Osteotomy / knee trauma advice

[holliscx]

Hate to air my medical history but I've got a question about a knee osteotomy.

Has anyone had one or does anyone work in trauma that could comment?

The Cliffs Notes is I had a bone tumor (Giant Cell Tumor) that was discovered in my knee in 2017. Two weeks later I crashed on my bike and broke my leg. The femur fracture healed by itself and I had knee surgery to remove the tumor in February 2018. I'm almost 2 years post and everything is looking good except that my leg got bowed off straight a couple degrees which has affected my gait. I don't like to walk anymore for it's bothering my hip. I avoid going anywhere with my kids or taking them to do activities because I don't want to walk. This is a bear and I have to find a way to get back closer to fine.

I had an x-ray taken before summer of me standing and they said the difference is so negligible that I should just keep trucking along.

Tonight I met with a friend who's a knee trauma surgeon. I gave her my x-rays. She hasn't looked at them yet but she said that I should have my tibia cut to realign my leg to straight.

The only good news apart from the tumor is controlled and I'm almost in the clear for recurrence (3 year benchmark) is that I feel good cycling. My quad is still MIA maybe because I'm still favoring my good leg but my bad leg was switched off for almost 3 years possibly more so I think it takes awhile for the muscles to climb back if they ever will.

But if I'm having trouble walking due to a bowed leg from the femur fracture what kind of doctor do I need to see to rule on an osteotomy? Based on my limited research and talking to a friend who is a knee surgeon who has known me through all of this is that my only or best option? She was explaining to me that osteotomies used to be more common but at least in Spain they've been replaced by prosthetics. But she was stressing that it's a pretty common procedure that all trauma surgeons have been trained to do.

Again sorry to air my medical laundry but I really need an opinion on this for I'm trying to be proactive to get my leg back closer to normal so I can have quality of life.

Appreciate any feedback. What are the downsides to osteotomy is it safe to do at 44?

I lost a few degrees ROM in my knee so I can't bend it back all the way. I don't think this matters but forgot to mention.

[j44ke]

So how long have you been working with a physical therapist and doing targeted exercises to increase strength in your quad and restore muscle balance to take displaced work load off your hip since you recovered from the break and the removal of the tumor?

[holliscx]

So how long have you been working with a physical therapist and doing targeted exercises to increase strength in your quad and restore muscle balance to take displaced work load off your hip since you recovered from the break and the removal of the tumor?

I had PT for 6-7 months pre-surgery after I broke my leg and then probably about the same amount of time post-surgery. Was never able to get back full ROM in my bad leg (I went in to surgery with about 110 degrees ROM)

I joined a gym and was doing squats and leg lifts trying to rebuild my muscles but when it was affecting my cycling I ditched the gym with good weather but I'm thinking about rejoining. My quad is MIA but it makes a lot of clicking sounds when I do seated leg lifts especially. I really don't like to sit there and grind through reps when my knee sounds like Rice Krispies with milk.

I rode up to the hospital today and made an appointment with my trauma surgeon for the 24th of this month. I've always told him my bowed leg bothers me but so far nothing has come from it. He's been proactive but not as much as I wish as his priority is monitoring and controlling the tumor which he's done exceptionally well. I'm going to try to stress again how it's affected my quality of life and see what he says we can do. I don't really want to mention osteotomy but I will and ask if I should see a specialist or anyone who can help me with straightening out my leg. I'm sure an osteotomy will be a trickle effect and the next hurdle in a lifelong struggle. Damn it would be nice to have a straight leg. It really sucks to not want to walk. The good news is I don't notice it much cycling due to cycling being non-weight bearing and for whatever reason I feel decent biomechanically or not as off as I do walking.

[j44ke]

So you are doing exercises now on your own without guidance from a physician or physical therapist who is familiar with your medical history and who has seen x-rays of your leg even though you are having trouble walking to the point where you avoid walking? Does that sound logical to you? I mean, you are still injured essentially.

[AngryScientist]

I'm definitely not qualified to be commenting here, other than to say that i think it's remarkable what the human body is capable of adapting to through physical therapy and just time. there are so many people who are bio-mechanically [very much] imperfect and able to get around very well.

if it were me, i would avoid major surgery at all costs without first exhausting the PT route to straighten the walking issues out.

just a thought.

[holliscx]

So you are doing exercises now on your own without guidance from a physician or physical therapist who is familiar with your medical history and who has seen x-rays of your leg even though you are having trouble walking to the point where you avoid walking? Does that sound logical to you? I mean, you are still injured essentially.

I think you're oversimplifying it's more complicated than that but you're right that I am essentially still injured. I can walk fine as in get around to lead my daily life it just sucks to do so.

It's kind of like my brother he shattered his tibia into 20 pieces. They reconstructed his leg and put pins in but told him he would have a knee and hip replacement in his lifetime.

I feel like I have X many miles that my body can go with this bowed leg so I just don't like to get out and push it. I'm actually looking into purchasing a Brompton for the city to get around by not walking. Smaller wheels are more city friendly than 700c.

I thought someone might've had an osteotomy and could chime in

No amount of physical therapy or strength training will straighten my leg — I'm not a doctor but I know my body and I know that's the problem — that said with the trauma and femur fracture + tumor and knee surgery I think straightening it is a delicate situation. It may not even be an option I don't know.

I'm definitely not qualified to be commenting here, other than to say that i think it's remarkable what the human body is capable of adapting to through physical therapy and just time. there are so many people who are bio-mechanically [very much] imperfect and able to get around very well.

if it were me, i would avoid major surgery at all costs without first exhausting the PT route to straighten the walking issues out.

just a thought.

Agree re: the human body. That's one of the reasons I've ran and cycled most of my life I'm just in awe of our bodies' potential. And you're right under duress they can adapt amazingly too.

But there are a lot of gimps on the streets too and I currently am one which I don't like

[randonneur]

If I were you, I wouldn't be so quick to dismiss the idea of targeted therapy and training (physio, weight training, yoga or otherwise) managing to effect change.

I'm just gonna throw this out there (and there's a good chance I'm completely wrong) but your knee and quad are not the problem (anymore). Your problem is your core and maybe your hips and your subconscious body. You said yourself that a Dr reviewed your x-rays and said the skeletal difference was negligible. And you've also said that you've essentially spent 2 years protecting the injured leg.

I feel like I have X many miles that my body can go with this bowed leg so I just don't like to get out and push it.

As AngryScientist mentions, the human body is capable of remarkable adaptation. Your body is subconsciously still actively working to protect the injured leg, and that is working against your full recovery. And on top of that, it looks like you're consciously working against yourself here also. If there's anything I've learned about working with physiotherapists, it's that your body kind of needs to be pushed. I'm essentially echoing J44ke here, but get out there and work it (with the help of professionals).


(the part between 10:30 and 15:00-ish is particularly inspiring).