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High Tibial Osteotomy LAman's Recovery to play sports again

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LAman

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thanks! had one of the worst nights last night - they adjusted the brace yesterday, and it felt ok then, but boy, last night was terrible. I'm not sure if its a combination of the adjustment, the removal of the bandaging, and being off the pain meds - but I just could not get comfortable at all wearing the brace. Barely got any sleep at all. Tried raising the leg, flat leg - but no matter what, the brace just feels way too clingy around the bare skin on my leg. I took an over-the-counter sleep aid, and ibuprofen when i went to bed, but they didn't seem to help. I do have a prescription for ambien, but i've never taken it before and am hesitant having heard crazy stories of people getting up and sleep walking down their block in in their pjs etc.

Anyone come up with good solutions of sleeping with the leg brace?
 

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Twice, I had them, each time my kneecap removed. Sleeping is extremely difficult. My best way was with my whole leg elevated. Still it wasn't easy.
 
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LAman

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Yeh, maybe i'll try and double up on the over-the-counter sleep aid tonight. Not looking forward to bedtime! :(

Why is it as I crutch around, I only need to crutch for 3-4 minutes and my right leg feels like its ran a marathon? It gets SO tired and it's not doing anything, just hanging there. My arms and hoping left leg seem to hold up just fine, i'm sure i'd be much more mobile, but my right leg is always exhausted.
 
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LAman

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Hey folks, just adding an update. Now 12 days post surgery. Things are improving in general;

Sleeping - i found doubling up on the sleep aid I was taking has done the trick. Maybe a little too much - I'm probably getting about 6-7hrs of sleep, but when i wake i'm very drowsy and spend 60-90 mins just really waking up. Not really ideal, but def. the lesser of the two evils vs. only getting 2-3hrs of sleep.

PT - I started PT 2 days ago (right at the 10 day mark) and that went well. I was surprised at how nonsensitive my two surgical wounds were - i'd mostly been afraid to touch them, but the PT got right in there with them, and it didn't cause me any problems. They took all the metrics as to how far i could bend my leg and then had me do some strengthening and ROM exercises, most of which are easy to do at home. I've been trying to maintain doing them at least 2-3 times per day. I have scheduled out 2x PT sessions for the next 6 weeks - which is my prescription. My wife thinks I might be able to get a 3rd session approved with our insurance, and if I can, I will do that.

CPM - I've been still using the CPM machine, although will return it tomorrow as I'm told I don't really need it now I can do the PT exercises - also, I've maxed out on the CPM machine, going the full range minus 10-120 degrees at max. speed. I don't think my leg is actually doing minus 10 - 120 degrees, as it passes around 100 degrees I sort of feel my thigh area lifting more, and in the minus range, my leg is not making contact with the base - so i don't think the way the machine functions is quite accurate. Anyhow, for now it has served it's purpose.

Pain - mostly minimal - around 1 or 2/10, totally manageable with no meds, but i take ibuprofen before bed and after i exercise. After exercise, pain increases, but more so my leg just feels *very* tired. A strange sensation to have one leg feel like its run a marathon, and the other is totally fine. Occasionally I get little random pain spikes of a 7 or 8, but just for a second or two, I sort of gasp, and then its gone.

Showering - previously I had to shower in a big plastic sleeve - no longer, I can get my leg wet now. This improves the experience, but, it's still a dangerous prospect getting in there and being in a wet environment without the brace. And it's not something i can do on my own. Right now, I get naked, keep the brace on, my wife puts a plastic chair in the shower, I carefully crutch my way in to it, sit down in the chair, then remove my brace, hand it to my wife, and rest my foot on the shower curb. When I'm finished showering, my wife hands me a towel, I dry my leg, then put the brace back on, before I attempt to stand and crutch out of there. It's a big production, but really seems like an area where I could genuinely do myself some serious damage and therefore worth the effort.

My goal now aside from just trying to improve ROM and strength is to improve my ability to be vertical. Right now, If my leg is vertical for more than 3-4 minutes, whether in the seated or standing position, it gets sore, and my foot in particular gets itchy/sore/red - this obviously inhibits my ability to really go anywhere at all, so I'm going to talk to my PT tomorrow about what I might be able to do to help get over that hump.
 

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I wonder what the PT will say about your verticality challenge? (I made that phrase up!)

It sounds like an alert to elevate more, rather than an alert to push through it.

I hope it improves soon.
 
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LAman

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so yeah, talked to the PT - the general thinking is, its still early for me - tomorrow is just the two week mark, so i still have a good deal of swelling, so elevating is important. But, for my body to ultimately get use to being vertical, i have to be vertical. So she suggested taking a walk every day, and just incrementally increasing the distance so my body gets use to it. I will try that.

PT going well - 3 days ago I measured at 0-85 range of motion, today I measured +2-110, and was able to get to 123 degrees using a harness. So a very decent improvement in that time span. FYI, my legs hyper-extend slightly, so my goal for 'flat' for my right leg is actually +4. From all of the PT exercises, the heel slides are definitely the ones that cause the most struggle, my knee starts to get tight fairly quickly, and its a struggle to get past 100 degrees. But i'm happy with the progress and things should get easier as the swelling subsides.
 
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LAman

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Could an admin change my general tag from OATS to HTO? As I've learned more about the two procedures, it seems HTO is by some measure a far harder/longer recovery time vs. OATS, therefore I think my experiences would be better reflected by the HTO tag.

I completed another PT session yesterday. ROM at 15 days post surgery is now up to 124 degrees unassisted, and 127 degrees assisted. It looks like 132 degrees is my target based on measurements of my non-surgery leg, so i'm not far away. Knee still starts to tighten around 80 degrees or so.

Sleep continues is now my stand-out issue. After two failed nights, last night I took percocet, which has effectively managed my pain for a week after surgery, and had been a good sleep aid (other than having to set an alarm every 3-4hrs to take the next dose of it). Unfortunately it didn't help me sleep, and I had another restless night, well past 3am wriggling around with the knee brace. I'm desperately unhappy and wish I could find a good way to sleep with the brace. I've tried loosening the straps a little, but that doesn't seem to help at all.

I have ambien, which i've never taken before, but am planing on trying tonight.
 

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I completed another PT session yesterday. ROM at 15 days post surgery is now up to 124 degrees unassisted, and 127 degrees assisted. It looks like 132 degrees is my target based on measurements of my non-surgery leg, so i'm not far away. Knee still starts to tighten around 80 degrees or so.
your ROM is very good for so early in recovery. But there really isn't sny need to rush that. Certainly, don't try to increase flexion by pulling on anything. As your knee swelling subsides, ROM will come more easily without any need for forcing it.

There's no need to rush to get ROM because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM will increase naturally.
 
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LAman

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Hi - so, it may be a bit different with my HTO/OATS vs a TKR, I couldn't tell you for sure. What I can say is my surgeon is VERY focused on early ROM ability. My understanding is that one of the two procedures I had (I forget which...) has a relatively high percentage chance for follow-up surgery, I think it was 30%, and the dominant reason was to remove the build-up of scar tissue that had formed in the knee, and tightened the knee restricting ROM. My surgeon says early ROM can prevent the scar tissue build-up, and my PT is also heavily focused on that. I'm pushing myself to make the progress, but don't feel like i'm doing anything silly with it - it's not significant pain, just unpleasant tightening.
 
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LAman

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Just to add on - my last PT appointment I explained the issue sleeping - most of my pain/discomfort being in my surgery leg calf muscle. PT spent a good amount of time working that area, and showed me how to 'roll it out', using a foam roller. Something I am now doing 2-3 times per day. That has dramatically improved the pain, which in turn has dramatically improved my ability to sleep at night.

Today is 3 weeks since surgery. ROM unassisted is at 127/+2. Pain has mostly gone, and occasional. I do get tightness in the knee performing ROM exercises. Aside from ROM I'm focused on rebuilding my leg muscle, and yesterday began blood flow restriction therapy - which is hard work, but i'm told, will help significantly in rebuilding muscle.

I am crutching around much more now. My leg still swells very quickly and turns red in just a few minutes being vertical, but the pain is now minimal. I take an ibuprofen if I know I'm going somewhere and will be vertical for a while, just to help with swelling, otherwise, I'm not on any meds now.

My next appointment with my surgeon is not for another 3 weeks (week 6), but I plan on sending him an update report at week 4 to see if there should be any changes to my setup; currently still no weight-bearing, and brace locked at 0 degrees.
 
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LAman

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Think I must have gotten my target ROM wrong, this week (week 5 post surgery) I managed 135 degrees, and am still a little short compared to my non-surgery leg. Anyhow, progress remains good. Next follow-up with surgeon is 8 days away, and am expecting to start going partial weight bearing then. Can't wait.
 
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6 week checkup today. Things are going well. I'm told my range of motion and muscle development are well ahead of the curve. I'm 135/138 on range of motion - but can mostly bend/straighten my leg quickly and comfortably, and I only get stiffness now if my leg has been in the brace for a while, and then the stiffness goes completely after a few seconds of bending. The 3 degrees shortness on range is only evident when i bend both legs together and compare them. Xrays indicated bone healing is going well, and is on course for standard healing, which should finish in around another 4-6 weeks. They've told me I can ditch the leg brace completely (omg, sleep!), and can now go to partial weight bearing, advancing to full weight bearing as soon as i can tolerate it over the next 2 weeks. Once I'm full weight bearing, i can ditch the crutches. Just went for my first partial weight bearing walk a few minutes ago - alien experience, feels like i'm learning to walk for the first time!!! I found out my insurance has no limits on the amount of PT I can do, so i had them up my prescription from 2x per week to 4x, and will go as often as I can.
 
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LAman

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an update: I'm now 10 days since i started going weight bearing. So far, so good - i typically walk 2-3 miles per day, mostly with very light weight on a single crutch to maintain could walking form. My PT has urged good form with one crutch vs. hobbling around with no crutches and risking hurting other parts of my body through overcompensating. Today I progressed from the one crutch and walked about 1/2 mile with no crutch and maintained good form, some making good progress there, and I can walk at a good pace also. Being mobile again has radically improved everything - showering standing, carrying things, making meals, the list goes on and on. But huge quality of life improvement.

My PT sessions have changed significantly now, with warm ups on the exercise bike, and lots of use of equipment to really try and strengthen my muscles. Blood flow restriction therapy has upped significantly also now, and I've certainly seen a big impact on my leg muscles in just the last 10 days. I typically do about 90-110mins with my PT 3x per week now, and am exhausted when i get home, but it def. feels like progress. I continue to do some PT at home, mostly balance and walking form related.

The biggest concern I have now is about my plate. Reading other HTO experiences, the #1 issue seems to be people having problems with pain/sensitivity or restricted motion ode to the plate. They later have the plate removed, the screw holes in the bone filled, and then there's rehab from that. When I lift my surgery leg in the bent position while standing, i really feel my plate. Pressure all around my shin bone, and quite sharp pain at the top of the plate, just below my knee. I'd hate to have to have another surgery and rehab. My PT reminds me that its still early on in the process, and my body is still getting use to the plate - so I hope it will improve over the coming weeks.

Anyhow, that's it for now!
 
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LAman

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another update - now weight bearing for almost 4 weeks. Progress is good. On the elliptical now, and able to comfortably do 9 minute miles with varied resistance and no pain. Leg press i'm up to 190lbs, not breaking any records, but getting some muscle back in my legs. I mostly walk with no limp now, unless my leg is tired or sore from exercise. Most all PT exercises i'm making good progress with, except step-downs, which are a complete failure. Even at 2inches, a simple step down gives me quite a jarring pain in my knee. Hoping to get past that soon. Expecting new xrays in 2 1/2 weeks, which will hopefully show complete bone healing, and would allow me to progress to light impact exercises. But all in all, very happy with the progress.
 

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