Femoral osteotomy for valgus and fixed flexion

I had a meniscus repair following a climbing accident around 20 years ago. The knee was never quite the same and I had a regular programme of yoga, pilates and physio to keep it mobile.

Around a year ago the pain got worse and in denial I just kept telling myself that I just needed to work on some quad strength and it would be fine again. The morning I got out of bed several thousand miles from home and couldn’t put any weight on my left leg I knew it was time to stop kidding myself.

A competitive rower in my twenties, I’ve always been active. Not exactly superwoman, but my preferred way to spend free time is on a bike, in the water or on the water. The pain meant I could barely stand first thing in the morning, it would ease in the day but by evening or weekends all I wanted to do was lie on the sofa channel hopping. God forbid anyone suggest I get up - it wasn’t going to happen. The result wasn’t good, I became fat, grumpy and depressed.

I was referred by another knee specialist who had explained to me how bad my knee was and that he personally didn’t have the experience to carry out an osteotomy, the operation he felt I could be a candidate for. I don’t know what made me cry more as I sat in my car afterwards- the thought that there wasn’t anything to be done or the thing that might be able to be done involved effectively breaking my leg.

Honestly, before I met Prof. Wilson I was terrified. The small amount of information I’d found online in runner’s forum seemed to suggest that everyone who’d had an osteotomy of any sort felt it was worthwhile but they all spoke of long and often painful recovery times. I have a demanding job and I travel - my employer is incredibly sympathetic but there’s only so long you can take off. Once I’d had my first consultation it all felt so much more manageable. Prof Wilson was clear that it is a major operation but he was also clear about the process of recovery and rehabilitation. My personal expectation was that I would be at the outer edges of timescales based on the fact I’m not a teenager any more and my muscles had become very weak. I suppose I had vague thoughts of not leaving my bedroom for a month to avoid stairs then probably crutches for another two months

I was doing stairs with the hospital physio two days post-op. I’m now at five and half weeks post-op and my 4-week x-rays showed I’m almost healed. I mostly walk with one crutch (two for when I’m tired) and have taken some careful unaided steps. I didn’t expect to ever be able to straighten my leg fully, even after surgery because even at its best I couldn’t before, and I can now. So I’d say my expectations have been both met and exceeded.

My advice to any patient reading this is firstly and most obviously don’t Google it…..Talk to the Prof. He’ll be honest about what is and isn’t possible. There was a lot of planning before my eventual surgery and I was well informed about the problems and what we were trying to achieve.

Once you’ve had the surgery, follow the advice, or more bluntly, do as you’re told. My experience has been extremely good but I think that’s because I didn’t expect miracles from the surgery alone. I did EXACTLY as I was told afterwards. I took the pain meds, did the physio as prescribed in the hospital (even when it felt like I was barely twitching a muscle let alone completing a leg raise), made sure I rested in between and used a GameReady machine to take care of the ice process. Show up for your own recovery people! This doesn’t mean I don’t think the Prof isn’t a miracle worker because obviously I do.

I was aware that an osteotomy is major surgery, but it really hasn’t felt that way. Any post-operative pain was extremely well-managed and under Prof. Wilson’s care my recovery time has been much faster than expected. I wasn’t bothered about the scar but that too is minimal and a lot smaller than anticipated. Much of the available information tells you that a distal femoral osteotomy is considered more complicated with a longer recovery time - my experience is that the methods Prof. Wilson has developed mean that it doesn’t have to be and right now I am so optimistic for the full recovery of my knee.

Adrian Wilson

Adrian Wilson

Deborah is a very nice lady who is 56 and who was referred to me by a consultant in Salisbury with very severe pain. She could only walk 1.5 km before she was really struggling and walking with a very severe limp. She rated her pain 10 out of 10 on a VAS. This all dates back to a rock-climbing injury and she was also a competitive rower.

She had two arthroscopies in the late 90s but gradually the knee just got more and more painful. having been so active she was now a the point where she was struggling to walk any sort of distance without very severe pain.  Imaging showed a significant fixed flexion of at least 10 degrees and marked valgus. The X-rays confirmed grade IV disease.

So we did an osteotomy plan and this showed that we could get her to neutral with a 9mm correction which is exactly what we did 4 weeks ago.

distal femoral osteotomy

 I am delighted to say that her pain has now completely gone and she was amazed that she is able to move her knee now and get it fully straight and bend it. Getting it fully straight is really important because it makes the effort of walking so much less when you can fully extend your knee, and she is absolutely delighted with her early outcome. Obviously things need to settle now and she needs to do her rehab, but I am pleased to see that we have a great result radiologically as well as clinically.

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