osteotomy vs partial knee replacement vs anything else?
Posted , 5 users are following.
Hello,
?Just some background as it seems to be a long story. After months of left knee pain went to GP who referred me on. Had steroid injections which did nothing.
Had arthroscopy/microfracture in Dec 2013 which was a disaster, more pain than ever before and off work for 4 months (couldn't bend or kneel which is vital for my work). Had right knee done in 2014 which was a success. Interestingly the physio I saw after the left knee said he felt the knee was out of alignment (more of this in a bit).
Back for another arthroscopy/microfracture in April 2015 which did make a bit of a difference. Surgeon said the previous microfracture didn't work. Got on with it and ignored the constant pain.
?Gradual deterioration and back to GP for more referral 2016/17 Through another round of steroid injections & hyaluronic acid injections. The first doctor I saw in 2017 - not a knee specialist - this is the Virgin Care musculoskeletal clinic; said I would need a partial knee replacement, sent me for mri then phoned (no appointments just telephone consultation) to say I had severe inflammation of the pes anserinus and a steroid jab would cure it along with physio - there was nothing wrong with my knee as such.
?Well this didn't work - not a jot. Physio gave me exercises, which I did, ultrasound treatment and strapping. I seem to have multiple points of pain, the knee cap itself constantly aches - all the time. This is a dull grinding ache. Then I have the sharp pain at the point of inflammation - very painful. The pain keeps me awake at night and does impact on my life. I cannot sit with my leg at right angles without pain at all. Strangely my mobility is very good - I can flex and bend and straighten it. I am consistent in doing my strengthening exercises and stretching too.
?So back to Dr who referred me on to the consultant sports knee specialist for some ultrasound shock treatment which first Dr assured me would cure the problem.
?Saw this man who looked at my knee and said I had multiple problems, the main one being my knee is out of alignment and wearing the medial (?) inside bit of my knee. Which in turn is causing the inflammation problems. He talked about doing an osteotomy to realign my leg/knee.
?He said my situation was not clear cut in that he wouldn't say yes he would do it. He said the inflammation problems will not go all the time my knee is wonky. He has sent me for a set of xrays and another mri which is this week and I have another telephone appt at the end of February.
?The pain is constant and does affect my life. I have a physical job in that I have to be able to get up and down off the floor multiple times a day (I work with disabled pre-schoolers). I like my job and would like to continue to do it. I'm 54 - nearly 55. I have been advised to lose weight. I have lost over 10lbs in 3 weeks. I know this must be beneficial and know this is a good thing to do, so am determined to do so. I know it must have made a difference but the pain has not eased at all. (I don't know what I expected really!) But I will lose it.
?So, after all that, my question is; does anybody have any experience of this? I can understand the reservations of doing a partial knee replacement at my age - once there's no joint you can't go back the other way. However cutting a bit of bone out of my leg and plating it also seems very drastic. But it does give me the option of a replacement later if necessary. Consultant did say that there are not many options for arthritic knees apart from replacement.
?I've had a bad weekend pain wise so feeling a bit down and lost. I would just like the pain to stop for once.
?What ever I have done I am committed to aiding recovery, I am very good at following through on physio etc. I also get very good sick pay from work which is something to consider. I would rather have something done now while I am young enough to be able to recover well. How much should I push for something to be done?
Has anybody had an osteotomy vs knee replacement?
?Thank you and thank you for getting to the end of this very long ramble!
0 likes, 7 replies
Snoozy69 trizwizz
Posted
Hi it looks like you have had a lot of input and choices I take it this was through private health insurance. Everything I have gone through has been through the NHS so minimal input. I was only 47 when i had a total knee replacement last September. I tore my meniscus cartilage in my early 20s and had an arthroscopy where most of the cartilage was removed there was no attempt to try and save the cartilage and so I was bone in bone straight away. In my 30s arthritis had set in I ended up having 3 steroid injections which did nothing and then another arthroscopy. At this point I was told I needed a knee replacement but because of my age nothing would be done. So there has been no attempt to prolong the life of my knee it's just been left to wear away. I managed a good 12 years but this last year has been really bad, my knee was very deformed and damaged so unable to do a partial knee replacement or any other op so that's why I ended up with a TKR.
Ive heard an osteotomy is very painful post op but if it prolongs the life of your knee and they are still able to do a TKR later on in your life it's a no brainer.
just a word of warning you said you want it sorting while you're still young enough to recover well. Since having this operation I have found that it is the younger ones that have struggled more with pain issues and mobility and more importantly flexion. I'm 4 months down the line and I'm still taking time of work and my flexion is rubbish compared to some. I am dedicated to my exercises but you just dont get rewarded for the work you put in. I can walk a fair distance now but bending my knee is a problem.
I hope you find the right solution for you x
trizwizz Snoozy69
Posted
Hello Snoozy - no all through the nhs. I think this is why it has taken so long!
?I have been told the damage I have is equivalent to a professional rugby or American football player! If you could see me you would see why I laugh when told this! I have been sporty in my past but I have only ever swam or cycled - no impact sports at all.
?Walking for more than an hour is difficult now which is annoying. Work is an issue.
?Yes it seems that osteotomy is painful - I suppose they are breaking your leg, cutting a bit out and sticking it back together. &yrs ago I had an osteotomy for my toe joint - ended up with a large purple melon on the end of my leg if I stood for more than a few minutes for the fist few weeks! I can imagine doing that to a tibia will be very bad.
My flexion is good I think - I am conscious to keep on going and bending and flexing and keeping my hamstrings stretched as well. I swam for many years and my quads are reasonably good. Just wondering if they don't touch my knee but do my leg would it affect my flexion?
marilyn10235 trizwizz
Posted
Hi there, this really is a hard one to comment on!
I hasten to say that I have not had osteotomy so cannot comment on that.
My route to TKR was, I had arthroscopy on my left knee in 2008 as the surgeon strongly suspected a tear in the meniscus. In fact 2 meniscus tears were found. Arthritis was also found in the joint at that time.
After having all sorts of problems with my left knee I was re-referred to the Orthopods & X-Rays taken & given physio. In 2009 I was also referred for my right knee. After more X-Rays, in 2010 I was told that there was no treatment other than TKR that would alleviate my problems but I was too young for TKR & to go away until I couldn't stand the pain any more!! I was told no treatment would help, not steroid injections, nothing!
In fact it was the right knee that had TKR 1st in 2016, the left just 5 weeks ago.
My treatment has been solely under NHS.
From listening to my friend who had private medical insurance, I do wonder at the amount of treatments that private medicine throws at people! The NHS is more straightforward but a lot slower!
My friend was given numerous treatments, some of which exacerbated her problem & actively made her ill! I add she did not have osteo arthritis!
I'm sorry if I seem to be on a soap box but having watched someone being made ill like that really upset me!
As to your present problem, if the osteotomy will solve your problems in the short term but still give you the option of TKR in the long term, what choice do you have? Other than a 2nd opinion?
Having lived years with deteriorating arthritis in both knees, I know what long term pain can do!
Has the surgeon said you WILL be pain free after this op? You really must weigh up the pros & cons before you even consider this procedure!
Marilyn
XX
Snoozy69 marilyn10235
Posted
Marilyn I absolutely agree that with treatment under the NHS it's very straight forward you either have the op or you live with it. there doesn't seem to be treatments available to help prolong the life of your joint I suppose there just isn't the funding to do this
trizwizz
Posted
Thank you Marilyn, your long slow route seems similar to mine. It has all been through the nhs - no private care
In fairness to the nhs I don't think the service I have had has been bad really. In 2016/17 I also had prolapse surgery (going over 50 seemed to mean a new bit of my body fell off every week!) The first surgery for that didn't so much fail as reoccur in a different place. I pushed and persisted for the second surgery which was done last July and has worked and is much better. The surgeon I saw for that said it was because I was committed to recovery that she and the physio pushed at the mdt meeting for me to be done (the other gynae and colo-rectal man were not keen)
?I can see the point of the nhs trying other things first.
?As to my knee I am getting to the point where the impact on my life is getting greater. I do take painkillers but don't find they work particularly well. I am prescribed co-codamol. use ibuprofen gel for relief of the inflammation (try not to take ibuprofen in tablet form) was prescribed amitriptyline for the pain at night as well. They take the edge off it but it doesn't go really. It doesn't seem to really make a difference if I take them or not.
The surgeon hasn't said I will be pain free. I think this will be up for more discussion at the next appointment.
?I am sorry to hear of your friend's problems. I am a little sceptical of private care in a way - yes I think it can be quicker but the people are in it t make money - it's a tricky one
jenny80029 trizwizz
Posted
Well done on the weight loss!
Deformed knee .... treated surgically with a knee replacement worked well for me. Now 11 months post op. It's great.
Read around this forum, and you will see its not an easy operation to get over.
But does have potentially life changing results with respect to mobility. I don't know about the osteotomy compared to TKR.
Don't know what your BMI is but I would say get it down to 30, as it makes recovery so much easier. Sounds like you have the right mindset for whatever you choose.
I am 52, and my TKR experience has been very good. Surgeons cannot tell exactly what your knee is like until they get in there! It is depressing, endless pain and lack of mobility.
Do you use a stick at all?
Not good for the ego, but can make a big difference.
Weight loss didn't help my pain, but it is well worth it regardless, as it helped the experience of my surgery, I am certain. Now mobility is easier and I am keeping the healthier habits I worked at so hard.
You may like to go to my profile by clicking on the image next to my name. I kept a journal of my own knee replacement journey, and I have been told by several people they found it helpful to read, or skim through. It has a lot of useful suggestions and information. Hopefully it might be useful to you.
Trust your instincts after doing as much research as you can on your options. I knew my knee was screwed and was desperate to have it treated surgically. I am very glad i did, as i can now get on with living my life.
Depending on how disabled you are, and how depressed you are getting, I am sure you will make the right choice for yourself. The main thing is that you absolutely want whatever you decide to have done. That way, you will have the determination and commitment to get through all it entails.
Blessings to you!
trizwizz jenny80029
Posted
Thank you - I do feel that something needs to be done. It's been a long time and it's getting worse now after the brief respite after the second surgery. "016/17 were somewhat taken up with the other medical issues - prolapse etc so I only now have the mental energy to think about this. I think my mobility is compromised - I'm certainly not elegant when I get up off the floor at work these days!
?I will continue with the weight loss - eating sensibly - not putting rubbish down my throat! Seem sensible to do so. The consultant recommended weight loss as a first thing so if I want anything done I have to show commitment - that I can do it.
I don't use a stick - unless out walking then I have the proper walkers stick things - can't think of the name. I am wary though - I don't like stairs these days.
?I think I had a bad weekend as well - elderly parents too are a problem. I don't normally get down. I'll bounce back I'm sure.
I look forward to the next appt (in a way). Hopefully the xrays +mri will give an idea. He did say he wouldn't do another arthroscopy as it wouldn't be worth it.
?I'd like to know someone's experience of the osteotomy was.