High Tibial Osteotomy Hypersensitivity at incision area.

Shack

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Hello all. 51 year old active male here (well....I WAS active, hope to be again :loll:)

8 weeks post HTO surgery on left knee, things are finally feeling like they are improving. Decent ROM, minimal actual knee pain, swelling coming down in the shin. So I am hopeful, because the first 6 weeks were, well there's no way to sugarcoat it, hellish! I can put some weight on the leg but not quite up to full-on walking although I can sort of go through a walking motion now with thee crutches..

BUT there is one thing which is not improving and I have not heard that this is a thing. The incision area itself which runs from the bottom of the front of the knee south toward the shin for about 12 cm is super sensitive to the touch. Like I can't even sleep with a blanket on that area as the sensation is is so uncomfortable its unbearable. It's hard to wear pants even. I have to regularly numb it with a gel ice pack, and at night in order to sleep I wrap a tensor bandage around an ice pack to secure it to the area so I can fall asleep.

Has anyone heard of this? Will it get better? Just seems weird that I seem to be alone on this one. I would eel much better about the procedure and recovery if this would stop.

Thanks for having me. :)

Dave
 

Jockette

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Hi and Welcome!

Almost all of our knee replacement members have this issue, and it does lessen in time, as you heal.

Even though you don’t have a knee replacement, I will leave you our Recovery Guidelines, as they will be helpful to you. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​


4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Jockette

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Please give us your surgery date and we’ll make a signature for you. :flwrysmile:
 
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Shack

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Thanks so much Jockette, I appreciate all that great info.

Surgery date was Sept 7, 2021.

One last question. Aside from the incision sensitivity I have one other issue. In the middle of the night I am woken up by pretty strong knee pain. I don't have this in the day.

I have to get up and move around for a while in the middle of the night and it does subside if I do this. Does not see to matter how I sleep, or if I am wearing the knee brace or not. And it is EVERY night, without fail.

Do you know what causes this? and is there anything that can done?
 

Jockette

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I’ve learned quite a bit about knee replacements, but I don’t know much about HTO, but my guess would be that the knee got disturbed a bit during your surgery and it just needs time to sort itself out. Thankfully getting up and moving around a bit helps it subside.

Sometimes extra pain at night is a sign of more activity during the day than our leg is ready for, and/or you may be under medicated.

We tell our knee replacements members that complete recovery takes an average of a year, and it’s probably about the same for what you had done. All these types of surgeries cause quite a bit of surgical trauma to the area, and often beyond.
 
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Shack

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Thanks Jockette. I didn't find the pain meds helped overnight and all they really did was constipate me so I am down to Tylenol and Naproxen now. Again I have no pain in the day aside from right around the incision so I'm ok with this.

Given the HTO horror stories I read online I guess things could be worse at week 8 here. so I will keep on trucking with the PT and keep up on these forums.

Thanks again or your help.

Dave
 

Sara61

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@Shack With regards to the incision being so sensitive I was told in the early days of my replacement in 2019 to very gently rub different types of material near the knee incision to desensitise it, I mainly used materials that I wanted to wear in the future, denim, wool etc etc, it did take time for my knee to feel normal, and fast forward 2 years, I still have an spot that is still sensitive and numb ( very strange having to shave it :heehee: ) I'm just about to do it all again with my right knee, so your post has reminded me to do this again.
Hopefully this will work for you too x
 

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Hi @Shack, welcome! I also did have the extreme super-sensitivity of the incision area to any fabric or such touching it with my first TKR more than with my more recent one, so it is “a thing”, apparently! In my case, since my incision had mostly healed by the time this occurred, I was able to use a magnesium gel I had been given a sample of, and it took away the super-sensitivity when used. The fact that it helped, to me indicted it was nerve-related, so I then realized it would be an on-again on-again type of pain, since most nerve discomfort tends to be that way, at least for me! Bonesmart moderators have a link we can send you if you are interested, I think…
 
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Shack

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Thanks @Sara61 . How interesting! That sounds like a very long process, and with mixed results. But obviously it got better (perhaps it would have anyway?). 90% of the material near the incision will be denim and cotton so I'll give it a shot for a while.
 
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Shack

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Thanks @BBCG. I also feel that this is neve-related which is why I think it may not be so easy to get rid of. So the sensitivity remained well after it healed for you and remains to this day?? (5 years according to the dates in your signature)

By all means I'll take the link for the gel.
 
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Shack

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So now about 9 weeks pot-op. Knee is a little better, range of motion is a little better, but the big issue is the tibia (shin). I mean I get it, she cracked my tibia in 2 and wedged it, I should expect discomfort. But the swelling is unbearable if I am vertical for any period of time at all, which is frustrating as I can actually move around a bit with the knee itself improving. It's keeping me in bed with the leg elevated.

Any tips to speed up the process of healing a shin and bringing down the swelling after an HTO? Would compression stockings help? Do I just have to wait this out?
 

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Are you icing your leg? Many are told to ice no more than 20 minutes at a time. That may work for an injury, but 45-60 minutes at a time is good for post surgery swelling.
Yes, your bone took a beating, but so did all the soft tissue in the area, and that really takes time to heal.

Some of our members do wear compression stockings for a while. Personally I am not a fan, so I never wear them any more than required. They do come in different sizes, so if you choose to get some, make sure they are not too tight.
 
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Shack

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Hi Jockette.

I am icing up, although far less than the time you recommended, mainly because I have been putting the cold gel compress directly on the skin, and 15 min at a time is about a I can stand. Sounds like I should be using a "buffer". The thing is I don't really feel much of the cold through a towel, does that matter? 60 mins would be easy to do if I don't feel much of the cold,

I am wondering about using a tight tensor bandage in lieu of compressions stockings, and then I can ice over that. Kill two birds. Do you think that makes sense?

Thanks again for all your help.

Dave
 

Jockette

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I don’t know what a tight tensor bandage is, I just don’t think you want anything too tight. You can‘t force the swelling into submission. If only we could! :heehee:

Instead of a towel, any cloth will do. A T-shirt or a pillow case could work. You don’t want to damage your skin by putting the cold source right on it.
 
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Shack

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LOL! Yeah that was kind of the idea, wrapping a tensor bandage around my shin tightly and scaring the swelling away. :) I will try a tensor anyways, not too tight though.

And will do some indirect icing for here on out. An hour at a time,

Thanks again. :)
 

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I had a high knee osteotomy and just three weeks ago had the plate and screws removed. As to the sensitivity for me it stayed unfortunately. I was 53 years at that time fit and healthy. So the numbness has and always will be there as far as Im concerned. Good luck with your recovery
 
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Shack

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Thanks Atlas. Hope the screw/plate removal went okay.

5 weeks later now and that numbness is getting a little better but the incision sensitivity is pretty much gone. It does indeed feel like the numbness will continue, so to speak. Just feels weird.

Otherwise a little over 3 months post HTO surgery and I can go for gentle walks without a cane or crutch and can do some low intensity stationary biking. Not much else yet although my range of motion is almost normal now.

As for pain, aside from some arthritic pain overnight (man, I hope THAT stops soon!!) I am not in much discomfort anymore as long as I don't walk too far. But the last month has made me more optimistic. This is good, I was getting pretty depressed.

I was a runner, I am very skeptical that will ever happen again though. Maybe I'll be surprised.
 

Jockette

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I’m glad things are improving and it sounds like you are being very sensible with your activities. Keep being patient, give your leg the time it needs to recover, increase activity very slowly, pay attention to your leg’s response, and you’ll do fine.
 
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Shack

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Thanks Jockette, that is sage advice. I pushed it a little bit a few weeks ago when I felt improved and believe I set myself back. I wonder how many post-op recovery horror stories I hear about are a direct result of not letting things progress at a slow and healthy pace, especially with those who have had an HTO where there seem to be lots of scary stories.

I will pop in every 4 weeks or so with updates. Hope everyone at Bonesmart have a great holiday!

Dave
 

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