At the beginning of the new year I will be having a femoral rotational osteotomy on my left leg to counteract a femoral acetabular impediment which has cause a 30 degree retroversion and in turned caused a patellofemoral malalignment.
I am a 22 year old male college student who has been dislocating my left patella since I was eight years old. I have not been able to ride a bicycle in years, swim, nor even have a vigorous workout at the gym; limping constantly limits my activity.
I have had two previous arthroscopic surgeries on the left leg including a lateral release. In 2010 about 5 years after the first surgery, in which the doctor inserted a screw to hold the patellar tendon, I made a misstep on a sidewalk and ripped that tendon out of position. The second surgery I had in 2010 was to correct this problem, but unfortunately something, I'm not quite sure what, went wrong, and while, yes, my tendon is reattached, when I bend my knee my patella dislocates anteriorly and when I extend my knee my patella dislocates exteriorly.
I went out of town for college the next year and continually kept dislocating the patella. I would dislocate it 4 or 5 times a semester, and it had become increasingly frustrating.
I am now (Dec, 2012) going to college in Metro Denver. Late last year I decided to bite the bullet and see someone else about my problem. But instead of just going to one clinic, I would go to two because I knew that if I had done the same when I first saw the original orthopedic specialist, I might not have gone down that mud-ridden path.
The first doctor said I should have the femoral osteotomy. Both my mother, an LPN, and I were wary citing the previous surgeon. So we got our second opinion at the University of Colorado Anschutz Sports Medicine clinic. I definitely felt more sure about their diagnosis because 6 M.D's (lead by Dr. Armando Vidal) observed my leg and X-Rays and came to the same conclusion that the first doctor did, except there was one caveat. Because of the long abnormal wearing of my patella against the femur and tibial bone behind it, I have early onset osteoarthritis and I am going to have a second surgery to put the left patella on a metal track so that it functions normally and pain free.
Dr. Vidal has sent me to another doctor who specializes in the femoral osteotomy (he will be performing the knee surgery at a later date; some time this spring) at The Children's Hospital Colorado, Dr. Laurel M. Saliman. After a CT-scan, she and the Dr. Vidal concluded that the femur needs rotated 30 degrees to the anterior. Additionally, they concluded that I must be in a lot of pain with this constant dislocation. (1) My nerves were severed in the first two surgeries. Could that be hiding the pain or have the nerves grown back and am I just that stoic?
Much to my own agitation, I have decided to take spring semester from school off to focus on my health. I have talked to Dr. Saliman's office and have learned some interesting facts. First, I'll be in a cast for a month. Second, I will be in the hospital for two days.
(2) Do you know if I will be getting metal hardware inserted? I've seen a question mark shaped metal slit with screws inset (picture after the jump: (http://openi.nlm.nih.gov/imgs/rescaled512/3135568_1475-925X-10-57-4.png). It that a reasonable assumption?
(3) What kind of physical therapy will I need (technique, exercises, etc.)? I realize that I am fairly old for this surgery (usually done at 15 year old and younger) and that a femoral osteotomy on a patient with a retroversion is rare. When can I expect PT to begin?
All questions begin with a number in front of it, like so: (#). Thank you for sticking with me on this long journey, and I really appreciate the answers.
Ask questions if you have them, and I will respond post haste.