Returning to the operating table – removal of metal work. Osteotomy concluded

In January 2018, I underwent a Tibial Osteotomy operation at the One Hatfield Hospital in the UK. I had been suffering from the onset of arthritis on my right knee and needed a solution that would avoid a knee replacement operation and get my life back to some level of normality.

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Returning in 2019 to remove the metalwork

The osteotomy had given me a lot of improvement. The physio work and muscle built around my knees in the gym has given me 90% of my life back. The knee issue hasn’t gone away but I feel so much stronger, some pain does remain but this differs from day to day – that’s just the ageing process!

RHS shows healed bone

As the metalwork in my leg did irritate me from time to time, I took my surgeons advice and booked myself in to have the metalwork removed on 27th March 2019. Mr Minhal Chatoo would be my surgeon again. He was brilliant.

The metal work extraction procedure would be a day case. The procedure would take up to 1 hour to remove the screws and plates. Due to the nature of the operation, I would be under general anesthetic, meaning the time in the operating theatre increases to allow for the time to recover as well.

Upon arrival and being allocated a room at the hospital, one of the nurses came in and read my BP, went through standard paper work, handed over a gown, pants and socks – I’m not sharing any pictures of that!

Shortly after, the anesthetist came round as well and confirmed that Mr Chatoo would be operating on me as the first patient of his day.

Mr Chatoo came in to mark my leg before the operation and we had a light hearted conversation. He mentioned the operation is very quick and low risk so was happy to proceed.

Once he left, I was taken downstairs to the operating theatre. As I walked down someone talked me through the procedure again and kept me assured.

Once I was asked to lay down on the bed, I was connected to the ECG and given the anethestic. In seconds, I was out.

Coming round after the operation

I felt groggy after the operation. It was about 10:20 am as I noticed the clock. They showed me the metalwork that was removed from my leg – 2 pins 4 inches long, 3 screws 3 inches long and 6 other smaller screws. They told me I was unable to keep the screws due to protocol; though I wish I could have kept them as a souvenir…

The pain was unbearable and the nurses gave me strong pain killers. 20mins later, it still felt bad so they gave me more – but I think it was codeine. 

Shortly after I was taken back upstairs to my room and Loiza was sat waiting. 

I remember falling in and out of sleep and still in pain. To me, this felt much more painful than the osteotomy last year. 

It took a while for me to eat lunch (soup and a sandwich), just the tiredness from the drugs and the pain. 

I remember the Physio “Saul” visit . He got me out of the bed and made me go for a walk. We made it to a stairwell and then down a flight of stairs. He did say the pain will be high but I will need to get moving sooner. The recovery period would be :

  1. Next 2 days full rest and some movement
  2. Use crutches for a few days after that
  3. Walk without crutches thereafter
  4. Keep moving and apply icepacks if there is swelling

The recovery period was a lot shorter but I kept in mind that there was a deep cut, stitches and several holes in my tibia that would take time to recover.

I was able to walk however I was very tired due to the drugs. I made it back to the room and then met Mr Chatoo again. I remember him telling me that he placed “wax plugs in the screw holes!” to reduce the bleeding from the bone. 

Mr Chatoo also said the operation was uneventful- this is good news.

I rested again and of course, fell asleep. When I came round again I was still in pain and was given more painkillers. 

The nurse mentioned that I could be discharged once Mr Chatoo comes round at about 5 pm. The discharge was quick and easy and everything was set for me to go home.

I was wheelchaired to the car – We drove home in my Audi. The ride was great as I was glad to be going home. 

When I got home, we took the picture below.

I was exhausted. I slept in Aroon’s room and was out as soon as I hit the pillow. I know I woke up in the middle night and Loiza had to help me to go to the restroom – it was still to early and I was unsteady on my feet – the drugs were not helping and as it transpired I had a bad reaction to the codeine.

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.

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.

Arthoscopy compounding the underlying issue – Osteotomy the answer?

In early 2017 I underwent an Arthroscopy and debridement procedure on my right knee. Essentially they removed loose cartilage debris and to shave my knee bone where there were abnormalities. This was a symptom of the early onset of arthritis in the knee and a possible knee replacement in my later life.

Whilst i was undergoing physiotherapy, there was a noticeable remnant pain in my right inside leg. I was recommended later in the year to meet with a knee specialist. Physiotherapy outlined another issue with my knee. Loiza and the kids also noticed that after my leg surgery that my right leg was becoming more “bow” as well. I was unable to run, even on a treadmill and i added weight on.

Something had to be done. I met with the recommended Surgeon Mr Minhal Chatoo in Hitchin Hospital.

Mr Minhal Chatoo,  Consultant Orthopaedic Surgeon 

I underwent a MRI scan as well as a full leg X-ray. All this happened in November/December 2017. On meeting with Mr Chatoo, he recommended a Tibial
Osteotomy (https://orthoinfo.aaos.org/en/treatment/osteotomy-of-the-knee/).

Prior to having the surgery i looked for blogs, use cases of people who had undertaken this type of surgery so that i can understand this type of surgery- its very thin.