So here it is, one year on from HTO surgery. This is one of those posts you know you’re going to be writing at some dim and distant point in the future but now it’s actually here, I’m not entirely sure where to start.
To think this time last year I’d been batch cooking, wine drinking, kids’ life organising and generally getting everything ready for what I knew was going to be c.8 weeks of limited mobility and not too much clue how much pain I was/wasn’t going to be in, what the outcome would be, and whether this was going to finally be ‘the big fix’ or just part one of a multi-stage project.
For those readers who missed the fun and games that was surgery and the first few weeks of rehab; roll up, roll up, you can read all about it from here. Or to really go back to the beginning, try here.
12 months on, I can say one thing for certain: The knee is definitely more stable than it was pre-HTO.
And, after a weekend in Tuscany (also a result of the surgery in a roundabout way), that’s a great position to be in as there’s no way I could have managed the historic, hilly streets before I went ahead with the HTO and (ongoing) ACL rehab.
So, for those considering HTO surgery, I’m an all-in advocate: For lateral closing wedge HTO, amending both varus alignment and posterior tibial slope, at least. We’re still in the wait and see phase of full recovery (lax ACL graft still means knee shifts about a bit but, to date, it hasn’t given way completely during my rehab. Yes I’ve had swelling and loss of ROM following one slip but it only put me back a few weeks. A full blow out would be the cue to go back and look at re-doing the ACL yet again, otherwise we’re hoping I can become a ‘coper’ instead).
Surgery
The surgery itself was no-where near as painful as I’d been worried about - the thought of someone breaking your leg, sawing a wedge out then clamping it shut with metalwork is definitely a weird one - but it really wasn’t that bad. Yes it was uncomfortable for a few weeks but nothing that ice and pain killers couldn’t manage. The Cabin Fever is a killer though - so, if you’re contemplating having this surgery, definitely get yourself a friendly chauffeur lined up to get you out and about a bit after the second week before you totally lose your mind.
Oh yeah, it was also a bit of a shock to realise I can’t stand with my feet together when my knees are anymore - clue’s in the name ‘leg realignment surgery’, d’uh! 🤦🏻♀️ - but it’s not obvious unless you’re looking for it and doesn’t cause any issues day-to-day. Really, I’d much prefer that to a constantly giving way knee and arthritis/accelerated knee replacements etc.
If I hadn’t been rehabbing the revACL again too, I’d have been done and dusted really by early Spring (4-5 months post surgery) but I'm still going at the moment - not quite at physio discharge.
I have a Bodycad plate and it’s really about as ‘comfortable’ as you could expect any plate to be. Yes, I can feel it under the skin, yes it can be a bit uncomfortable when trying to kneel for any length of time or on hard floors (no real protection on that side of your leg), yes my shin can be sore when jumping/running too long, but that’s actually still improving so I’m holding off getting it taken out for the time being.
Why?
Firstly because I’m a bit mad and love the tech behind the ‘personalised plate’ approach. A strange part of me really wants it to work and not need removing, even if it does irritate a little, just because it’s as good as I think you could probably wish for and keeping it in reflects that.
Secondly, because there’s still some wobbliness from the remaining ACL graft so I want to give that a really good chance to get as strong as it can be and properly test it out (beyond running and ‘everyday’ stuff). If it isn’t quite up to it, we can do plate removal and bone grafting for a last shot at the ACL recon at the same time.
Whisper it quietly but, as time passes, I’m increasingly confident that what’s left of the current ACL will stand up to what ‘I’ need from it now my leg has been realigned, but I need to properly explore that before making any final decision re the plate.
Lessons learned and chain reactions
So, aside from the medical stuff, what has the last 12 months taught me?
Kids are great. Nothing so cute as finding out they’d set up the living room for me as a second bedroom so i wouldn’t have to go up and downstairs after surgery. Even the then 5 year old checking which knee it was, before launching himself at me, was a show of consideration of sorts!
People will surprise you in both positive and negative ways. Those who talk loudly and promise to be there to help might not be, but others you weren’t expecting to will really step up to the plate. Home-cooked dinners delivered, sanity social visits, jail break adventures, lifts and helping with the kids - all very much appreciated! 🙏🏻
Painkillers and recovery really screw with your cognitive abilities. If you can, take more than two weeks off work - even if you work from home. Yes we actually won some new business from a pitch I wrote during the second week post surgery but I’d really rather not have to put myself through that again.
Trust the process and put in the work, but also know when to take a day or two off. There’s so much out there on social channels about the importance of showing up, grinding the physio out on difficult days BUT sometimes, rest really is best. I’ve been here on the ACL rehab trail three times previously - I know what’s involved - but I’m not great at cutting my body some slack when it needs to recover. I guess I’m 15 years older than the first time and training/physio’ing smarter - rather than harder - is the better way to go. No pain, no gain isn’t always true.
If you go out for a blow out with friends after 8 weeks of being housebound, don’t take your credit card with you!! Why? Well, you’ll just end up in Tuscany 9 months later enjoying a wine-tasting holiday you’ve ‘won’ in a charity auction. Flip, I was so fed up of always being the sensible one that evening, that something had to give. I got drunk, bid on the auction and won. Then it snowed to add a little more magic to proceedings. Wouldn’t have happened had I not been housebound and sick of being sensible. So scratch that, DO take your credit card with you and have some fun - it’s good for the soul and the trip was WELL worth it ✈️ 🍷
I’ve said it before and I’ll say it again, get yourself a flippin’ good physio. Still blows my mind how poor some of my previous physio has been but this time round has been a lot better. Ask lots of questions. Be a pain. Take ownership of understanding what you’re doing and why? And if it isn’t working, ask again. From building strength to re-training the neuro-muscular responses, there’s a lot to get right. Oh, and don’t think you’re finished when you hit your targets. A month off physio over the summer due to juggling work and childcare = more wobbly knee - already much improved after a couple of regular weeks back in the gym.
Pick the positives from the bones of a messy situation. 35 years of knee instability and various attempts to fix it have not been fun BUT this latest round has also triggered conversations that have helped me get on the front foot in ways I’d never have imagined 12 months ago:
Shifting the weight away from the inside of my knee to delay/prevent otherwise inevitable arthritis;
Starting HRT following conversation with GP over bone-quality concerns flagged during surgery. Not only am I now able to protect - and to some extent rebuild - my bones before it’s too late but I have also benefited from:
Losing 1 inch off my waist during the first week of using it, when previously NOTHING was shifting it (Thank you PCOS/Perimenopause - NOT!)
Stopping my fingers sub-luxing every time I get dressed (yes really, another positive side-effect of HRT!)
Clearing the brain fog (which I assumed was just tiredness, mental load and getting a bit ‘thick’ in my old age)
Vastly improving mood and increasing energy
All of these HRT-related issues are so insignificant on their own that I’d never have bothered the GP with them. Without the HTO surgery, I’d never have gone down this road and now I feel back in control and things I didn’t even know were ‘symptoms’ are being resolved/managed.
There’s a whole other blog in there - in endocrinology and the missing women in healthcare research - but I’ll save you from that 😂 Just to say, in a round about way, I’m glad it happened, because now I know about things I wouldn’t have and can be proactive about managing them.
So the results to date:
More stable knee, although not altogether there (yet)
Holding off osteoarthritis progression and reduced/delayed risk of knee replacement
Opportunity to prevent osteoporosis and get on the front foot re other unacknowledged issues
🏆 One small ‘major’ op. A whole lot of positive outcomes. That’s got to be win right?
Happy a-knee-versary! And thanks to EVERYONE who has played a part in getting me here.
🐒 🏄🏻♀️ This really ought to be the last post - but I’ve still got a zipline, full flexion and surfing to conquer. If those all go well, I think it will finally(!) be over and out. Maybe this one really, finally was Operation Change the Narrative 🍀.
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