CASE STUDY

Active 45-year-old climbing mountains, mountain biking and stronger, faster and fitter, 5 months after a double osteotomy

A previous knee injury, numerous operations and restricted activity led Rob to be referred by his consultant to Professor Adrian Wilson

Rob is an extremely active and fit 45-year-old with a passion for mountain biking. In 2018 he’d already covered over 2,000 miles including Mount Boldo Italy, Peak District, South Downs 100 and the Welsh mountains.

A football injury when he was 23 had led him to have several knee arthoscopies, an ACL reconstruction and an ACI – autologous chondrocyte over a 10-year period.

More than 10 years on, and Rob was struggling with discomfort and was quite limited in terms of what he could do day to day. He also noticed that his leg was getting progressively more bowed and this was making him less and less active because of pain developing.

Rob had been under the care of a well-known knee surgeon, Mr Andrew Unwin, who had carried out all Rob’s previous surgery.  Knowing Professor Wilson’s interest in realignment surgery, Mr Unwin referred Rob to him.

Long leg X-rays were taken and Adrian recommended a double Osteotomy due to the nature of how bowed Rob’s left leg had become. This procedure had to be done in two stages as metal work from his previous ACL reconstruction needed to be removed to allow for a successful osteotomy.

This first operation was performed successfully in November 2017, with Rob’s rehabilitation similar to his earlier ACL reconstruction. He was back riding his bike by January 2018, and a date for the double osteotomy procedure was agreed – September 2018.

Rob says: “Keeping healthy and enjoying the countryside and life in general are of a high priority to me, therefore the decision on whether or not to have an osteotomy was huge, but also very much the clear and obvious one to take. It’s my hope and understanding that this should give me 10+ years before having a possible partial knee replacement. Having a straight leg will also enable future surgery to have a better outcome.”

A double osteotomy corrects or realigns the lower femur and the upper tibia, both being done on the same day. This procedure aims to get the weight-bearing axis into the middle of the knee, away from the damaged area, and by off-loading, relieves pain and restores function.

Rob’s osteotomy surgery went extremely well he had very little discomfort. He woke up with no pain, rating it at 2-3 out of 10 as he began to get mobilised. When he saw Adrian after four weeks he was already able to walk with a normal gait and had started walking his dog again.

Three weeks from after the double osteotomy surgery, Rob was very pleased with his progress: “I walked via crutches the day after surgery and climbed the hospital stairs on the 2nd day! I’m actually a little dumbfounded by how pain free I’ve been post-surgery. My pain levels have never been beyond level 3 and in truth mostly 0-1.”

He continues: “I know am still in the early stages, but my initial feelings and expectations are VERY positive. Firstly, I have a wonderful straight leg and am virtually pain free. I am currently attending physio with hydrotherapy sessions and looking to fully weight-bear by week four. My advice to others with similar problems is to stay healthy prior to your operation, and keep building your leg muscles as much as possible prior to your operation. Do some good research, there’s lots on the web! Also get a Game Ready as helps with swelling after the operation. My overall experience so far has been an excellent one. “

Adrian summarises: “I think this is the power of osteotomy where you can take an individual with really quite severe arthritis on the inside of the knee, offload that inner compartment by doing an appropriate osteotomy (in this case double-level) and I am delighted Robert is doing so well.”

Rob’s osteotomy surgery went extremely well he had very little discomfort. He woke up with no pain, rating it at 2-3 out of 10 as he began to get mobilised. When he saw Adrian after four weeks he was already able to walk with a normal gait and had started walking his dog again.

Rob was treated at The Wellington Hospital’s London Knee Osteotomy Centre, which brings together leading Osteotomy surgeons from across Europe, all passionate about joint preservation.

Rob updated his story 5 months after his operations: “Just swam my furthest distance last week – 86 lengths (2.15km) as training for an AquaBike comp (river swim then bike race). Have been up the Welsh mountains in the recent show, mountain biking and most my friends think I’m stronger faster and fitter than I’ve been for years.”

October 2018

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