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Tibial osteotomy, anybody have it????

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Tibial osteotomy, anybody have it????

Old 01-24-18, 12:40 AM
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OldTryGuy
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Tibial osteotomy, anybody have it????

New sub forum kick-off?

Seeing Dr. this AM and will be discussing both legs having "open tibial osteotomy" to finally straighten out my 67.5yo bowed legs. Being bone on bone isn't too bad for cycling but walking/stairs-not so good. Was talking about TKR but ortho said life expectancy would be compromised due to my desire to continue walking half/full marathons and besides, the osteotomies would still need to be done before new knees are installed.

So as a shot in the dark, it's 1:40AM EST right now, I am wondering if anybody out there has had the procedure, how long was your recovery to full weight and have you had any mitigation of the pain?

Had x-rays and CAT scan last week so today I will find out how large the wedges will be to straighten.

Just because I'm aging doesn't mean I have to slow down.

Thanks for the new sub-forum and thanks for any input.

Last edited by OldTryGuy; 01-24-18 at 04:33 AM.
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Old 01-24-18, 09:30 AM
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CliffordK
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Hmmm...
I have somewhat bowed legs. I never thought about that as a source of knee pain, but perhaps it is.

It sounds like the osteotomy procedure is done within the knee, so I'm a bit surprised it has to be done before knee replacement, although perhaps it is a last effort to prevent the need for knee replacement.

Many knee replacements are supposed to be good for 10 to 20 years, then perhaps require a revision. So, at 68, that would put you up to 78 to 88 before possibly needing a revision. A lot can change in those decades.

My father got bilateral total knee replacement (not the osteotomy). Both at the same time. His reasoning was that he didn't want to have 6 weeks or so of recovery time for each knee separately. Mom, of course, was able to help care for him. He was up and walking in a day or so, and within a couple of weeks was better off than before the surgery. One thing is that he had lost a lot of flexibility in the joints over time, and had significant "rehab" to stretch out his tendons again. Perhaps that is a reason to tune-up the knee before the total knee replacement.

As far as sports after a total knee replacement, I think the data is at least ambiguous.
Total knee replacement for athletes | Total joint replacement for athletes | Sports after total knee replacement | Sports after hip replacement The Stone Clinic
https://www.medicinenet.com/script/m...iclekey=114367

In the first article, the theory was that a lack of exercise was harder on the bones than actually exercising.

A lot of the recommendations apparently are being handed down without data to support them.

I'd encourage you to get a second opinion, especially whether you will need 2 surgeries or just one. Whack off the knees, straighten them, and rebuild in one operation.

This brief article/video seems to indicate that it can be done.
https://www.premierhealth.com/Your-W...eo-Transcript/

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Old 01-24-18, 12:06 PM
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Originally Posted by CliffordK View Post
Hmmm........I have somewhat bowed legs. I never thought about that as a source of knee pain, but perhaps it is..............
This osteotomy takes place below the knee in the tibia. Cut bone, wedge open, insert wedge needed for alignment, screw in template to secure bone. Insides of knees are bone on bone due to bowed legs. If new knees are installed without the osteotomy, undue pressure on the inside and early wearing out.

Met Dr. and we had more discussion. He would do whatever I want but for now I will put everything on the back burner and forget about half/full marathons. He is 4th doc to have been questioned. He is the ONLY one to suggest the osteotomy. He was also Team doctor for Cincinnati Reds for 10 years.

Thank you for your response
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Old 03-16-18, 08:06 AM
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I know this response is a few months late.

Unfortunately, surgeon’s opinions are just that - opinions. It’s hard for patients to discern which opinion makes the most sense with respect to the logic from which the opinion is derived. Sometimes an surgeons’ opinion merely reflects the doctors’ willingness to perform the procedure, regardless of whether it makes sense to do it, in my opinion.

To illustrate:
I was avoiding a TKR on a long-ailing (3+ decades with bad lateral meniscus) right knee. My left knee started acting up a two years back, but really only had some minor patellar cartilage erosion compared with the right one. The main problem with the left knee was that it was taking a lot of the load from my bad right knee. One orthopod I consulted wanted to totally replace the left knee, and partially replace the right. But this one said that he wouldn’t replace the left one until I had a syndesmosis rupture on my left ankle fixed - this was from an equally old ankle eversion.

It turns out that the second opinion I got completely disagreed with the first, on two counts:
First, the second orthopod said that good practice usually demands to fix proximal issues before distal issues - that if I had my tibia end screwed into my fibula to fix the ankle syndesmosis before I replaced my left knee, the ankle syndesmosis repair would be stressed by the change in loading that came from replacing the left knee. He said If it were sensible to replace the left knee, that should be done before repair of the ankle. My ankle surgeon (who repaired my torn achilles) concurred with this analysis.
Second, my left knee would not even be a replacement candidate until I surgically addressed the right knee, since that was a much more compromised joint (no lateral meniscus at all). Once I get the right knee replaced and properly/carefully strengthen both knees, my left knee may simply stop being painful. After all, the left started to give pain only two years ago, the right has been painful for decades, so it made sense that as the right knee became more painful, the left would suffer from “offloading” stresses. Once relieved of this offloading and distortion of muscle loading, the left may simply become quiescent.

So I went with the second surgeon and replaced my right knee. It’s only six weeks since the TKR, and I’m over the largest part of the pain. Hoo - that is major surgery! I have been given leave for another six weeks off work, since my right quadriceps group still is regaining proprioception and full engagement. For three or four weeks after TKR, my right quad would simple ripple like jelly when I tried to do extensions. Since I've biked all my life and not much else, my quads were overdeveloped w.r.t everything else on me!

Anyway from all the above, OP, if it were me, I would be hesitant to do anything to my tibia until I figured out clearly what is going on above, in the knee.
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Old 03-21-18, 10:07 AM
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CiffordK -- As video shows my doctor has a good solution, HOWEVER, the osteotomy is usually done MANY YEARS earlier before it is BONE on BONE.

Originally Posted by CrankyFranky View Post
I know this response is a few months late............Anyway from all the above, OP, if it were me, I would be hesitant to do anything to my tibia until I figured out clearly what is going on above, in the knee.
This last ortho was number 4. What's going on above in the knee is medial bone on bone due to almost 68 years of bowed legs. He even recommended that I delay until I am finished walking half and full marathons.
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