High Tibial Osteotomy

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  • With all due respects to the surgical opinion out there. 

    But the one common deniminator is the lack of global approach to dealing with the possible causation of the knee issue. 

    Understood if the legs are really bandy, I can see how that helps alignment , but to do a unilateral operation, opens up a whole new world of assymentry that will manifest down the line. 

    I beleive an holistic approach to dealing with the knee, including a Podiatric opinion of functional mechanics, and physio opinion of muscle function and rehab, and an osteopath opinion of pelvic assymentry. As a part of whole approach.

    maybe I'm just smoking weed, dreaming about this potential ????

  • Thanks Tim,

    I've searched high and wide to find some accounts of people that have returned to running after a HTO. There are a few stories of people returning to distances up to marathon distance, so I'll take that as the green light to give it a go. Most professionals seem to advise against it, although I'm not 100% sure why that is. I'm guessing it's because of accelerated damage to the remaining cartilage. I'll have some more discussions with my surgeon post op. When are you booked in Tim? I'm scheduled for February 8, and am still really struggling with the justification of whether or not I'm in enough pain and discomfort to warrant this op. What are your symptoms Tim. Although I can't really run, I can cycle unimpeded at the moment and am wondering if I'm a fool to take 8-10 weeks off activity all together.

    Look forward to your reply

    Steve
  • Hi Steve,

    Thanks for your response.

    I'm booked in on 2 March. Like you I can't really run but can do most other things that I want to. Again like you I'm laboured over the decision as to whether to proceed or not frequently weighing up "its not that bad" and " I'm doing brown ones in my pants over the recovery time and process" with "its not getting any better" and "Eventually it will turn ugly". Most of all however I do think that if you've got to get something like this done at some point - better to do it while you and young and fit with the best prospects of a speedy recovery. If your going to cop 10 weeks on your bum in a brace may as well bring it on sooner rather than later.

    My symptoms are pretty tame at this stage - just a saw knee after a do a hill walk and or leg weights - nothing radical.  

    If I believed that I could return to running it would have made the decision a lot easier. Unfortunately my orthopod is pretty well dead against it saying that this is a treatment not a cure and even with the meniscus transplant I am on borrowed time with the knee. I'm not game to go against his advice but I will pressure test him post op to see if I can get the green light.

    At the end of the day I've decided to take a spoon full of concrete in my coffee and get on it with. I've a 2 YO little girl and number 2 arriving in July so I'm justifying it to myself that I'm getting it done so I can take them hiking, snowboarding and generally get around with them until they are adults. 

    Steve, I'll be with you in spirit on the 2nd mate - hope it goes well and would love to hear back from you to see how your going.

    Cheers

    Tim

     

  • Hi Tim,

    Sounds like we are in a similar situation, except my kids are teenagers!

    im booked in for Feb 8, and would be interested in maintaining contact and swapping rehab war stories. Feel free to contact me on

    [email protected]][email protected]

    If you are also interested in communicating.

    where are you based?

    Although there are not too many people out there that I know have had the operation, there is a lady at my work who had both legs done last year, and is fighting fit now. Although she is not a runner, she said she feels like her legs would be up for it.

    I've put myself on a YouTube ban after watching the procedure, best to be ignorant in this situation I think.

    cheers

    Steve

  • I have bilateral HTOs. Rt knee 12 years old. Left knee 9 years old. Have good days and bad days but pretty pain free for the most part. Gait sucks but it is what it is.  Again, I'm pain free. Was a big runner before all this and cried when I could not resume to the level of running I previously was use to. Also I sell hip and knee replacements for a living to orthopedic surgeons. Here is my advice.......... Unless you want to expedite getting a total knee quit running! Cold hard truth. Instead you can bike, walk,  hike, and ellipticle. I even crossfit but shuck the knee moves in circuits. Biking is the only thing that I have found that can give me the runners high that I miss. By the way I refused to accept this fate at first as I tried to run again. It was a painful disaster and just really bummed me out.  Again take my word for it if you try to run again you will be running into getting a total knee fast!!!!! No sugar coating it!!!!! Its hard I still dream at night about running again believe me.
  • Hi All, I am new here , and see this forum and felt I had to offer some insight into my own HTO experience.
    I was a regular runner cross country and 1500m and was also a keen footballer,
    Unfortunately I suffered a serious ACL injury in 1988 playing football,
    I was never properly treated at my local hospital and remember just having a plaster cast for 6 weeks, as there was no break when x-rayed.
    several years later, I could still get over the injury and while trying to return to sports, it never really materialised, I was psychologically damaged, my knee would come out of the joint.
    Things deteriorated further as I reached my 40's and I was struggling to even walk without pain.
    I decided to see a consultant and had the cartilage trimmed and flushed out, but it never really helped, and I soon developed a limp and struggled with day to day walking.
    It was then after a frustrating 2 years,
    I visited a consultant who was a specialist in his field for sports injuries and knee reconstruction,
    Having had scans I was advised I had the knee of a 80 year old, due to the original ACL damage,
    It was suggested I have the HTO and in 2013, I had the procedure.
    It's not a nice procedure, as anyone who has had it, will I am sure agree,
    but it's a life changer for me, i no longer have a limp and while even to this day I still have numbness, around the scar it's getting less and less, 
    My knee still is loose and will still move around, but I am not in pain unless I walk for 8-10 miles.
    I still want to return to running one day, and while I can strap my knee to improve the movement, I still have psychological doubts.
    Would I have the procedure again on the other knee if required, absolutely without a doubt.
    I was off work for 3 months, and I am not the best patient, as I have no patience.
  • PewpewpewPewpewpew ✭✭✭
    Just to add to this thread.  There is an alternative to HTO called knee distraction.  It very much depends on the state of your knee and the extent of the damage already done but you should ask your consultant about it.  It is still in its infancy but basically what we do is hold the joint slightly apart and inject a stem cell mix into the joint to create new cartilage.  The knee is fixated in this position for 3 months then you begin rehab.
  • I did here of this particular procedure a few years back, but it was such a new concept, there was not many consultant's trained in the procedure.
    But this sounds like a great alternative and less intrusive procedure.
    Hopefully this will become more and more popular once the benefits are taken into account over a HTO.
  • Hope people still talking about this subject.... I had a bi-lateral HTO and arthroscopies on 15 Feb 2017, so now into week 7 post op. I chose to have both done at once because each knee was as bad as the other - I'd not been able to run or cycle for around 18 months and was walking like a bandy legged old lady - I'm 55. I also didn\t want to go through the awfulness of the operation and recovery period twice! And I can assure you that the recovery is just as difficult as the consultant warned and very much a roller coaster. Wheelchair bound for first 4 weeks and then allowed to partial weight bear using crutches in weeks 5 & 6 - I just zoned out of the outside world for five weeks and tolerated not being able to do anything for myself really. Luckily mum and daughter looked after me for those five weeks and I could work on my laptop lying down with laptop on a banana board!
    I'm still pretty helpless as I can't drive yet, can't walk properly, still use crutches, mostly just one to help with balance and stairs, but have followed consultant and physio's instructions to the letter - absolutely crucial. You think you're not going to be able to bend or straighten your legs the first day or so after the op, but you can and you should, in fact, a nurse helped me by pressing down on my leg to flatten it!
    I do about two hours physio a day at home on my own, listening to music and imagining being actually outside on my bike cycling up the hills again. I started on my turbo trainer the day after saw consultant at 6 week point - okay so long as you have v little resistance on it. Two days after that I wobbled out on my mountain bike round the village and felt elated to be outside again!!! Sciatica was my enemy after sitting around for so long, but another set of eight exercises seems to have got that under control at last! Had it for three weeks and it brought me to tears often.
    I don't dream of running again for a long time, but I do dream of walking properly, driving where I want when I want, swimming in the cold lakes, going to the pub and being able to get up from the table and walk to get a round in without looking like a bow legged old lady... my dreams are tiny at the moment, because I'm holding back on the energy I always used to have and the urge to do too much too soon. I'm looking long term... the next ten or fifteen years... I'm only seven weeks post op... but I'm getting there, I think!!!
  • New to forums, but could really do with being in touch with someone else who has had a HTO. I had mine on the 23rd Feb.
    Everything to do with the operation has gone well, my difficulties are all linked with the rehabilitation. I see the physio once every 3 weeks and the exercises are concerned with strengthening the quads but as a consequence of using ankle weights as instructed at week 7, I tore my medial hamstring. It has really set me back due to pain and then stiffness.
    Week 9 I started seeing a sports injury therapist as well as the NHS physio. She is hands on and has focused on lengthening my hamstrings through massage as well as some exercises without weights and using hydrotherapy.
    Week 11 whilst using weights again as instructed by NHS physio, I felt meniscus pain in the joint, which I hadn't had since before the op and now it swells, clicks and is painful. I had an aspiration last week but it doesn't prevent the swelling returning.
    I have lost faith. I don't know anyone who has under gone this procedure, so I'm not sure if these set backs are common place and normal, or whether the NHS physio is following the wrong rehab protocol for this operation.
    I'm hoping the meniscus pain I now have will reduce in time, or if it is a sign that the whole thing has been a waste of time.
    Can anyone offer some encouragement, please?
  • Hey all. This forum and the stories really helped me decide to go ahead and get my HTO. 

    I snapped my ACL about 10 years ago. Wrongly diagnosed for years. Got ne ACL however the inside of my knee has worn away - stage 4 arthritis and chronic pain. I had to do something to stop taking pankillers daily. Went through Bupa and got HTO done two weeks ago. 

    I'm struggling with the recovery atm. Everytime I'm on my crutches and my leg is hanging down the weight/gravity is causin me real discomfort where the plate is. It's unbearable at times. Has anyone else had similar issues? 

    Thanks
  • Here I am on day 3 after my HTO looking for similar stories and this forum has helped a lot. I'm a 48yo male, not a runner but injured my meniscus 20+ years ago stepping off a kerb. I have always done weight training and as long as I kept up the squats didn't have too much trouble with my knee until a few years ago. I had the meniscus shaved about 2 years ago which didn't help. The ortho said I was a perfect candidate for an HTO due to my age ang activity level so decided to give it a go as I was continually re-injuring my knee on uneven ground etc. The weight bearing cartridge on the inside is almost gone and the outside is pristine. I am having trouble doing the physio knee bends but looks like this is normal at this stage. The entrance to my house has a dozen stairs and I live rurally so I'll be at home for a while. Anyway thanks to all who have shared their experiences.
  • Seen surgeon again today. He said the pain I'm suffering is scar tissue inside. Can go on for months. Got another xray to confirm everything else is good - which it is. 

    Might be a longer recovery than anticipated.

    Hey Svenmal. 1st couple of weeks are tough. Gets much easier to move and rotate knee. 
  • Thanks Moonheid. I have the same pain when I get on the crutches and move around. Good to hear all is normal.
  • Moonheid - the pain you are getting when on crutches is normal i had that for quite some time,it's like a weight pull down and stretching everything thing at the back of your knee. it can be quite painful bt will ese up as the swelling and bruising dies down. I my my HTO in Nov' 2014 at 48 yrs old and had the plate removed in Oct' 2016 and find i have a lot better flexibilty with it removed. Recovery from HTO is a long process i reckon it took me a good 14 - 18 months to fully recover and for my leg to get adjusted to it's new alignment and load bearing axis etc, but it's been well worth it. I can cycle, hike, swim and do some good weights, i haven't tried running as i don't see much point in taking the risk when there are other impact free options. It's a long process but hang in there it's worth it in the long run (no pun intended).
  • Gonzalezgomez, thanks for your comments. The pulling pain has already stopped. Still a fair bit of swelling and the more I do (which isn't lots at the moment), just walking short distances causes a fair bit of pain at night. Manageable though. I'm about 6/7 weeks post op. Just started physio, been told I'll be doing it for 2/3 months. 

    I'll be happy if I'm pain free and pain killer free. Not fussed about running again. 
  • Hi everyone,

    I am new to forums so bear with me.....I had my hto on 16th March at UCLH and it was the best decision I have ever made. I suffer hEDS - hypermobility Elhers Danlos Syndrome. In easy terms I have faulty cognitive tissue so it's like being stuck together with a cheap print stick rather than superglue!! so I am prone to dislocating joints which my right knee has been my biggest issue since I was 13 (now 44). I have had 9 knee operates prior to this one but nothing worked. I was on high strength pain killers for nearly 18 years ( Remediene Forte, Gabapentin and Tramadol) and I am now tablet free....which feels amazing and a little sureal after so long of being dependant on them to allow me to work and go to gym. I have learnt to manage what pain I have through pacing and exercise.

    It was after an MRI last year I was told in December I would need a total knee replacement which due to my age I wasn't keen on and it meant I would have to stop my body pump and body combat classes at the gym. I plucked up the courage to say no to the replacement (after years of just having done what I was told was my only option.....so my consultant suggested an hto. He explained it wasn't a nice operation and the recovery was long and that wouldn't be the end of my journey as some time in the future I would need a full replacement but hoped it would give me another 10 years before I had to have that done. So I decided to go ahead although really nervous after previous failures.

    The day of operation went well and due to a spinal injection had very little pain.....then it wore off I was not ready for the pain level I then had. I ended up in hospital for a week while they got my pain under control. The first few weeks were hard when I got home and like you all I was non weight bearing and pretty much stuck in my house. The only time I could go out was with my hubby at the weekend I a wheelchair (known in our house as my wheels of steel....lol) However as the weeks went by the pain eased and I slowly stopped my pain killers (nasty withdrawal effects after so long on them but I was determined). I went back to see my consultant at week 6 so nervous that he would tell me it hadn't worked but it had and so far everything looked great. My physio is amazing and with her support I have felt I can succeed. Went back to see my consultant at week 12 and he was really pleased and at last allowed me to go back to body pump with light weights....I was over the moon as it was a bit of normality.

    I had to take four months off work and now I am back on reduced hours as I have an hours drive to work but getting stronger everyday. I am suffering with what feels like electric shocks where my nerve endings are slowly coming back to life and it feels tight. It aches too but I gues that's to be expected as I start doing more. Hardest thing is ensuring you don't over do it to early.

    It was certainly a tough few months during the start of my recovery (not used to sitting doing nothing so found it hard) but I have stuck to exactly what my physio and consultant have told me and I am better than I have been in years and it's till early days.

    I am happy for people to contact me by email if they want to chat further privately. [email protected].

    Keep Smiling
    Tara
  • Hi, 
        I'm new to this site.
    I had bilateral hto late March. I was 59 and a half at the time.
    I was bedridden for 4-5 weeks, then wheelchair onto zimmer then crutches onto two sticks and now one stick.
    The before and after X-rays are remarkable, I've got straight legs for the first time in years.
    I don't see the Surgeon (Matt Dawson) again until next month. I know I got two done but I thought I would be off mobility aids by now. I'm not able to do stairs properly yet and my work involves climbing stairs for 12 hours.
    Its frustrating not to be able to get about as I'd hoped but Surgeon says it will all fall into place.
    Has anyone else had both done together and how long before you were fully mobile.
    Best decision I made and no regrets. Only had 5 days of real pain when first out of hospital. BMI in Lancaster helped me as they recommended an epidural. It was absolutely great. Surgeon is a top bloke as well as a top Surgeon.
  • Hey Tara. Welcome and thanks for sharing. Very happy to hear that it went so well. I'm pain free from the majority of the time now. Been told my knee cap is a little off and because of this I get the occasion jarring. This is more than manageable. 

    Strange question for anyone. Did you leg around the operation site get hairier? At the moment it looks like I've got someone else's leg on. It's unbelievably hairy.
  • Hi Moonheid

    Not a strange question at all as it seems that I am now having to shave my leg more than before!! Which is odd I have to agree. 

    I was back to see the consultant last week as I have a sore area where the bottom of my plate is. He believes it is scar tissue which has attached itself to the plate (just my luck) but in his words "it's ok Tara I'll just take the plate out" I nearly fell off my chair as this was not what I was expecting him to say. Thought he would just tell me to toughen up and it would go eventually. So as they like to have the plate in for 12 months looks like I'm going back in mid march to have the hard wear out
  • Sorry seems to have lost the last bit of my post.....

    I nearly fell off my chair when he told me it would have to come out. I'm nearly over the pain of having the plate put in. He did say this operation not as bad as the last....thankfully...least once it's done that should be it for many years to come. 
  • Hey Tara. I've heard of folk getting the plate out. What kind of recovery is involved in that operation? My surgeon seems to think I'll have mine till I get a full replacement. Hopefully 20 years down the line. Hope it all goes well for you. 
  • Hello all. Stumbled across this forum a few weeks ago and wanted to say how much it has helped me. I am now into my 2nd week post op. Got lots of lower leg bruising which is very tender to the touch. Also enduring agony every time I stand up with the pulling sensation. I'm assured thanks to this forum that this is all normal and I'm really looking forward to losing these damn crutches in about 5 weeks from now. Thanks
  • Hello friends of HTO!
    I am a 48 year old man who decided to go with the HTO. I also had what is called a Maquet Osteotomy. I also had arthroscopic treatment. My knee is also stabilized with Tomofix.
    I am on three and still in bed most of the time. I have started physio and the knee is very stiff. The muscles in my leg are weakened due to no use. I am using crutches but this is still very limited due to the pain. I am trying to manage the doses of the pain meds with stool softeners.
    I really regretted my choice to do this procedure after the first 10 days. I have never felt such continuous pain. Now the pain is manageable with drugs and I can at least function.

    I Really have enjoyed the discussions and I feel optimistic that this was the good choice. I have one more week to lay in bed and work on physio and then I am going to try and go back to work with crutches until week 6.

    Anyways, anyone out there want to share success stories, would really like to read some.

    For those just starting, the first week is tough, but it will get better.
  • I have just turned 50 and had my HTO operation on Tue 7 Nov. My operation was to correct wear on the inside of the knee. I was a keen runner, cyclist and swimmer. Up until the operation I was still cycling and swimming but gave up running some 8 months ago.

    The consultant told me that he was happy with how the op went and that I must put as much weight as possible on my leg to promote the bone knitting effect through the inserted and donated bone wedge. The first night after the operation, the pain was quite epic but after a few drugs I managed 2 hours sleep. I now have the pain in some sort of order mainly using paracetamol and the occasional use of codine phosphate.

    I have been home for a couple of days now and sleeping is improving every night. The mornings and evenings seem quite challenging in terms of managing the pain. When I stand up and use the crutches it feels like the whole bottom of my leg is on fire and swollen to almost bursting. When I rest the leg it is fine.

    Can anyone advise on what I can do to alleviate the swelling. I've tried cold compresses but this doesn't seem to work. Also how long does this last?

    I'm happy with my recovery to date but clearly it is only early days.
  • Left leg HTO plus microfracture Sept 6th.
    Prior to the op I did as much exercise as possible to help build up my leg muscles which I think really helps in speeding up the recovery process.
    I managed to be in and out of hospital the same day, which I believe is a bit unusual but I was determined to get out.
    Post Op the first week I really focused on the physio and getting my leg back in full movement, I’ve had to do this before following an ACL replacement on my right leg so understand how critical it is in speeding up recovery.
    I was unrealistic about what I could do post op and spent a bit more time in bed than I expected to.
    I was non-weight bearing for 6 weeks which was the most difficult part of the whole process.
    I could drive after a week as my car is automatic but this meant I stopped taking painkillers relatively quickly. To be honest there was little pain from my knee, mainly from my lower leg and foot.
    Leg elevation (foot above the heart) I found really helped with the fluid build-up in my lower leg and the pain from this. Also exercises designed to prevent deep vein thrombosis on flights.
    I stopped using crutches after week 6 post op and in the last week I have got up to 1 hour on the gym bike. I am 8 weeks post op and walking without a limp unless I become tired. Really focusing on building strength in my hip to get back to normal.
  • Hello to all,

    I'm new to this site. Also, I'm looking for some answers and would like to read how things go for other people with similar problems.

    My husband (39) had HTO on left leg (no graft insert) + microfracture in May 2017. He was a runner for 20 years.

    Now, 6 months after the surgery, the bone did not completely union. X-ray pictures from 2 months apart seems the same (last taken a few days ago), and can't see much progress in bone healing. It is like the process of union stopped at a half. He is swimming and riding a bike for two months now, and driving a car for three.

    How long did it take for your bone to heal completely, till complete union? I'm a little concerned that it is healing to slow.

    Wish you all the best,
  • @bunny_M my consultant and physio estimate 9-12 months
  • Bunny M, non-union does happen but it is rare, especially in men.  Only your consultant can give you the answers you are looking for.  Does he smoke or is he overweight?  Everyone is different, he may need a graft.
  • I posted a comment in November shortly after my Op. I am now 6/7 weeks post Op and hopefully this post may help someone understand a bit more about the journey after the Op. My Op involved placing donated done graft in the brake to assist the healing. The consultant told me to put weight on the leg straight away which surprised me as I was anticipating that wouldn't happen to week 6.
    Around about week 2 I managed to get off painkillers and just occasionally took some paracetamol if the pain came back. I was walking with two crutches every day outside for 30 minutes at a time. I also hit the gym every other day and concentrated on the excercises the physio gave me along with 30 minutes on the exercise bike.
    By week 3/4 I was able to stand for more than 30 seconds without my leg feeling like it was going to explode. By week 4 I was down to one crutch and walking short distances around he house without a crutch. I kept the gym going every other day, increasing the resistance on the bike.
    By week 6 I returned to work and was walking without a crutch, I used the crutch occasionally when walking more than 1/2 to 1 mile. I managed a 15 mile cycle on my road bike but took it easy.
    As I sit and write this post I am no longer feeling any pain or aches, I still raise my leg when sat for long periods and the swelling has all but gone. Muscle is returning slowly and all looks good.
    I'm glad I went with the op when I did and didn't leave it to late.
    The physio said he could have me back running in 6-9 months but I'll take that one step at a time, may just stick to cycling.
    Hope this helps anyone who is thinking about having the Op done.
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