Post Tibial Osteotomy and returning to work as well as starting Physiotherapy

Recovery in weeks 3 and 4 (Feb 2018)
In the weeks surrounding returning to work, I did find it tiring in the afternoon. I was able to work from home for a reasonable period; it helps the sense of things returning to normal.

Trying to balance a laptop, having a bag of frozen peas (to reduce swelling) and laying flat as much as possible does get uncomfortable – be aware. The swelling is getting less and some mobility was returning. I am going out more for a walk around also.

Starting Physiotherapy (at last!!)

Physio day (at the One Hatfield hospital) was something I was really looking forward to. In the same week, the UK was being braced to abnormally cold weather. Very challenging journey indeed to the hospital!

Loiza was worried on the day to drive. The outside temperature was around -1 to -3 centigrade on the day but snow was very light. In my mind I was completely set on going and would have driven myself to get there. I say this because I had set my mind to get to this milestone-  its where the expert can tell me if my recovery is going well and what i need to do to get better. Having stopped work at 2pm, we set off.

I have to say that just sitting in the car and going for a drive is something i really enjoyed.

We waited for the physio to arrive and sat with a coffee.

We met with the resident physio, Craig. He started by testing my strength, assessed flexibility. He then went over additional exercises. Examples for strength exercises are :

  • Lying on the floor and lifting the leg up 6 inches and lowering slowly
  • Tensing the Quads and pushing the knee down
  • Bring the knee to your body
  • Roll up a towel, rest under the knee and straighten the leg
  • Stand up and hold a ball behind the knee and push the leg back

Craig said he was happy that I had been exercising- he could tell.

The final task was to walk and alternate the walking sticks – aiming to move me off 2 crutches and onto 1.

Having concluded the session, the task was to continue at home on a regular basis and get some core strength back.

Removal of metal clips after Tibial Osteotomy – Feeling lighter!

Check out my #Osteotomy blog. I share the day the metal clips are removed from my leg.

Removal of the clips

3 steps to Osteotomy. Simple!

On the 14th February ( and yes on Valentines day!) we returned to the One Hatfield Hospital for the removal of the stitches/ metal clips.

The resident nurse took us away. I had Loiza and Priya as my support team; or rather for Priya to watch me pass out and make a mess of myself.

The nurse was very helpful and knowledgeable. We didn’t know that Osteotomy’s in the past resulted in patients having their leg in plaster for over 8 weeks. She mentioned surgery now is much more accurate and less evasive. I have to thank the surgeon Mr Chatoo for his expertise.  

Initially I thought the removal of the clips would be very painful, it was the opposite. Using a pair of metal clips, she pinched the clip in the mid point and that forced the clip to bend and pull out. Out of the 17 clips, only 3 hurt when they were removed. I didn’t have any local anesthetic.

The wound feels very raw but the good thing is it is healing without an infection.

Clips now removed. Another milestone achieved

And a closer look where you can see the ink marks from the surgery. External healing is definitely a “work in progress”

As a treat for Valentines, Loiza took us to a well known fast food establishment serving fried chicken- this is payback for when Loiza and I were dating at University and i took her to this place when I was broke. Anyway I loved it!

On going to bed, i asked Loiza to add a bandage to cover the wound as i didnt want it to catch or split whilst i was asleep.

The pain in the knee and ankle remains however the shooting pain on my shin is less painful. Also the red bruising on my calf muscle has almost gone. For the pain, Loiza set up a call with a GP who administered stronger pain killers. This is working, the swelling on the knee is  less so and i am able to walk a little easier. However the ankle pain remains. That will need gravity and ice to give me movement back over the coming weeks.

Q &A How the Tibial Osteotomy became the recommended solution

I thought I would take time out from my diary blog in order to answer a bunch of questions that friends and family have asked me in the past.

Q: Was the cause a Sports Injury?

A: When I was younger, I was very active. Loved Martial Arts so trained 3-4 days a week; did this for over 12 years to a high level. I also played Soccer, Basketball for school, college and clubs. When I got older (into my 40’s) I took on Sprint Triathlons and 10k runs. The training takes its toll. Also I would consider myself overweight (or heavy boned 🙂 )

Q : You had an Arthroscopy and Debridement – thought that was the fix?

A: You would think that, but in effect brought on the pain more, my right leg became bow. (keyhole surgery where they wash lose cartilage from within the knee and shave some bone)

Q: Who recommended you for the tibial osteotomy?

A: I was undergoing Physiotherapy for my arthroscopy at the time and I complained the pain was getting worse. At this time, the physiotherapist recommended me to arrange a consultant session with a specialist, Mr Minhal Chatoo. He was doing some great work in surgeries that avoid having a knee replacement. I was referred to Mr Chatoo.

Mr Minhal Chatoo, Consultant Surgeon

Q: What happened during the first meeting with Mr Chatoo

A : Prior to meeting with Mr Chatoo, I went for an MRI scan and a full leg X-ray (starting from my hip down to my foot – 2 X-rays merged to 1). Mr Chatoo analysed the X-ray.

On meeting with Mr Chatoo, he shared his diagnosis and then outlined the course of correction that an Osteotemy would provide and more importantly deferring a knee operation. He also shared success stories of his previous patients. He considered me as a candidate as I was young and capable of making the right recovery.

Q: At high level, what would the surgery entail?

A : I am no expert so can only share my recall…….Mr Chatoo used software to outline where a line of gravity should pass after surgery (A line should move from the hip, down the middle of the knee and to the middle of the ankle). There was a lot of wear and tear on the inside of my right leg/knee. As my leg was bow he showed me where the line of gravity was passing versus where it should be. To achieve this, he will cut my tibia and remove enough bone (in a triangle) to allow correction. Steel plates will be applied to allow the bone to grow back and straighten my leg and to conclusively reduce the pain caused the rheumatism. I was a borderline candidate but Mr Chatoo was confident of success.

Q: Why did you proceed with the Surgery, sounds painful

A: The surgeon, Mr Chatoo was the reason. He was caring, knowledgeable, confident and human. He has a great success rate and convinced me of a decent recovery.

Right, that’s it for now, I’ll post more in a few weeks. If you have questions, post them to me and I’ll add them to another post.

Living with the Osteotomy – venturing out of the house!

After my Tibial Osteotomy, its times to get moving again. Read my blog for my diary entry

The next 4 days

Hello there! I took a few days off from blogging as the weather in the UK is just amazing.

Shoreditch, London. Keeping the rich out of our common places

Forcing a routine of getting up and resting is just something that has to be done. As Loiza and others tell me when I become impatient, the importance is for a full recovery of :

(1) the soft tissue beneath the skin

(2) the bone that is missing coupled with the metal work

(3) tendons and muscles that are affected by the surgery

It is so important to recover well in order to have the right level of mobility, otherwise the surgery will not be as effective.

The overarching pain at the moment is the joint pain. My knee is still stiff and swollen. Slowly movement is coming back but I am conscious of keeping my muscle mass however it will be noticeable that I am losing muscle. My ankle now is the most painful. The swelling (and blackness of the bruising) is more painful and keeping my knee above the rest of my body is easier said than done.

I am now negotiating the stairs and taken showers by sitting on the stool – the stair climb is painful as pain is felt on the outside of the knee (as the alignment takes effect).

On the 12th February Loiza took me out for a walk and I covered the longest distance (ok it was about 20 metres there and back). Compared to the last time I went for a walk, I have trebled the distance. The issue is the continued pain in the knee.

Get some loose clothing and get some exercise.

The pain in the evenings is interesting, I get shots of pain from the top of the tibia to half way down. A throbbing pain as well as the area around the stitches. If this is the healing process then great but they are heavy bursts of contracting pain. I really cannot wait for the clips to be removed, I won’t miss the protruding metal clips i can feel within the bandage.

Revealing the staples after Osteotomy

After 7 days, it was time to see the stiches and the healing process after the Osteotomy. Read on!

February 7th (day 7)

Nothing to do with my operation, but a snap from my holiday to Langkawi, Malaysia in 2017.

When you are unable to walk and get out of the house for a number of days, it does drive you a little crazy. There is only so much daytime you can take before insanity sets in. I also noticed that my swelling from the leg has traveled to my ankle. Late in the morning, I was sat on a stool in the kitchen in the sunshine as my mother lunch. I must have been sitting for 30 minutes. After I sat back at the sofa, my ankle did begin to hurt.

Additional bruising, the case for gravity.

One of the more consistent pains I am experiencing is the pain of standing up. The shin area of my leg is really tender and when I stand up, that area becomes overbearingly painful for a few minutes. So much that I am unable to walk. Do watch out for this after your op.

Loiza planned to replace the current bandages and so we took off some of the tape around the wound to see if we could proceed. Unfortunately the replacements provided by the hospital were too small so had to wait. What we did see (as below) are metal clips. The points where the skin are pinched together still look raw and I can understand why I have so much pain in my shins.

Markings made by the Surgeon and the staples appearing. Too soon me thinks.


February 8th (Day 8)

My nights sleep was very uncomfortable, a combination of heartburn and leg pain. I also felt that I was coming down with the flu. I did go back to sleep after a warm glass of milk but felt rough in the morning.

My breakfast routine of tablets, porridge, fruit juice and fybrogel continues. Today my mother took over as Loiza went to work early,

My parents were going to leave to day, a little sad but i think my dad was getting a little tired. I will miss them as they helped me during the day and kept me company.

Today I found walking even more painful than normal, walking by sliding my foot just made it easier for a short time. Unbearable today. Also I fell asleep on the sofa with my leg resting above my head; i jerked my leg for no reason and woke me up. The pain was a 9 out of 10 – right on the stitch lines on my leg. It took 5-10 minutes for the pain to die down.

Once Loiza returned from work, we removed the bandages and had a chance to look at the stitches. There was also blood on one of the stiches – may have been a result of knee moving while I was asleep earlier

Ok, so it is a major operation guys!. Recovery will be gradual.

I didnt want to speak much for the rest of the evening; also the pain and swelling from my ankle was at a 8 out of 10. Loiza gave me a salt bath to soak my ankle. Helped a bit


Osteotomy recovery on days 3 , 4 and 5

After my Osteotomy surgery @OneHatfield, recovery continues, slowly. Don’t panic if bruising appears

The bruising appears

February 3rd (Day 3)

I may have woken once last night for painkillers and so felt well rested. The pain was less and felt like I had some more mobility. I was able to wash and change by myself however Loiza did helped me. I sat in the day room and watched Priya get ready for her Saturday league football match. Aroon was going to stay with me for the morning and keep me company. I felt a lot stronger today and walked a little with the crutches. The exercises and movement are so important and really helps psychologically. Having watched The Punisher on Netflix (which is just awesome) I fell asleep for an hour – tiredness hits you and comes in waves. I know it helps with the healing.

The key thing is to remain mobile and to keep the joints moving. I have started doing ‘light weights’ to keep the upper body muscle mass although need to be careful as not to pull any tendons in the leg.

I stayed up until 10pm and then was helped to bed.

February 4th (day 4)

I only woke up once last night for painkillers (3:42am) and I could feel the pain. Waking up at 7:20am thereafter and I was really thirsty. I did drink ¾ of the water bottle but could not go back to sleep. This morning the pain level was very high.

The length of my tibia was painful. Loiza also noticed that I had new bruising on the back of the knee. Also the swelling is more prevalent this morning and appeared purple and red towards the bottom of my leg.

Red bruising appearing after the operation

I did get a chance to walk more. Distance and frequency is improving but the stiffness around the ankle and knee is still there.

February 5th (Day 5)

Monday morning and I woke up at 7:20am. I was able to sleep on my side although felt uncomfortable when i woke up. Loiza still had to help me out of bed and had to take the day off; it was the right thing to do. I cannot manage by myself just yet.

I think i have one more day of the co-didromel pills afterwhich i am on 400mg ibuprofen and the paracetamol.

Sitting with Loiza today and i am continuing with the icepacks on the leg. I did notice that my knee is stiff and getting new pains in the knee. Also as the picture below, more new bruising is appearing and this time in the back of the knee.

Further bruising appearing on the back of the leg

I was able to walk a little more than yesterday so at least my mobility is improving however by lunchtime I am exhausted. I know that movement is still needed otherwise mobility in the joints reduces and becomes harder.

My parents arrived at 3pm and so i sat, chatted and stayed awake until about 10pm.

Recovery starts at home!

Time to leave the hospital and going home. Recovery gets real

February 2nd (Day 2)

The One Hatfield Hospital, Hertfordshire, where the
Osteotomy was conducted

Last night I only woke up twice in the night. I was given stronger pain killers and the sleep was so much better. I was able to go to the bathroom by myself, major result in getting some independence back

Later in the morning I met with the resident doctor, pharmacist and physio again. The doctor mentioned 6 weeks recovery for the bone and 2 weeks for soft tissue. This sounds tough but I need to recover properly. I guess I will be house bound for the initial duration of 2 weeks at the least.

I was taken for a walk with the physio at 10:46am and they got me to walk much further. This was tiring but a great milestone reached.

Other than the nurse washing my leg this morning I really want to go home.

Right now it is dealing with tiredness, loss of leg muscle mass and taking drugs to control the pain is what I need to acknowledge. I need to make sure I am doing exercises every hour to ensure recovery is fast.

Loiza arrived just after 11am and we chatted; I was excited about going home. People came and went to check my BP, O2 and administer more pain killers. The pharmacist came round and mentioned providing me with Co-didromol and ibuprofen. The pain will be high for the next week or so as the soft tissue heals.

Mr Chatoo came round at 1pm, he helped remove the bandaging and reassured me again on progress.

He recommended ice packs to reduce the swelling and pain killers to manage the pain. I was happy to hear from Mr Chatoo, a person who does take his work very seriously.

At Lunchtime, I was discharged from hospital. At last!

Getting into the car was not as painful as I thought and Loiza. I really enjoyed the ride home; I was finally out of hospital and moving around.

As I made it into the house, I felt relief of being back home; sitting in a hospital watching daytime TV drives you mad but also have my own creature comforts around me as well as the kids.

I sat on the upright sofa for a while and then lay flat once the pain started.

Movement is getting better but the swelling is causing discomfort in terms of knee movement and feeling my skin stretch across my calf. This in turn causes me to itch.

The pain and tiredness came in waves today and after having dinner (lentils) i fell asleep whilst watching tv at about 9ish. I just could not get warm and could not tolerate the cold peas. Hoping tomorrow would be better

Day of the Tibial Osteotomy Surgery

January 31st (Day of op)

I didn’t have a good sleep the night before so got up early. No food or drink as prescribed by the hospital so getting ready was quick. Priya was awake and gave me a hug before she went off to get her breakfast. Aroon was asleep so i gave him a shove. Time of arrival to the hospital is 7am. I remembered for the last 4 or so weeks repeating to myself “this is the last time i do….in a while”…well that the end of the line now.

We arrived at the hospital on time and taken to my room. All sparse but the TV was good. Not sure how many people have used the room as its all very new.

Mr Minhal Chatoo (Surgeon and specialist ) came in and spoke about the operation and highlighted the risks. This is expected as he covered risks in tibia under/over correction, risk of cutting a nerve and rehab time. The good news from what he said was movement on the Knee will be possible as the cuts will be below the knee. He was very reassuring as he drew an arrow on my leg

He left by saying that i am the second person on his list and that the anaesthetist will be round later. We sat until 10:20am and then was taken down to the operating theatre.

I remember an Australian lady and Joan Washington (Sister) taking me down on the lift; i made a comment about the disco lights in the lift (nervous energy!).

I was led into the operating theater and laid on the table. At this point another chap who was administering the drugs noted my DOB was incorrect – born in 1953? That was corrected quickly.

Once the anesthetist came back, he mentioned the drugs and an additional injection in my right thigh to aid the operation. We chatted and had a giggle for 10-15 minutes as their actions were completed. I noted the time was about 11:40am.

The operation was to cut below the shin on the right leg. A wedge 11mm wide would be cut out. A bone graft applied. The gap create in the leg will have metal strips screwed in to support the bone growth to correct my leg.

The drugs took action and i passed out

Coming round after surgery

I came around at about 1:30 and i was in agony – a sawed leg, 2 metal pins and bunch of screws added to my leg. 2 nurses were near by. They talked and administered drugs once they spoke to the anesthetist. I was left downstairs for a while. Once the pain was tolerable, they wheeled me back upstairs. I was glad to see Loiza in the room.I held her hand. I cannot remember if i fell asleep again but i guess it was on and off. They gave me oxygen and connected me to saline and heart rate monitor.

Mr Chatoo then called us to talk about the operation. He said the procedure was on plan and that he was satisfied. This was a relief. Loiza and I reflected and after  a while and then she left for home. I fell asleep again. I remember waking up as Joan was taking my Heart Rate when i complained that i wanted to vomit. I felt that i was losing consciousness and could feel my self sweating and my heart pounding. The Doctor lay me down and i could hear them telling me to keep my eyes open. I was struggling but they pulled me through. After laying flat, i felt much better. My blood pressure dropped due to a reaction of the drugs. At least that gave me something else to worry about rather than my leg.

The pain in my leg is prevalent but didn’t feel like it was sawed, had metal strips and screws put in. the air pumps/ cushion on both legs is helping my blood circulation. Dinner arrived and it was seabass with potatoes. It tasted dry but i finished it so quickly.

Loiza, Aroon and Priya arrived at 7:30ish..if felt like they had been gone for a long time. The  kids made me a card for “Brotato”.

Priya read her “grand designs” magazine with me and Aroon talked about his Physics lecture at school. He mentioned the speaker was very enthusiastic about her subject matter. We sat chatted and i just watched everyone -i was just happy to see them and didnt want them to leave.

Joan came by with her shift replacement and went over my case notes. A shame to see her go as she really looked after me as i came round. She was calm, direct and very precise,

Loiza and the kids left and i fell asleep again. Another nurse came in and administered pain killers. They kept the oxygen running. I was a little impatient on waiting for things but the nurses must be busy. Anyway things went as per plan anyway. Every 2 hours they came in and checked my vitals. The pain was bearable and was able to move my toes. I didnt want to risk moving any more than that.

Is the remedy an Athroscopic Debridement

I visited a local Physiotherapist in 2016/107 as  I found that running on a treadmill and even jogging was becoming painful and recovery was taking much longer. My plan to train for the summers Sprint Triathlons was on the balance.

I was refered to a private hospital in Enfield where the specialist reviewed my x-rays. He noted the rhumetism in my righht knee for my age (47 at the time) was severe and that I would need a knee replacement in a few years.

As an interim, he would carry out an Arthroscopic debridement procedure. In my own words, its a day case where the surgeon washed the debridement from within my knee and cavity and provide some resolution to the pain I was getting.

They say the recovery is quick…well not for me. I could’nt walk for weeks and underwent Physiotherapy for over 6 months to recover