Positive change post Tibial Osteotomy – 6 months on…

In January 2018, I underwent a Tibial Osteotomy 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.

I did get the chance to visit Chicago in the summer. Perfect weather!

By June 2018, I was signed off my Physio. He felt I made good enough progress to get my life back to a normal state and gave me some tough exercises to continue with. This was coupled with my surgeons recommendation to return on the 12 month operation anniversary (Jan 2019) to have the metal plates removed. This is a big deal as it means the cycle of pain in the knee could be reaching its end point. A weird part of me wanted to keep the metalwork in my leg as its a great conversation opener or filler (“I have a bionic leg”) however I was experiencing the odd skin irritation or swelling where the plates were located. Mr Chatoo (Surgeon) did mention a number of patients having the same experience. I set my mind to return in January for the final operation.

The gym workouts were going well. I was able to run 5k on the treadmill, lift and pull leg weights that was a clear improvement to pre-operation. I kept to a routine of fitness as well as cutting down on my alcohol intake and losing as much weight as possible, through healthier eating.

In July, I had to take time out from work to help my parents. My dad went into hospital to undergo a Quadruple Heart Bypass operation.

My dad is doing well 12 months on but it was a very tough time for my immediate family. Thank you to the NHS!

At the end of August and as a family, we decided to spend our 10 day summer vacation in Chicago, Illinois. For a Brit living under the cloud of Brexit some destinations were becoming very expensive and we felt that Chicago was a great location and is excellent value for money. Also we booked at the last minute and found a great value deal.

I felt much more confident in travelling and doing more outdoor activities; a real turning point as I felt my confidence was coming back.

Yes, there are some great beaches on the lakeshore. Fresh water also!

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.

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.

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

Surgery done, here comes the Physio!

The start of Physiotherapy after my Tibial Osteomety

February 1st (Day 1) 2018

Feeling misty, can see things in the distance, but slow down, its a journey!

I woke up at 6:30am and watched some television and read the Economist magazine that Aroon left me. The article on Google, Facebook and Amazon becoming larger than economies and becoming monopolies questioned their business ethics in terms of acquisition was rather interesting. I remember reading that the new bargaining currency of DATA is a dangerous issue – this will cause governments to sue these large companies – they are no longer immune…..

Anyway that was my riveting morning as well as developing constant hiccups.

I sat up on my bed and could not see any change in swelling around my knee but I did see a big change in my leg’s alignment. My only worry is that it has been overcompensated, but the swelling on the inside of the leg (where the op took place) is surely distorting it.

Breakfast arrived at about 8am and had an English fry-up –  polished it off as well as 2 cups of tea. The doctor came round with the pharmacist and physio. The doctor explained what happened to me the night before and he explained to me the cause. He reassured me it was a cause of the drugs and I should not have another episode.

The physio mentioned she would return later and that due to the nature of the operation, they will take it very carefully. She wanted to start me on a walking frame followed by desired crutches. They removed the pillow under my leg and mentioned they will return later in the day

I waited for Loiza to arrive and when she did , she brought magazines with her as well as her smile. We read some magazines and my lunch arrived and was the best meal so far in hospital – chicken with gravy.

Later on the physio arrived. They got me out of bed and with crutches added weight to my leg. As I stood up the pain in my leg was felt. My calf muscle was hurting as well as my ankle. They helped me walk with the COGS process (Crutches, Operated leg, Good leg, Step). It worked. As Loiza recorded me walk i made my way out of the room and in to the corridor. It was a relief to be able to walk however the pain was immense. I could feel the tightness of the skin and my bone was hurting.

As I sat on the chair for the first time, i had to remember that I had taken strong pain killers to numb the pain. After the physio left, Loiza let me walk a little more in the room. I also called my parents to give them the good news that i was able to walk.

Physio Staff at One Hatfield Hospital starting the rehab

The physio returned to help me walk up a flight of stairs. We walked a longer distance (as I had now changed my clothes and wasn’t wearing a revealing hospital gown) and went to the stairwell. I stepped down and then back up, The joy was felt as well as the pain. The 2 physios brought me back in a wheelchair. It was at this point that I decided to stay another day in hospital as I was not ready to go home. My tolerance to pain at this moment was low, and I did not want to risk any damage by being at home.

The Physio team are critical post operation, they are key to focusing your mind on the power of the human body and the program of activities that inevitably impact on a speedy recovery.

Thanks again to @OneHatfield Physio team and to Mr Minhal Chatoo.