Tibial tubercle osteotomy w/distalization

[TooTrusting]

Anyone had one of these? 15 y/o DD is having it next Saturday. Just wondering what the recovery is really like and what to expect?

Is that the same as a tibial tubercle transfer?
Carried out to correct a partially dislocating patella?

They cut the tubercle off, cut a bit off the bottom, then move it down and sideways and screw it back on. I think it's the same (it is for recurrent dislocations - it dislocates at least weekly and she can spontaneously dislocate it just by tensing her knee - the kneecap is now very worn and if this doesn't work the damage will continue and it will be a knee replacement in about 10 years).
Just wondering how painful she will be in the first few weeks and trying to formulate a plan for school.

That does sound the same.

I had it done but this was about 25 years ago (I was in my mid/late 20s at the time) so it may be done differently nowadays. I have to say though I somewhat underestimated the pain and recovery period as I don't think I realised how big an op it was.

Immediately post-op I was written up for morphine (which gives you an indication of the likely pain) but chose not to take it so managed on heavy duty painkillers and anti-inflammatories and gradually weaned myself off them. I might even have had an epidural or local anaesthetic on one side as well as a general as I remember the leg being numb for some time when I came round on the ward.

My leg was in a brace for a total of about 6 weeks IIRC - once things are settled after the op you gradually have to increase the angle of the brace to get the knee to bend again. I think the only time the brace could come off to begin with was for showers/baths.

It took me a long time (and lots of exercises) to build up strength and muscle in the leg again and to trust the joint as it felt so vulnerable but I got there in the end.

From a practical point of view your DD will have to think about clothing that fits over the leg brace and how to get around safely. Having the leg dead straight is a lot more difficult on crutches than if you can bend your knee!

How is your DD feeling about the op and how is she with pain?

@CompleteBarstool

That does sound the same.

I had it done but this was about 25 years ago (I was in my mid/late 20s at the time) so it may be done differently nowadays. I have to say though I somewhat underestimated the pain and recovery period as I don't think I realised how big an op it was.

Immediately post-op I was written up for morphine (which gives you an indication of the likely pain) but chose not to take it so managed on heavy duty painkillers and anti-inflammatories and gradually weaned myself off them. I might even have had an epidural or local anaesthetic on one side as well as a general as I remember the leg being numb for some time when I came round on the ward.

My leg was in a brace for a total of about 6 weeks IIRC - once things are settled after the op you gradually have to increase the angle of the brace to get the knee to bend again. I think the only time the brace could come off to begin with was for showers/baths.

It took me a long time (and lots of exercises) to build up strength and muscle in the leg again and to trust the joint as it felt so vulnerable but I got there in the end.

From a practical point of view your DD will have to think about clothing that fits over the leg brace and how to get around safely. Having the leg dead straight is a lot more difficult on crutches than if you can bend your knee!

How is your DD feeling about the op and how is she with pain?

This surgeon doesn't use a brace although virtually all others do. I can't envisage how that works really. I would have thought she'd be immobilised at least for the first few days. She's in a very big school so quite a lot of distance to cover between lessons. I'm wondering if she should use a wheelchair at first, or even occasionally because I think going from hobbling around at home on crutches to the distances covered at school overnight might be too much and I'm sure the muscles required for crutches aren't ones that would normally be used much. She is thinking of tracksuit bottoms for school as these will be easier to get on and off. I'm in Wales so non essential shops are opening on the Monday after so I can go and get her what she needs. She's got shortie pyjamas and oversize T-shirts to mooch around in at home. She's quite good with pain I think. But I don't think she realises how painful the recovery might be. They've said she "won't be running around" this summer, but will be mobile and walking, so not to expect too much. I'm wondering how much time I will need to take off work before she will be able to fend for herself. If I make her a bed on the big sofa downstairs she has everything within reach. And I can come home to make her lunch (and her siblings will be home at 3.30 for company). I was thinking if I stay with her at home for 4/5 days. I am aiming for her to be back at school 9-10 days post-op. We'll have to play that by ear. There's a chance it won't work because the problem is hard to fix. She's also hyper mobile so has very elastic ligaments. But the surgeon is quite confident of a good outcome and we have to try because otherwise the kneecap will carry on wearing away. How often did you have the physio? More than once a week?

I've read something about leg numbing as well. Can't remember how they do it, some sort of nerve block.

@TooTrusting ....sorry I forgot to reply!

That's strange that the surgeon doesn't use a leg brace post-op. How is the movement restricted and then gradually increased?

Re: physio - it's a long time ago but I remember having physio before leaving hospital and then going back a few times but not weekly. I was shown how to increase the angle on the brace myself and how often to do it.

With the current Covid situation I'm guessing your DD might have online physio appointments to check her progress?

Do you know how long she will be in hospital for? Once she's home she should be ok to be left after 4/5 days although make sure she has everything to hand especially food and doesn't need to use stairs.

A chair or high stool in the kitchen is good too because if she wants something to eat or drink there she can sit down and have it there/sit and wait til the kettle boils - it's hard work being up and about in those first days and can cause swelling.

Regarding going back to school I think it very much depends on how your DD copes post-op TBH. I remember being very wary being out and about anywhere - I was terrified someone would knock my leg or bump into me. I felt very vulnerable. I think it must have been due to the pain if it was knocked or if I moved awkwardly. It was different to when I broke my ankle for example because although that was painful when I did it, once I was in plaster it felt "safe" IYSWIM. With my knee, it just felt vulnerable.

Keep me updated won't you

Oh my gosh. Literally the worst. The pain is unreal post-op.

I’m now 2 years post-op and I still occasionally need something for the pain.
I was also on vvv strong painkillers for a few months after. I think I took codeine daily for 3-4 months. I wouldn’t say I have a low pain tolerance (I had a natural I medicated birth).

I saw the physio 3 times/week for almost 2 months, then we dropped to once a week. The rehabilitation process is extremely hard and painful.

I laid in bed 24/7 for the first 3 weeks quite honestly. Having a shower every second day absolutely exhausted me. Put a chair in there for him. Also recommend ice packs for swelling.

As for leg numbing, some area of my tibia is still numb. Never came back and apparently that’s ok.

Good luck to your DD! It’s a truly awful surgery to go through!

http://www.gameready.co.uk/Howitt_works.html
I've ordered this which apparently really helps with the pain and recovery. She will be in for one night.
I'm curious too about the no leg brace because this will make her much more vulnerable. That's why I was thinking a wheelchair might be good at school for the first week or two, it will protect her more. I think the school risk assessment means that pupils on crutches (and presumably in wheelchairs) leave lessons 5/10 minutes early so they are crossing the school to the next one while the corridors are empty.
Good idea about the high chair to perch on, we've got bar stools so I can place them strategically.
We have a really good physio. I'm hoping he'll come to the house as his clinic is down narrow stone steps. He was the one who pushed us to get the surgery because of the ongoing damage. It dislocates at the drop of a hat - at the first surgical consult the surgeon videoed her dislocating it spontaneously by doing no more than tensing her knee while lying on the bed. Close contact services are allowed in Wales from Monday so I'm sure that home visits are permitted.

Not sure if I had the exact surgery as your daughter is having but due to recurrent dislocations I had surgery where they removed a strip of my tendon from my thigh and drilled hole in knee cap and a bolt to hold new tendon in place. That was 10 years ago now and I was young when I had it, little older than your DD. Remember they wouldn't let me out of hospital until I could go up and down 3 steps. The pain and recovery was long and hard. I had lost all strength in my leg and found using a long scarf (hooked around the bottom of my foot) to manoeuvre my leg in and out of bed etc worked really well and allowed me a bit more independence. Remember being on tramadol for a few weeks due to the pain but the physio is the most important thing to focus on. 10years on I've had no problems and it is so strong (even though mentally I still feel it is weaker) . Only thing I struggle with now is when it gets really cold, can feel the knee seize up a bit. Best of luck for your daughter!!!

@beanys they can't do the tendon repair because she's hyper mobile and it will just stretch again. But the pain and mobility issues will be the same. The scarf is a good trick, thank you for that.

She had it done at 8.30. Took about 90 minutes. Full of morphine in the recovery room which was quite comical. She's been very good but it's starting to hurt now so she's about to have more morphine. The leg was very numb when she came round so I think that's why the first few hours were ok.
She's had the Gameready icing machine sleeve on her leg all day and it's set to go on automatically for 30 minutes every hour. My friend said that really helped him. She is to be non weight bearing for 6 weeks which will be tricky. She's quite wobbly on the crutches, although to be fair it's only day 1 and she's only got up once to go to the loo.

Oh bless her, she' might be in the "why did I have this done" phase that I remember in the early days when it was really painful and I wasn't very mobile.

So how does the icing machine work? Can she still wear it when she's up and about? That's where the brace was great as it kept your leg in one position and meant you were less likely to knock it or bend it too much

We are home now.
The icing machine has a big Velcro sleeve which goes round her leg knee to ankle. It has a tube leading from it to the machine which has a tank in it and it pumps ice cold water through that to a pad inside the sleeve. There are different settings, but the one we're using does 30 mins on/off and it constricts then releases. She likes having it on because it's almost like a splint and she can't make sudden movements by mistake. It's supposed to speed up recovery significantly.
Consultant says he likes movement to start immediately and that's why he doesn't use a brace, but if she feels too vulnerable at school then she can have one. I'm worried about her on the stairs but I'm sure she'll get less wobbly.
She's remarkably cheerful, but I suspect it's because the nerve block hasn't fully worn off yet (consultant pretty much said that and warned her she'd find this next 7 days very hard).

This is the machine

It looks like a good idea for reducing swelling and for resting but I can't imagine what it would be like when not wearing it.

It's when you move your leg a bit too far/a bit too quickly that it would really hurt. Ouch.

I guess though that research has shown it works for a quicker recovery in the long run.

This is like the leg brace I had, with the adjustable bit on the side. I had to gradually increase the maximum angle of the bend over time.

Dr said if she doesn't get on without a brace then he will give her one but he thinks it's better to try without.
She's doing remarkably well. The game ready really helps with the pain. When she puts it on in the morning she sighs with relief as the cold really numbs the pain.

How is your DD doing @TooTrusting?

Really well. Overdid it when a friend visited, but nice for her to see them. She tried school today and only managed until 12 but I was expecting that. So she's going to go in part time for this week. She's fine at home with her ice machine but travelling between classes and having her leg down all day is too much.
Thank you for asking x

I'm pleased to hear that she's doing ok.

Its a long old slog and will be exhausting at times especially if she's at school too but good on her for going in yesterday even if it was only for half a day.