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Do I or don't I?

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ship4

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Re: HTO v's TKR

Hello Pieman, and Welcome to BoneSmart.......
Do you have degeneration in the knee joint itself? What exactly is the issue for the possible TKR vs the Osteotomy?
My son, at age 7 (now 32), had Bilateral De-rotation Osteotomy in each femur to correct a hip issue which allowed him to walk straight without tripping himself all the time.
Just wondering what the actual issue is........
 

Josephine

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Re: HTO v's TKR

This is a surgery to relieve the pain of arthritic changes, Crystal. Different thing altogether.

Pieman, I would never let anyone do osteotomies on me. They are, at best, a two stage knee replacement - meaning that most HTO patients ultimately end up having a replacement anyway.

It involves cutting across the tibia just below the knee (that's what osteotomy means - osteo = bone; otomy = cut) and adjust the angle of the upper part so the weight bearing area is changed. Then a plate and screws is used to secure it. So effectively you have a broken leg and have to be non-weight bearing until it heals. Probably about 6-8 weeks. It's also an exceedingly painful procedure.

ai39.tinypic.com_33otnw3.jpg
ai39.tinypic.com_2s1lt6x.jpg


We used to do these a lot years ago before knee replacement was perfected. I doubt many good knee surgeons would support their use these days.
 

milanfire2

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Re: HTO v's TKR

Thats what the Cleveland Clinic Drs. wanted to do to both of my legs 7 years ago. I think. Help me here Jo they wanted to take a pie shape out to straighten each leg to take weight bearing off inner knees,. Does that sound right. Any way didnt let them do it.
 

Josephine

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Re: HTO v's TKR

Yep - that's the point of the angle in the diagram. Wouldn't be much point in doing it if they didn't remove a wedge to alter the angle of the top of the tibia to thereby alter the weight bearing of the joint.

Still doesn't work much, though.
 
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PieMan

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Re: HTO v's TKR

Jo - if the consensus seems to be No to HTO - then why would RHOH suggest it as a possibility - is it because of my age. They are the experts ! - has surgery techniques improved making a HTO more viable now. If they suggest it as the appropriate course of action how have i the knowledge to question it. Thinking as a layman - breaking the leg to reposition weight doesn't sound too clever - lots or room for error, recovery sounds horrendus and if it all goes wrong can it cause complications for a TKR.
Regards
 
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Re: HTO v's TKR

Pie,
You are right Jo has given you some good points to bring up with the Doctors. Please keep us informed.
 

Josephine

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Re: HTO v's TKR

Jo - if the consensus seems to be No to HTO - then why would RHOH suggest it as a possibility
This is Stanmore that has suggested it? :shk:

Which surgeon are you seeing there? Is he a member of Professor Brigg's team?

Remind me how old you are? You're not displaying your age.

I would ask them to quantify
1. how effective is JTO - or in other words: how often do patients with HTO have to be converted to TKR and how soon
2. how long is the recovery/non-weight bearing period
3.
how often do they get failed union
4. at what point does the ironmongery get removed
5.
how does the HTO impact upon the ability to convert to TKR
 
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PieMan

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Re: HTO v's TKR

Jo - i am 46 - yes it is Stanmore - my consultant is Ashton ( not seen him ) who was a registrar for Briggs who is now retired.
 

Josephine

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Re: HTO v's TKR

Well, that explains it! Ask to see Briggs or Cannon.

I wouldn't have it done at any age. It's really not worth it.
 

skigirl

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Re: HTO v's TKR

Pieman,

Remember that doctors are not gods. They are also not the Pope and thus are not infallible!!! Remember too that some graduated at the top of the class and some at the bottom.

Plenty of docs get stuck in a rut and don't progress much beyond their initial training. so, if HTO was big in 1970 and that is when the doc was trained . . . .

I regard myself as part of my health care team. I spend a lot of time researching my illnesses and different types of treatment. I want the surgeon to work with me--not pontificate from on high.

Lance Armstrong is a case in point. He went to one group of docs for his testicular cancer and they recommended a treatment that would have destroyed his lung function. He then visited a different group and they recommended a treatment plan that did not include the drug that would have destroyed his lungs. As we all know, the second plan was quite successful. However, if Lance had not done his own homework and explored more than one team of docs---he would no longer be a professional cyclist.

I have a friend who had a HTO and she very much regrets that decision. It was horribly painful for months!! And, now that she needs a tkr, it is a much more difficult surgery working around the fracture, the missing bone and all that hardware. I think you need to research that procedure a lot more.

If I had a surgeon who offered me only one solution---HTO---I would run for the door. I do not want someone so rigid and out of date. I want someone who is open to my own thinking and who would offer me more than one solution to the problem of arthritic knees. Good luck with your quest!! Kelly
 

Josephine

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Re: HTO v's TKR

Plenty of docs get stuck in a rut and don't progress much beyond their initial training. so, if HTO was big in 1970 and that is when the doc was trained . . . .
Exactly so, Kelly. Great post.
 
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PieMan

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Arthritis grades

Dear Bonesmart - just had a arthroscopy - whilst they trimmed cartliage, removed some tissue deposits and abraiding ( i think thats what the consultant said ). He also mentioned thta the medial side arthritis was grade 4 - just wondered if someone could explain the various grades and the implications.

Cheers Pieman
 

Tykey

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Re: Arthritis grades

Hi, pieman.

Grade 4 should mean your bones are rubbing together because the cartiledge has worn away (called bone-on-bone on here). That's how I was in November last year.

Normally, that means you need a knee replacement. I've now got mine, and it's a wonderful improvement.

Didn't the Consultant discuss it with you?
 

Josephine

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Re: Arthritis grades

The Outerbridge Classification
  • Grade 0: normal cartilage
  • Grade I: cartilage with softening and swelling
  • Grade II: partial-thickness defect with fissures on the surface that do not reach the underlying bone or exceed 1.5 cm in diameter
  • Grade III: fissures to the level of underlying bone in an area with a diameter more than 1.5 cm
  • Grade IV: exposed underlying bone.
 

Jamie

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Re: Arthritis grades

What you had done was "debridement" where the surgeon grinds away at the cartilage to clean up rough edges. Sometimes it can buy you some time before needing a TKR.

Generally the grades indicate the amount of cartilage loss that exists. A grade 1 or 2 would indicate some breaks in the cartilage layer, 3 a loss of some cartilage, and 4 (the worst grade) would normally indicate bone-on-bone in that compartment of the knee joint.

You are going to need a TKR or a PKR at some point. But when will depend on your pain levels and how your life is impacted by the arthritis.
 

Jamie

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Re: Arthritis grades

Once again, Jo!!! Gosh we are TWINS today!!
 

Josephine

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Re: Arthritis grades

Sometimes it can buy you some time before needing a TKR.
And sometimes it can accelerate the condition. Just saying!
 

Jamie

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Re: Arthritis grades

Yep....that's exactly what happened in my case.
 

nephronurse

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Re: Arthritis grades

I had a few of those "debridements" myself. In my experience, I had a rougher time with the arthroscopies than I did the replacement.
 
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