Osteotomy: high tibial (valgus) osteotomy
Discussion
Has anyone had, or know about, the above? I have quite badly bowed shins and for years have thought about getting something done about it as I believe it to be the cause of the knee pain I get (and was Medically Discharged from the Army for). I have only found out about this procedure today and it looks like this should sort things out. Some links for reference:
http://noyeskneeinstitute.com/bowed-legs/
http://www.royalberkshire.nhs.uk/patient-informati...
http://noyeskneeinstitute.com/bowed-legs/
http://www.royalberkshire.nhs.uk/patient-informati...
I haven't had one ( yet) but I was a candidate for one a while back before they went a different route. This wasn't for bow legs, but because I have an arthritic condition exacerbated by sports that basically means that I have no cartilage and an underlying bone surface like a moon crater on one side of my left knee where I should have a nice smooth hemispherical cartilage covered bearing surface.
The suggestion for the HTO was to shift the weight bearing onto the relatively up damaged side of the knee to buy me a few more years of less painful motion.
In the end we/ they went a different route with various bits of carbon fibre and stuff to patch it up for a while longer with the full expectation that I'll need a knee replacement at some point. Went through all the discussions though with surgeons at the RNOH ( the leading ortho place in the UK- all the good knee boys have generally spent time there). Relatively common procedure - well understood and practised. I would have gone for it but we went a different way in the end.
One of my friends who also enjoys "rugby knees" has had it done, however. He was non weight bearing for about a month - crutches and then had around 6 months of increasing physio/ getting back to normal. He has an office job but it does involve a lot of long distance air travel as well which he avoided for about 2-3 months post surgery. His view was - yes it was painful - all bone surgery is, I'm afraid- but he's glad he had it done as now - a year on - he has "forgotten" that he has had it done unless someone asks him about it and the previous pain from before the op has gone.
Hope that's helps a little
The suggestion for the HTO was to shift the weight bearing onto the relatively up damaged side of the knee to buy me a few more years of less painful motion.
In the end we/ they went a different route with various bits of carbon fibre and stuff to patch it up for a while longer with the full expectation that I'll need a knee replacement at some point. Went through all the discussions though with surgeons at the RNOH ( the leading ortho place in the UK- all the good knee boys have generally spent time there). Relatively common procedure - well understood and practised. I would have gone for it but we went a different way in the end.
One of my friends who also enjoys "rugby knees" has had it done, however. He was non weight bearing for about a month - crutches and then had around 6 months of increasing physio/ getting back to normal. He has an office job but it does involve a lot of long distance air travel as well which he avoided for about 2-3 months post surgery. His view was - yes it was painful - all bone surgery is, I'm afraid- but he's glad he had it done as now - a year on - he has "forgotten" that he has had it done unless someone asks him about it and the previous pain from before the op has gone.
Hope that's helps a little
He worked from home for a month or so.
Re both legs at once - maybe; we can't have you walking in circles....
More seriously, I don't know if they would in practice as you'd effectively be completely immobile until you can weight bear again. Your ortho doc is the best bet for that sort of question rather than just us spackers on here!
Re both legs at once - maybe; we can't have you walking in circles....
More seriously, I don't know if they would in practice as you'd effectively be completely immobile until you can weight bear again. Your ortho doc is the best bet for that sort of question rather than just us spackers on here!
a) If you want to come and see me about this, then I am a surgeon that does it. And I do it because it can be a very powerful way of putting off a knee replacement, because that's what it's for.
b) in Reading there are people too, ironically one of the three best guys in the UK is in Basingstoke (Adrian Wilson), and as a friend of mine I cannot rate him too highly, more than that he teaches other surgeons how to do it. http://www.hampshireknee.co.uk/contact-us Your GP will advise if he is accessible through Choose and Book. Otherwise it's chequebook time.
c) in most cases you can walk on it immediately, in fact I have done both legs at the same time on patients, so they have to walk on something.
d) a valgising osteotomy or HTO is not for every case, and you need an experienced knee surgeon, specialising in treating younger knees to choose the best for you, or rather offer the best for you.
Any more detail about it really needs to be done in person, as with all medical advice of gravity.
b) in Reading there are people too, ironically one of the three best guys in the UK is in Basingstoke (Adrian Wilson), and as a friend of mine I cannot rate him too highly, more than that he teaches other surgeons how to do it. http://www.hampshireknee.co.uk/contact-us Your GP will advise if he is accessible through Choose and Book. Otherwise it's chequebook time.
c) in most cases you can walk on it immediately, in fact I have done both legs at the same time on patients, so they have to walk on something.
d) a valgising osteotomy or HTO is not for every case, and you need an experienced knee surgeon, specialising in treating younger knees to choose the best for you, or rather offer the best for you.
Any more detail about it really needs to be done in person, as with all medical advice of gravity.
The_Doc said:
a) If you want to come and see me about this, then I am a surgeon that does it. And I do it because it can be a very powerful way of putting off a knee replacement, because that's what it's for.
b) in Reading there are people too, ironically one of the three best guys in the UK is in Basingstoke (Adrian Wilson), and as a friend of mine I cannot rate him too highly, more than that he teaches other surgeons how to do it. http://www.hampshireknee.co.uk/contact-us Your GP will advise if he is accessible through Choose and Book. Otherwise it's chequebook time.
c) in most cases you can walk on it immediately, in fact I have done both legs at the same time on patients, so they have to walk on something.
d) a valgising osteotomy or HTO is not for every case, and you need an experienced knee surgeon, specialising in treating younger knees to choose the best for you, or rather offer the best for you.
Any more detail about it really needs to be done in person, as with all medical advice of gravity.
Errr, wow. I saw the Basingstoke clinic was the leaders in this area, good to know it is rated highly. Would be a bit of a mish to Cumbria to see you though. Does a fist gap between knees and a medical discharge from the army count as a good reason? Wish this procedure was about 13 years ago!b) in Reading there are people too, ironically one of the three best guys in the UK is in Basingstoke (Adrian Wilson), and as a friend of mine I cannot rate him too highly, more than that he teaches other surgeons how to do it. http://www.hampshireknee.co.uk/contact-us Your GP will advise if he is accessible through Choose and Book. Otherwise it's chequebook time.
c) in most cases you can walk on it immediately, in fact I have done both legs at the same time on patients, so they have to walk on something.
d) a valgising osteotomy or HTO is not for every case, and you need an experienced knee surgeon, specialising in treating younger knees to choose the best for you, or rather offer the best for you.
Any more detail about it really needs to be done in person, as with all medical advice of gravity.
R8VXF said:
Heya Doc, I have a question on the whole smoking thing. Would Vaping be okay? Or is it all nicotine related products that affect bone healing?
thanks for the kind comments above all,as for smoking/vaping, there is little evidence on what vaping actually does to your body, but as it's the nicotine that interferes with blood vessels (closes them off) and stops the osteotomy ever healing then you can see the answer..
If I had a patient who wanted to continue vaping around the surgery, I would not perform the operation upon him. My colleagues use as a rule of thumb: stopping all nicotine abuse (!) 3 months before and 3 months after.
ironic eh, you can get back on it once it's healed.
and because I have a few minutes spare, it's not the bow-ed-ness of the legs, but where the Mikulicz Line passes through the knee that we alter:
cruddy picture, but I cannot post up my patients' actual images. That picture is a closing lateral wedge, whereas mostly now we do a medial opening HTO
It's the Minacci Method using Mikulicz's Line aiming ideally for the Fujisawa point.
easy eh?
cruddy picture, but I cannot post up my patients' actual images. That picture is a closing lateral wedge, whereas mostly now we do a medial opening HTO
It's the Minacci Method using Mikulicz's Line aiming ideally for the Fujisawa point.
easy eh?
R8VXF said:
Looks like about 800 for the surgery alone iirc. Got consultation costs etc on top of that. Am sure The Dock will be able to fill in more info. Think I found that information linked from the Basingstoke Knee hospital website.
Surgeon consultation £150-£250Surgery (package price) .......... try £6,000 to £10,000 -Surgeon's fee makes up a small proportion of this
a phone call to any Spire/BMI/Nuffield would give you this kind of number, or the actual nailed down price for self pay. Geographical variations account for the range.
The_Doc said:
Surgeon consultation £150-£250
Surgery (package price) .......... try £6,000 to £10,000 -Surgeon's fee makes up a small proportion of this
a phone call to any Spire/BMI/Nuffield would give you this kind of number, or the actual nailed down price for self pay. Geographical variations account for the range.
I just assumed fees meant total cost, not the surgeon's fees. Surgery (package price) .......... try £6,000 to £10,000 -Surgeon's fee makes up a small proportion of this
a phone call to any Spire/BMI/Nuffield would give you this kind of number, or the actual nailed down price for self pay. Geographical variations account for the range.
Anyway, saw the Dr yesterday and she is sorting out the forms for referral and I asked to go to the Hampshire Knee clinic. She said she would put it on the form
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