The value of biplanar osteotomy

Neil was referred to me by Steve Bollen, who is a very well known surgeon in Yorkshire who has been a leading light in sports knee surgery for many years.

Mr Bollen has several times seen me talk on osteotomy and in particular about my minimally invasive technique and the use of a bone wedge as part of that procedure. He has been looking after Neil for some time, and decided to refer him to me with a view to osteotomy.

Neil came down to see me, and at 54 was really perfect in terms of indications. He was doing a 'half-ironman' a year before the surgery but developed sudden onset right medial knee pain with no precipitating trauma. He had constant discomfort and swelling after this which was particularly bad with activity.

He had remained very active and was able to walk up to 10 miles a day with his dog but was taking ibuprofen and paracetamol and always had a limp. He also noticed that he could not straighten the knee.

Bi-planar deformity

I saw that he had quite significant varus, was tender medially and had a fixed flexion deformity.

One of the big benefits of the osteotomy technique, particularly the bi-planar technique, is that we can actually get rid of fixed flexion deformity as well as varus, so we can re-align in two planes - getting the knee straight such that one can fully extend it as well as making the leg look straight from the front.

In fact his surgery went very well and I was impressed that he was actually able to leave hospital within two days of having the procedure. He reported absolutely no pain and on getting back to his home in Yorkshire he decided that he was actually so pain-free that he would walk on a treadmill half a mile a day! He soon worked out that this probably was not the best thing as he developed some discomfort. It is important after this surgery that patients take it easy for two weeks and rest the knee as best they can. After this they then obviously increase their activity levels.

He is doing very well at the two-week stage and I am delighted to hear that he felt confident enough to go on the treadmill for half a mile within a day or two of surgery. I think that this is a testament to the new technique.

Adrian Wilson

Adrian Wilson


Although I appeared to be OK one day and struggling the next, we all believe that the injury was through wear and tear through the years I have competed in endurance competitions such as Ironman triathlons, as well as being involved with full contact martial arts when younger.
I initially saw my GP who referred me to a local specialist who drained fluid from the knee and injected steroid into it but two days later had me hobbling around again.
I consulted an old friend of mine who is a sports physio, who tried manipulation and ultrasound, but after the first session said “I have seen this kind of injury before and Physio won’t cure the problem."
He recommended a knee specialist called Steve Bollen at the Yorkshire Clinic, close to where we reside.
After tests, he stated that there was significant degradation of the cartilage and his speciality of knee replacement wouldn’t be the best method of approach. He recommended Prof. Adrian Wilson at Candover Clinic in Basingstoke, and despite the 5 hour journey, having researched the procedures Adrian carried out, I decided that this was a promising option for my injury.
After consultations with Adrian we decided that the bone wedge osteotomy would be the best way forward, and like any major surgery I was slightly apprehensive, but considered myself in the best possible hands for the surgery.
My expectations, however, have been exceeded, finding that I could put weight on the leg after 24 hours, however delicate it felt at that stage.
I did actually get on my tread mill for just 5 minutes on the lowest setting after a few days, although I paid for it a little the day after!!
I am now 4 weeks into recovery and I am walking unassisted, having discarded the crutches 2 weeks ago and the brace a week ago. I highly recommend using the cryocuff ice wrap continually to keep swelling down!
Physio has now recommenced and is increasing my flexibility in the knee. Start biking this week, although very steadily!
I would recommend Adrian and his superb team for anyone who thinks that they may as well just “put up with the pain”. 
The procedure was 'minimal intrusion' so the scarring is fading nicely already.
I have a way to go but I am confident that I will be training properly again within a month or so.
My heart felt thanks and gratitude. "

Neil

(patient)

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