Another pain-free double level osteotomy

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Robert had a double osteotomy - with a correction in the lower femur and the upper tibia done on the same day.

Robert is a fit 45 year old gentleman who was referred to me by another specialist knee surgeon because of my interest in realignment surgery.

He came to me with severe bowing of his left leg as a result of a previous injury. He had an ACL reconstruction many years ago and had quite a large problem with hardware both in the tibia and in the femur (for fixation of the ligament). He was struggling with discomfort and was quite limited in terms of what he could do day to day, but also he noticed that his leg was getting progressively more bowed and this was making him less and less active because of pain developing. We talked about options and started thinking about two stages - in the first stage I removed all the hardware and bone grafted his tunnels which then gave me a much more straightforward situation to do the osteotomy.

His alignment was significantly varus (bowed) and we went for a double osteotomy, doing an opening wedge in the tibia and a closing wedge on the opposite side on the femur. This was planned out and executed a few weeks back, and he flew through the surgery and fortunately had very little discomfort. He woke up with no pain, rating it at 2-3 out of 10 as he began to get mobilised. When I saw him at four weeks he was already able to walk with a normal gait and had started walking his dog again.

I think this is the power of osteotomy where you can take an individual with really quite severe arthritis on the inside of the knee, offload that inner compartment by doing an appropriate osteotomy (in this case double-level) and get the weight-bearing axis into the middle of the knee, away from the damaged are, and by offloading relieve pain and restore function. I am delighted Robert is doing so well.

Post-operative

The day after surgery he was experiencing absolutely no pain.

Before went home he was walking with crutches and still experiencing no pain.

At three weeks post op

I had a football injury at 23yrs old, requiring initial arthroscopy followed by ACL reconstruction. I went on to a further three arthoscopies over the next 10 years or so, followed by an ACI - autologous chondrocyte implantation aged 32. All above surgeries performed by Dr. Andrew Unwin. It was Dr. Unwin who referred me to Professor Wilson. Once referred by Dr Andrew Unwin, Prof. Adrian Wilson discussed the options to me in depth and allowed me time to consider what was available:


  • Injections 
  • Knee brace
  • Partial Knee Replacement
  • Full Knee Replacement
  • Osteotomy

Long leg Xrays were taken and it was deemed that I'd require a Double Osteotomy due to the nature of how bowed my left leg had become. This procedure had to be done in two stages as metal work from my previous ACL reconstruction needed to be removed to allow for a successful osteotomy. This was performed successfully in Nov 2017 - rehab was similar to an ACL reconstruction. Once healed from that, fit and healthy, I was riding my bike by early Jan 2018, and we agreed to a date for the osteotomy procedure - September 2018.
I remained fit and healthy and worked hard at ensuring both legs were as fit and strong as possible prior to my surgery.

So I'm now 3 weeks from the double osteotomy and very pleased with my progress. I walked via crutches the day after surgery and climbed the hospital stairs on the 2nd day!
I'm actually a little dumbfounded by how pain free I've been post surgery. My pain levels have never been beyond level 3 and in truth mostly 0-1.
If I continue to progress as hoped, then I can absolutely endorse Osteotomy surgery and ultimately Prof.Adrian Wilson for the excellent care and expertise given.

I know am still in the early stages, but my initial feelings and expectations are VERY positive. Firstly, I have a wonderful straight leg and am virtually pain free. I am currently attending physio with hydrotherapy sessions and looking to fully weight-bear by week four.My advice to others with similar problems is to stay healthy prior to your operation, and keep building your leg muscles as much as possible prior to your operation. Do some good research, there's lots on the web! Also get a Game Ready as helps with swelling after the operation.

My overall experience so far has been an excellent one. Normally I'm a very active 45 year old. I swim once a week and use my garage gym about 3/4 times weekly. My passion used to be playing football, but now it's mountain biking. I ride local forest trails averaging around 60 miles per week and had covered over 2000 miles this year including Mount Boldo Italy, Peak District, South Downs 100 and the Welsh mountains. I don't tend to have pain when riding my bike, but I noticeably limp when walking and often hold onto the banister when climbing stairs. My pain varies from 0 - 7, although I do have a good pain threshold.

Keeping healthy and enjoying the countryside and life in general are of a high priority to me, therefore the decision on whether or not to have an osteotomy was huge, but also very much the clear and obvious one to take. It's my hope and understanding that this should give me 10 years + before having a possible partial knee replacement. Having a straight leg will also enable future surgery to have a better outcome.

Rob 

aged 45

At 4.5 weeks

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1 comment
Sandra Chapman says September 17, 2018

I cannot say how extremely pleased and relieved I am that my son Rob Hall has had his operation completed successfully and is pain free. Thank you professor Wilson.

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