High Tibial Osteotomy + Mensicus Transplant - Complete Fracture!

[Viper6]

Hi everyone

First post here.

I have just undergone a meniscus transplant and high tibial osteotomy around five weeks ago. I was always for the meniscus transplant (as I had two arthroscopies previously to clean up the meniscus after a tear). I had just started to develop symptoms of pain and swelling, and could see on the x-rays that the meniscus had thinned out in some areas. I was however was extremely hesitant and really not keen on the high tibial osteotomy, however the specialist convinced me it was the right way to go as it was pointless just having the miniscus transplant without the osteotomy (something about changing the wheels on the car but not aligning the tyres). The meniscus transplant would be 'the icing on the cake', but the osteotomy was mandatory.

At the initial consultation with the surgeon, we discussed the procedure and the risks. We discussed a break in the shin bone just below the knee and wedge removed, and this was to be closed with a *staple*. They would then insert a meniscus from the bone clinic from a donor.

Unfortunately there was a complication with the HTO which I found out the next day (all up the operation was just over 4 hours long for both operations, resulting in a massive additional cost from the anaethetist as well, but that's another story). Apparently when they were breaking the bone, it broke too much all the way through the adjacent side. The specialist was uncomfortable leaving it the way it was so ended up putting a metal plate and screws on the adjacent side of the knee (remember I was only supposed to get a staple on one side to fix it!!).

The surgeon advised that a complete fracture across the osteotomy site was pretty rare and this was only the 6th time it has happened out of 100 osteotomies he has performed. He seemed to indicate it was because I had really strong bones (I do go to the gym quite a lot and do lots of cycling).

The more I read and research, the angrier I seem to be getting. I know that with every operation, there are risks, however I don't feel I was adequately informed of these risks beforehand. I was advised that there was the potential for blood clots, infections, poor bone healing, anaesthetic issues, etc, and the % risks associated with each of those, but was never informed the bone could break all the way through and end up with metal plates and screws

Basically I had a few questions:

1) Has anyone else had any experiences with an osteotomy whereby they end up with metalwork on *both sides* of the knee to hold it together? From everything I have read and researched, most people only get a plate/screws/staple on ONE side?

2) How do you think this would impact recovery time? My operation was 5 weeks ago and I can barely bend the knee more than 10-15 degrees (basically just lifts off the ground). Is that normal given what I have experienced? I am starting to get really really worried and anxious as I am watching YouTube videos of people walking around after 3 weeks after an osteotomy and bending it like Beckham!

3) How many of you have the plate and screws removed down the track? Surgeon seems to indicate that if it doesn't worry you, leave them in? However what if you need to have a knee replacement down the track, don't you need the plate and screws removed? Seems like you should get it done after a year or two, not 10-15 years down the track as the screws grow and solidify into the bone which makes it harder to remove?

Appreciate any thoughts and comments, as you can imagine I am pretty down and upset right now given the complications that have occurred.

[vickster]

Sounds like you've had a rough time. It's a major surgery with a long recovery. Yes, some people might be recover really quickly but they could well be the exception when they just have the osteotomy. The meniscus transplant in itself is also a major surgery with a long recovery period

I'd try to stop thinking about what might have been and look forwards, find an expert physio in rehabbing the surgeries you have once you have been cleared by the surgeon to start physio. A good physio will, in my experience, also help you work through the psychological side of recovery too

I'm not sure what you mean ahoy a staple? My understanding is that there are always a plate and screws with an osteotomy to fix the realigned bone

This surgeon is a UK osteotomy expert, there's some potentially useful info on his site, including X-rays to show what metalwork is used etc

http://www.hampshireknee.co.uk/knee-pro ... my-surgery

There are a few HTO stories (possibly not with the meniscus on top) and pretty much all say a good year to recover. Indeed, the link above says a year to remove the metalwork to be sure the bone has healed.

Good luck

[Viper6]

Thanks so much for the reply!

Here is a picture of what I signed up for and what was explained would occur with the staple fixation.



To be honest if I knew there was a chance of getting two metal plates and screws, I never would have gone ahead with the osteotomy and would have just done the meniscus transplant and see how that went..

You are right though that it is now done and dusted, and I have to try move on. Have my 6 week X-Ray this week and provided the alignment is satisfactory, I'm due to start physio next week. Hopefully I can get more bend in the knee because at the moment I am a little worried!

[slightfield]

Hello,

I had a DFO 6 weeks ago and my bone "broke" all the way through too.

[Krav3211]

Viper, I had an HTO just over 9 months ago. Certainly not a walk in the park. 6 weeks non weight bearing; and another two weeks walking with crutches. Then ankle issues. It takes awhile to get that knee bending and a lot of commitment to P/T to get the strength back. My 7 month strength test...I was still about 30% weaker than my good leg. Again, frustrating, but at least I know there is room for improvement. Definitely an up hill battle, and I still have bad days, but I think it was worth it. Just be patient and stick to those initial exercises to work the bending and flexing. It'll come. When you start some strength training, just take it slow, but definitely stick it out. It's a journey and unfortunately you can't turn back. Don't second guess yourself....it will get better. It sucks they split you completely through, but after the bone heals you won't even know the difference I'm sure. By the way, I was told my screws and plate would come out after a year...only to be told later they are staying in. They don't bother me, except if I bump them, so no biggie.

Just hang in there! I kept a journal with my progress; had intended to post it on this site. Simply because this was a "different" kind of procedure. I had your same concerns about "how many degrees should I be at..at 3weeks, at 6 weeks, etc". Perhaps I will still post it. But until then, if you have any concerns, just ask. Someone here will post to you. Good luck!