CASE STUDY

Professor Wilson brought together a team of expert surgeons for Andrew’s challenging osteotomy surgery

Andrew suffers from Charcot-Marie-Tooth disease, which means he needs to undergo a number of operations to his knee and ankle. This complex osteotomy on his right knee was the first

Andrew had been seeking help for the Charcot-Marie-Tooth disease (CMT) he suffers from for many years. CMT is a progressive condition whereby the myelin outer of the nerves disappears with time, so that feedback from your touch nerves gets less and less. The condition also tends to give people hip dysplasia, knee problems, and a lot of foot and ankle problems.

Despite some issues with mobility and strength, Andrew has maintained his fitness with cycling and even skiing earlier this year.

Following knee surgery on his ACL and kneecap, Andrew was referred to a foot and ankle surgeon, Mr Ali Abbasian, who suggested an ankle osteotomy to alleviate some of the pain in Andrew’s feet. However, as Andrew’s legs were knock kneed (valgus), especially the right one, Mr Abbasian wanted Andrew to have a knee osteotomy to straighten his leg before the ankle procedure.

Through online research, Andrew came across Adrian, who is an expert in the area of knee re-alignment or osteotomy. His first appointment was in June 2018.

Adrian quickly identified that Andrew had two main issues. One was progressive valgus (knees turning inwards, or knock kneed), which was making life very difficult for him at the knee, but also at the foot and ankle, as his ankle has been significantly affected by the CMT disease.

The other problem was that Andrew’s knee bent backwards too much, which makes both knees feel unstable and made him feel as though he is going to fall.

Adrian therefore elected to perform two operations at the same time, which required a team of surgeons to be put together at The London Osteotomy Centre at The Wellington Hospital.

The first operation was a distal femoral osteotomy which involves changing the shape of the thigh bone to make the leg neutral. He second was a slope changing osteotomy using Dutch surgeon Mr Ronald van Heerwaarden’s biological plating technique.

Andrew’s case was Mr van Heerwaarden’s first case for the unit. Adrian explains: “I think with these very complex procedures they are not really possible to do without the right kind of team and that is exactly what we have set up at The Wellington with our focus on complex osteotomy through The London Osteotomy Centre.”

When Andrew returned for his 4-week appointment he had no pain and his knee had a good straight leg raise with a comfortable bend to 90 degrees.

Whilst it is early days for Andrew, he is pleased with how his recovery is going: “So far, it looks really good and is healing very well. I’ve not gone to any physio yet, just done it all myself with researching the net, and a little common sense, but it’s gone really well. I’ve got the completion of my right foot surgery in the spring, and I’ll be knocking on Adrian’s door for the left knee at the end of next year. My quality of life will improve no doubt, and also it’ll future proof me as much as possible which is a big thing for me.”

Adrian concludes: “I am delighted that Andrew is doing so well and his only question today (at his appointment) was when can he have the other side done.”

November 2018

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