and the fact that he was such a good candidate, we elected to go for osteotomy surgery, and in September 2017 he underwent surgery. The procedure went very well and he has been nicely re-aligned.

The interesting this about this patient is that he has had no pain - only some slight discomfort when he woke up in recovery. He just took regular painkillers as I suggested, but required very little in those initial few days and only took relief for 5 days and then stopped altogether. When I saw him two weeks after surgery he had no swelling, no pain and it is just a testament to this new technique that we have developed how well people can rehab in the early phases following an osteotomy. I think GameReady cryotherapy is also very important, but I also believe that the use of a bone wedge to give some initial stability and the minimally-invasive approach that I've developed are crucial to achieve this type of result.

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