Improving alignment before partial knee replacement

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Mark is a local physiotherapist with a large practice and he’s always pushed himself with sport his whole life. 

He is young at 52 and has struggled with severe knee osteoarthritis for many years. He had a very noticeable thrust and “wobble “ as he walked, and had really quite bent or 'varus' leg. 

With these problems he was struggling with day to day activity and walking was becoming an issue. He has a very active life as a physio and also was heavily involved with the army which was becoming more and more difficult to keep going.

When I talked to him initially about options we both knew that these were limited. He wasn’t suitable for a partial knee replacement as his leg was already too varus, and he had some instability from his medial collateral ligament having had a significant MCL injury in the past.

So at that stage we opted to straighten the leg and re-tension the MCL by carrying out a high tibial osteotomy. This is a technique that works really well to deal with the MCL as well as medial arthritis.

This worked very well and got him walking normally and left him with a beautifully straight and stable leg.

He still however had discomfort with sport and wanted to be able to do physical activity and couldn’t. He was still limited for sport.

So this week we carried out a medial partial knee replacement because the limb was now straight after the osteotomy, and things went very well.

At day 3 he has no pain and is walking off his crutches. The big message today was 'slow down' !

This is a good example of how we can use osteotomy to open up other joint preservation techniques and stabilise ligaments.

My injury occurred through excessive use of military training with the British army. Currently still serving and need to return to full fitness. I am a physio in the reserve forces and run a private physio clinic Physio4life in Putney. I have worked with many many orthopaedic surgeons over last 25 years and when my knee started giving me problems which wasn’t fixed with physios and arthroscopic intervention and injections I realised this was a much more serious condition requiring major knee surgery. I sought out Professor WIlson as he was leading orthopaedic surgeon in tibial osteotomy which was believed to be best course of action for me to return to sport at this stage.
Over the last three years since the knee first developed discomfort I had two knee arthroscopies, numerous cortisone injections and aspirations prior to seeing Prof Wilson.
The tibial osteotomy by Prof Wilson was two years ago, followed by PRP injections and stem cell injections at the Regenerative Clinic.
Although tibial osteotomy has helped massively enabling me to walk pain free, I have never been able to walk for longer than 15 minutes without developing discomfort and unable to stand at a bar for longer than 10 minutes before discomfort in the back of knee required me to sit. This in my line of work in the army or as physio wasn’t acceptable, and so following further reviews I opted to have a partial knee replacement. Combining both tibial osteotomy and partial knee replacement we are hoping that I will be able to return to full fitness in the army reserves and sport.
The option for medial partial knee replacement is to return to me to a full functional life for both army and home life. The ability to go skiing and hiking is vital for my mental health. Over last three years I have put on weight and the stress from being unable to do my army job and sport has played heavy on my mental well-being.
It is very early days, but my expectations are to be able to return to an active life and be able to return to full duties with the army. So far I have had no issues with recovery from surgery and am currently resting over the Christmas period using a GameReady and having regular specialist massage to reduce swelling, which is the main post surgical issue I have. I had minimal pain following surgery which was brilliant and able to walk with a normal gait pain free by day three post surgery.
Professor Wilson and his team have been amazing throughout the last two years and I highly recommend anyone with knee problems who requires surgical intervention to pay him a visit.

Mark

Patient/Physio

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