A Bit More About i-Balance

It’s been a really long time since I’ve posted an update, but Angela’s good news has inspired me to touch base. I will make this brief.

I had a follow-up visit with my surgeon in December, one year exactly after my second HTO and almost two years after my first (how is this possible??). The bone growth, alignment and muscle regeneration all looked good on the x-rays. My surgeon said I was the “poster child” for HTO surgery. Well, I’ve always been a high achiever, so you can imagine how happy that made me :-) More importantly, what I walked away feeling was really grateful that my surgeon did such a great job and that I didn’t experience any complications.

The x-rays confirmed what I was already experiencing, which was close to what I would call a 100% recovery. I’ve been able to run and jump around since October. Admittedly, I waited a while to really push myself with running. Instead, I did regular yoga and strength training classes so that I could really build up my muscles before putting that kind of pressure on my knees and shins. In mid-November, I ran three consecutive miles for the first time in a long while and it felt like a real victory.

Here are some of the x-rays, showing how the bone has grown over the bone graft and around the supportive wedge. You’ll also see an illustration of the implant, which explains why there is still a gap on the x-ray at the outer most edge of my knee. That’s where the wedge is and will remain until the end of time.

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Four Weeks & Five Days Post Surgery

Today marks four weeks and five days since my second HTO with i-balance. The days are ticking by and I’m improving bit by bit. As my surgeon predicted and as I’ve reported already, the recovery is going faster in some ways this time around. I’m already down to one crutch at home and even walking around without crutches at all for short stretches of time while going from room to room in my apartment. I’ve been off the Percocet for about 12 days now. I still have some moderate general pain and walking around seems to provoke some sharp pain in my knee particularly, but so far I’ve been able to manage that with regular icing sessions and by taking 2 extra strength Tylenol every 5-8 hours or so. Mostly, though, I’m bored (which is a good sign, right?)

My next appointment with Dr. Youm is next Friday, at which point it will have been six weeks since my surgery on Dec. 13. I imagine he’ll have me start physical therapy at that point and possibly liberate me from the crutches. Last time I was on crutches for seven weeks. In the meantime, while I anxiously await this next appointment, I have been doing the physical therapy exercises I started doing at five weeks post surgery last time. The only exercise I don’t do is the calf raises, since I don’t want to put that much pressure on my right leg. Here a reminder:

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Since the wound has healed, I’ve just started treating the scar. This time around, rather than using Mederma or the silicone cream my dermatologist recommended (and which cost $50 for a small tube), I’m trying silicone sheets.

I went looking for ScarAway at my local pharmacy, but only found a generic version. An eight-week supply is $20. Basically, what you get are 3 inch long adhesive strips that look like band aids. You put the strips over your scar and leave it on for a minimum of 12 hours a day. You take them off to shower and then put them back on afterward. The sheets are supposed to keep the scar/wound hydrated and covered (both of which are essential to scar healing.)

An article in the Los Angeles Times singles out silicone sheets when comparing other scar treatments such as Vitamin E oil and Mederma:

“Silicone gel sheeting seems to be the exception. Several articles reviewing 30 years of research suggest that it can speed healing and lead to thinner, softer, less red and less painful scars. It’s not clear what silicone itself does. But the sheets do a better job of keeping the scar covered, and that prevents water from evaporating from the skin.”

I still think that time is the best healer of all wounds, but I guess a little help from a silicone sheet can’t hurt…

X-Rays: 2 Weeks Post-Op (Second Leg)

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Here are x-rays taken today, showing i-balance implant in both legs. You can see the progression from my legs about a year ago (November 2011) to now. Watch the gap disappear!

I have about 4 more weeks on crutches. Since my surgery on Dec. 13th, I’ve got about 100 degrees of flexion and 180 degrees of extension. The bruising is almost gone and the wound is starting to scab. I no longer wear the brace around the apartment, and I’ve got nothing more than a few horizontal strips of surgical tape on it now. I can put 25% percent of my weight on the leg and in another 2 weeks, Dr. Youm says I can put up to 50% of my weight on it. My next appointment is in 4 weeks, at which point I will start physical therapy and most likely get rid of the crutches!

It’s definitely easier the second time around, due in no small part I’m sure to knowing that I won’t have to do this again. My left leg (the first one that got the i-balance) is holding up really well as I hop around on it. No pain, no weakness. The right leg is still a bit sore, but it’s not too bad. I’m down to about 3 Percocet a day (half the recommended dose) and should be off it entirely and on Extra Strength Tylenol by mid next week or so.

I can’t stress enough how important the following has been to my recovery this time:

1. Elevate, Elevate, Elevate — above the heart for the first 3-5 days and longer if possible. Even when sitting up, I propped my leg up on towers of pillows to get it above my heart. This minimizes bruising, swelling and pain.

2. Ice, Ice, Ice — for 20 minutes at a time, up to 5 or 6 times a day. So soothing and this also helps keep the swelling, bruising and pain down. You can do 20 minutes on, 20 minutes off, 20 minutes on. If you leave the ice on too long, it works against you because the body sends blood to the area to warm it up. Keep doing this for first 4 weeks – no joke.

3. Move, Move, Move — ankle pumps, leg raises, 90 degree flexion, full leg extension (where you prop the ankle and let gravity pull the knee down — hurts at first, but helps with extension.) Otherwise, you will get stiff and this is not good for healing.

That’s it for now. Time to get on with the business of living!

In which I discover I have ‘funny legs’

Thanks NACG for the introduction in News. I am honoured to be writing for this Blog and I hope you enjoy sharing my journey. I am now a week post surgery; I will take you from the moment I learned I had ‘funny legs’ to the present day updates and I will include photos as I go along. I hope you enjoy …

It was 1995 when I was first alerted to my “funny legs”. At 14 years old I was in my Religious Education class and I was standing by my desk waiting for the bell to ring. I heard the group of boys giggle and saw them looking over at me and pointing. One boy was shaking his head annoyed with his friends and he then came over to me. “Ignore them – they are saying you have bandy legs but I told them it is because you go horse-riding…” The boy was being kind. I had been horse-riding lessons when I was about 6 but like most things I had grown bored of it and chucked it – if my legs were funny it was not the horse-riding to blame. Nevertheless I took his excuse “Yeah of course I go horse-riding” He looked relieved “Yeah that’s what I thought, it’s normal for your legs to be funny shaped if you do.”

And this day signalled the start of a very obsessed 17 years of hiding my legs.

I had resigned myself to living with my bandy legs. In Scotland this was not too much of a problem. There is not a huge demand for shorts and bikinis after all. The few months of the year where I wanted to wear these things I simply didn’t. I wore trousers…baggy trousers and baggy jeans. I also discovered I could wear skirts and dresses if they fell below the knee. Although my legs were not straight below the knee, it was only obvious if you could see my knees. This all depended on fashion though and sometimes fashions were kind other times not so much. Skinny jeans were evil! My legs also looked fine above the knee so when ‘over-the-knee’ boots came into fashion I was suddenly able to wear short skirts and dresses and I thought this was fab; although looking back it was all a bit Pretty Woman.

The worst time was always on holiday. I had mastered the art of going to the edge of the pool with a towel/sarong on and sliding out of it and into the pool in a swift fluid motion that would not allow anyone to see my legs. My obsession was vain and egotistical. Most people by the pool were not even looking but I assumed everyone was waiting to point and laugh.

At 14 years old it didn’t even occur to me to seek medical advice. I didn’t even tell my family outright about the boys teasing me, they gradually just got used to my ‘issues’ with my legs. As the years went by and the internet became a hub of knowledge I started to check out things in private. I was searching for exercises that would alter the alignment and I came across various suggestions but nothing that could change the shape of bone.

And then in August 2011 I was conducting another random search, taking comfort from the fact that others have also been cursed with this when I stumbled across a blog that changed my life! NACG was writing about me!! So many times whilst reading her blog I thought “I could have written that”. I was envious that NACG had been able to have surgery and thought that with the different Healthcare system in the US it would be something I could only get if I was part of that system or could afford to pay privately here.

I posted a comment to NACG asking about the procedure being done in other countries and she sent me this email address Dennis.OKeefe@arthrex.com . I got a reply with information about a surgeon in Glasgow which is about an hour from where I live in Scotland. The next day I made an appointment with my GP. This was the hardest part. At this point I was 30 years old. I had kept my legs hidden from the world for the past 16 years and I was going to have to stand in front of a stranger and ask for help.

The Long Haul

It’s been a while since I’ve posted an update. That’s probably because I’ve been more mobile and engaged in my usual day-to-day activities. Last night, I went out to dinner for the first time since my surgery four weeks ago and it felt so good to be normal! I also took a bus downtown about 70 blocks, venturing the furthest I’ve gone without taking a cab. I’m getting better at being out and about on my crutches. The only problem is that the heel of my hand starts to hurt a little from my weight as I haul myself around and I really feel it first thing in the morning when I’m back on my crutches after a busy day the day before. I’m actually getting calluses on that part of my hand and under my arms where the crutches rub against my body! Sexy …

I took what was left of my bandage off about a week ago (as per my doctor’s instructions) and I’m pretty pleased with the way my scar looks. I’ve started using Mederma on it, as recommended by NACG. I rub it in 3-4 times a day. I can’t explain what the small scar/wound is to the left of the long scar, but I’m thinking there must have been some kind of clamp there during the surgery. I’m going to have to ask my surgeon about that when I see him next week. The pictures below show a progression in the wound over the past week or so.

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I’ve noticed that the pain/discomfort in my leg when I’m vertical is not nearly as intense as it was a couple of weeks ago, though my leg is still sore to the touch — it doesn’t look as bruised, but it still feels bruised, as does my foot. I still wear the compression hose when I’m out for more than a quick errand, but I can get around without the hose for shorter trips. My big toe is still a little tingly, too, but I’m guessing that will go away once I’m walking again. Also, the inside of my knee is still super swollen — either that, or I have a bigger, rounder knee now (I hope not!)

I am counting the days until my next appointment, hoping against hope that I will get the green light to come off the crutches and start physical therapy. I’m also anxious to find out whether the bone is healing properly or not. One of the little fears in the back of my mind is “non-union,” where the bone fails to fill in the gap created by the osteotomy. Small risk, but still…

One thing I have to share is that even though it’s been only four weeks since my surgery, it does feel so very much longer. I cannot believe that I will have to do this all over again and that I’m not even halfway through the whole process. There are moments where I’m just incredulous and I can’t believe that I have decided to do this. But I know I want to finish what I’ve started and that once it’s all over, it will have been well worth it! Onward…

Bruising, Swelling & Bending

I took this picture yesterday — or rather my boyfriend did — just to show the amount of bruising I’ve got now. Much of the swelling in my ankle and foot has gone down, which is really surprising to me. I had expected to see it last for several weeks. What I didn’t expect was to see so much bruising, especially around my heel.

As you can see from the photo, the bruising runs the inner length of my leg up to around the bottom of my calf, which is where the bandage was for the first week after surgery. The bruise then starts again a couple of inches above my knee and runs pretty much the length of my inner thigh. It’s a mix of yellow, purple and red. The bandage must have been tight enough to control the swelling and bruising in the area around the incision, but essentially forcing the blood to travel up and down my leg.

The bruising itself isn’t much of a problem, except for when I stand up, at which point it feels like my lower leg and ankle are being flooded with blood — my foot turns a deep purplish red color and gets really hot. This is painful in a way I can’t even begin to describe — it’s a kind of tingly, electric throbbing. It makes walking around or even having my leg vertical in any way extremely uncomfortable.

My boyfriend has a theory that the arteries, veins, blood vessels and tissue in my lower leg have been stretched from the swelling and therefore temporarily have lost some of their elasticity, making it difficult for them to regulate the flow of blood to the area against the pull of gravity. This makes a lot of sense to me. NACG had recommended that I get compression socks to help keep the swelling down and I’ve become convinced that the socks will also help with this pain by controlling the flow of blood to my foot. So I sent my boyfriend out to a local surgical supply center to get some socks (I am so grateful to him.) I can’t wait to try them because this is the one thing keeping me from being more mobile. I just really want to take a walk around the block on my crutches, if only to smell the fresh air and see something other than the inside of my apartment.

Oh, I do have some good news: I had my first shower yesterday! I was able to stand on my right leg and balance with my left leg by putting some weight on the ball of my foot. I was even able to shave my legs by sitting on the edge of the tub with one leg resting on the opposite side of the tub at a time, while the other braced me. I’m now able to bend my left leg about 85 degrees, which I never would have thought possible a week ago.

I have always been very flexible and my legs have always been very strong, and I feel this is really helping me in my recovery. I also did a lot of exercise leading up to my surgery, so even though I’m losing strength and flexibility by the minute now, at least I was starting from a strong place. This won’t be the case for my second surgery, unfortunately :-(

I have another post in the works with a list of all the supplies I got to get me through my first couple of weeks post-surgery. I’ll post that tomorrow.

Post-Op Hallelujah!

Today I had my post-op appointment with Dr. Youm. I was a little nervous about leaving the apartment for the first time, being vertical for over an hour, having the bandages removed, seeing the  x-rays — just about everything. But I was also excited to find out how the healing is progressing. My boyfriend and I opted to take a cab rather than drive to the appointment since we didn’t know what the parking situation would be like near the doctor’s office.

The journey to the office went smoothly — I didn’t have to walk far on the crutches, luckily, because my hip flexor has been really sore, probably from holding up my leg with the brace whenever I’m ambling around the apartment on my crutches. But when we arrived, one of the aide’s informed me that I had my crutches set to the wrong height — at least a full inch too low! That explains the pain I’ve been experiencing in my hip, trying to keep my foot off the ground. That alone was worth the trip.

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Within a few minutes, my boyfriend and I were led to an exam room where I was asked to put on some hospital shorts for X-rays. Then a tech assistant took X-rays of my left leg from the back (first slide above) and the side (second slide). He needed me to bend my leg for the side X-ray and I was afraid I wouldn’t be able to, but I was. After that, Dr. Youm’s assistant, who has been the one to answer my calls off hours, removed the Ace bandage wrapped around my knee, the white bandage underneath that and one by one, he removed the strips of tape over my wound. I tried not to look during this process — which was more itchy than painful — but what I did see looked really good — a cut about 3 1/2 inches long below my knee.

Around this time, either because I had been vertical for so long or because I was having anxiety or because I was queasy, I began to get very light headed. I felt like I was going to faint. The assistant brought me some water and told me to just focus on my breathing. I was sitting in a chair, so when he was done, he told me I could lie down on the exam table and rest, which I gladly did. I went from boiling hot to having chills. I think the whole excursion was just too much for me!

After I rested for about 5-10 minutes — Dr. Youm had said, “Don’t worry — we’re not in a rush here. Take however long you need. I want to talk shop when you’re feeling better” — I felt much better. Dr. Youm came back and told me that the surgery was a complete success, that everything went really well, everything looks good, the X-rays look good, etc. He said it was a difficult surgery because with the extent of “bowleg deformity” (see third slide above, before x-rays) we were really pushing the limits of the i-balance system with the surgery. This was oddly reassuring to me, because it just confirmed that this is a surgery I really needed to have done.

Dr. Youm, (whose nickname, by the way is supposedly Dr. Yum Yum at NYU Hospital for Joint Diseases) also answered a few questions for me, that I’ll just summarize here:

1. The filling in the gap created by the wedge consists of plastic, synthetic bone grafts and my own bone grafts (taken from the wedge itself.)
2. Because the entire i-balance system is plastic, it doesn’t show up on x-rays, so that’s why you don’t see the screws and plate used to “scaffold” the opening. It just looks like a big opening, which is a bit scary! The whole area is really much more solid than it looks on the X-ray.
3. I can now put up to 20% weight on my left foot and he said I should feel free to roam around as I choose (on crutches, of course).
4. I only need to wear the brace now outside the apartment. He also loosened the brace so that it bends up to 90 degrees. Before it was set at 180 degrees (rigidly straight.)
5. I can now shower — the strips that his assistant put on my wound should dissolve naturally in the next two weeks (my stitches have already dissolved). I don’t need to remove them. I just can’t bathe or flush the area with water.
6. The numbness in my left big toe is likely from the nerve blocker and could take up to another week to go away (yikes!)
7. I can expect to spend another 4-5 weeks on crutches (we made a follow up appointment for the third week of March.)
8. I could either start physical therapy now, or wait until I’m off my crutches. Dr. Youm says it depends on whether or not I have unlimited sessions under my insurance. If not, he said I’ll get more out of it if I wait until I’m off my crutches. I have to look into my insurance.

Dr. Youm also said that they overcorrected, as they always do with these surgeries, which means when I do my next leg, my knees will touch. This is astounding to me! I honestly think people with straight legs just have no idea how much of a radical change this is, how much this can affect our self-esteem, how much simpler life will be when we no longer have to feel self-conscious about our “crazy legs.” My boyfriend said he “barely noticed” my legs were bowed, but I’m beginning to think he’s full of shit :-) Whatever.

As for the medication, Dr. Youm said I should feel safe being on Percocet for up to a month, even with my history of addiction, but honestly, doctors just really don’t understand how dangerous narcotics are for addicts/alcoholics. I already feel “checked out” and while it’s nice to feel this way while I’m in the first week to 10 days after surgery, in pain and bored, I really don’t want to feel this way much longer, and certainly not while I’m working. Also, I know that every day that I’m on painkillers will make getting off them that much harder. My advice to you: Take this stuff seriously, whether you have a history of addiction or not, prescribed medication can be as addictive and deadly as street drugs. In any case, Dr. Youm did give me a prescription for a non-narcotic painkiller (whose name escapes me right now.) He said I can combine it with the Percocet. This way I can continue to taper off.

One crappy thing that happened today amid all this great news is that I pulled a muscle in my neck/shoulder while maneuvering out of the cab when we got home. This is honestly the part of my body that hurts the most now! Every time I move my head I feel a sharp pain. Argh! Hopefully this will pass quickly. In the meantime, while I ice my knee, I’m now applying heat to my shoulder!

I do have to say that I have had a 100% positive experience with Dr. Youm as my surgeon. I can now say that I have complete faith in him and would recommend him to anyone. Please let me know if you have any questions about him for me and I’ll be happy to answer what I know.

Cindy’s Before and Post-First-Surgery Photos

It’s been about a month since Cindy had her first HTO, operated by Dr. K in Washington DC. Initially she was planning to have a surgery from a surgeon close to her home, southwest US, but the surgeon she found was rather conservative about the surgery despite of the fact the surgeon was referred by Arthrex representative.

She went through other treatments the surgeon advised – injection in her knees and 6 weeks of physical therapy. Ironically physical therapy worsened her pain and she was ready to move forward with the surgery. In September, 2011 she travelled to DC to visit Dr.K for the second opinion. Dr. K agreed with all the treatments her surgeon was doing but told her he would be also happy to perform her surgery. During her stay in DC, we met up and I could tell she was torn. She seemed to be tired of trying different treatments without knowing if the next treatment would work. The surgeon in her area sought the surgery as the very last resort to her pain. I understand the reason he wanted a long-term treatment because HTO is a BIG surgery and the complete recovery takes almost two years.  This is why it’s hard for me to recommend any other doctors but Dr.K although I have a list of surgeons on this blog.

A few weeks after Cindy had an appointment with Dr.K, she decided to have a surgery operated by Dr. K in DC and scheduled a surgery.

When I met Cindy for the first time in July in DC, I could tell she was in pain – both emotionally and physically. Her best friend who travelled with her then seemed to be very concerned and surprised to hear all the struggles Cindy had been going through. Cindy, just like how I was, kept her pain to herself. We connected instantly on how stressful our lives had been from having bowed legs; therefore, when I heard she’s getting a surgery from Dr. K, I was so relieved because I knew she was in good hands.

Now it has been about a month since her first HTO surgery. I was glad to hear her pain level after the surgery was not too high. According to Cindy, her pain level was no more than a 5 between 1 and 10, 10 being the highest pain level – 911 situation – my pain level a day after the surgery was between 5-8. She exercised a lot especially on muscle strengthening before the surgery and it’s been very helpful for her as she uses her core muscles to balance herself with one leg.

She hasn’t scheduled her second surgery yet but I am happy to share some photos that show the progress from her first surgery. Cindy – you have been so brave. I remember when you wrote me that your physical therapist told you your legs don’t look that bad and tried to persuade you not to have a surgery. It’s great to hear that even your therapist is impressed with Dr. K’s work! Thank you so much for sharing your story with me. It’s been comforting  and therapeutic to share our stories together and I am so excited for the new chapter in your life for you.

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Iris’ Story: Post-Surgery

It’s hard to believe it’s been only about 5 months since I met Iris in person (click here to read our first meeting). She was a sweet lady and we connected right away because we knew both of us struggled with the same problem from having bowed legs. From then on she went through two surgeries and currently is in recovery process. I know she’s been through lots of pain and physical therapy that requires patience, time and energy. Without further ado, here is the story and photos forwarded from her this morning. Although I went through HTO myself, I was amazed to see her photos! Congratulations, Iris! I am so happy for you!

I was fortunate enough to discover this blog and eventually met Dr. K and NACG in May. After my first appointment with Dr. K, I scheduled for my first tibial osteotomy surgery to correct my left leg in July. Nine weeks later, I had my second tibial osteotomy surgery done on my right leg. From two surgeries, Dr. K corrected 8.5 degree on my left leg and 9.0 degree on my right leg. In addition, he also corrected my uneven legs. Prior to the surgery my left leg was slightly longer than my right one. Although these 2 surgeries were identical, my experience were very different.

(I) First Surgery – Left leg
I decided to have my left leg operated first because the pain from the inner left knee was much more severe. Also, my left leg looked more bowed than my right leg at the time. The anesthesiologist decided to give me the general anesthesia with block. After all the pre-op work, I was pushed to the surgery room and the doctor asked me to inhale something and then I went unconscious. The surgery went well and I didn’t have any complication with the anesthesia at first. After I was almost awake from the recovery room, the hospital staff took me to my room, where I stayed one night. I had a big meal after the surgery and was able to get up with a walker to go to the bathroom. The pain level was not too bad for the first 8 hours because the block was still working. However, by midnight I was in so much pain that I had to call nurse every few hours to give me more pain medications (Morphine shots and Percocet). In the next morning, I started feeling very dizzy. I threw up a few times and felt sick in my stomach. Despite the nausea, the pain level was manageable. Dr. K visited me early in the morning and told me that the surgery was a big “A+”. I was relieved to hear that and a few hours later, they discharged me from the hospital.

On the way home to my sister’s house, I started throwing up like crazy. I threw up and thew up the whole 40 minutes of the drive. I was told that this was a side effect for someone who went through general anesthesia. Out of the whole surgery I think this drive was most awful than anything.

During the first week after surgery, my left leg was extremely bruised and swollen. The hospital gave me a “Polar Care Ice Cube” machine to wrap around the operated area and I used it for 24 hours for the first 3 days. However, on the 4th day I noticed that the hose on the machine was leaking around my knee, and I was supposed to keep the operated area dry until the stitches were out, so I stopped using the machine and I didn’t ice the operated area until after I met Nurse Stacey on the 8th day to take out the stitches. This was a big mistake on my part. My leg continued to be much more bruised and swollen than it should be for next few weeks so my advice to future HTO patients: keep icing your operated leg for the first 7 days non-stop.

My recovery on my left leg was very painful and slow due to (1) excess swelling and bruise (2) my age. I was very dedicated to work on all the exercises that physical therapist provided for me, however, my progress has been pitifully slow, especially with bending. As of today, my left leg is 15 weeks post-surgery and I can only bend up to 135 degree “after” warm up the leg. Without warm up the leg, I can only bend up to around 95 degree.

I visited Dr. K on the 4th week post surgery and at the time, the x-ray looked fine, so I started weight bearing after the appointment. I started putting light weight on my left leg with two crutches for one week, then down to one crutch for another week and was totally crutch-free by the 7th week. Also, since I had my left leg operated first, I was able to drive by the 5th week.

(II) Second Surgery – Right leg
I decided to have my second surgery done nine weeks after the first surgery. Everything was similar to my first surgery except for the method of anesthesia. After reviewing my chart and discussing about my side-effect from last time, the anesthesiologist decided to use a different kind of general anesthesia, hoping that I would have less side-effect after surgery. However, this was not the case. I developed a slight fever after the surgery and started vomiting. I could not eat, drink, talk, or even get up to go to the washroom. Since my good leg (left) was only operated nine weeks ago, it was not strong enough to carry my full body weight up so I could not use the walker to go to the washroom. The nurse had to give me the bed pan when I needed to go, and eventually ordered a commode for me on the bedside. Fortunately I also brought some adult diapers with me and that helped a lot. I continued to use adult diapers after I was discharged from the hospital since I was just too weak to get up.

The pain level on my second surgery for my right leg was also more intense. Since I kept throwing up, the nurse/doctor had to change to a different kind of pain medication. They suspected that I was allergic to Morphine so they stopped giving me the Morphine shots. Percocet, which worked like a gem last time, no longer worked. They finally changed to Dilaudid which seems to calm my pain slowly.

Also, since my leg was covered with the brace after surgery, I developed some rashes on the back of my thigh. The nurse suspected that I might be allergic to the material on the brace or the metal in the brace. It’s interesting that I didn’t have any of the allergic reaction from the brace on my first surgery.

Dr. K visited me the morning after the second surgery. He was very pleased with the surgery and the fact that my legs are finally “even” length. Since my correction is larger than many of other patients, he encouraged me to be more aggressive on the exercise afterward. I asked him why the pain level was so much more severe this time but he didn’t have an answer. He said my x-ray looked great and he couldn’t be more pleased with the result. By the middle of the day, my fever had dropped and my pain level had stabilized so they discharged me from the hospital.

Despite all the drama that I went through with my second surgery (right leg), my recovery was rather speedy. I had no problem with bending at all and as of today, 6 weeks post-surgery, I can bend up to 170 degrees without warm up on my right leg. I really think that few days of non-icing on my left leg made the whole difference. As Nurse Stacey told me during my second post-up appointment: “bruise and swelling will keep your range of motion away. Your number one goal in the first few week after surgery is to get the swelling down. Once the swelling is down, the bending will come back itself.”

With my right leg I started weight bearing on my 22nd day post surgery (beginning of 4th week). I was eager to get back to my routine so I forced myself to walk without crutches on the 5th week. I was limping but was crutch-free. On the 6th week, I was able to walk without limping and I started driving at the same time.

(III) After surgery
I am now 15 weeks post-surgery for my left leg and 6 weeks post-surgery for my right leg. I can walk fine now but the knees still feel stiff. I continue to work on the exercises that physical therapist ordered me and started stationary biking as well. My legs still get swollen at the end of the day so I raise them up and ice them for half an hour each. For the readers who are interested in having the HTO surgeries done on both legs, I recommend to have two surgeries spread out a little bit. It was extremely difficult to get around without an “able” leg. Also, since I was an out of town patient, I stayed in Washington DC for 4 weeks after my first surgery before I flew home; for my second surgery I stayed there for 3 weeks.

A few observations after surgery:
(a) So far my scars are pretty noticeable. My left leg’s scar is around 3.5 inches where as my right leg’s scar is around 2.8 inches.
(b) I am about 1.3 cm taller.
(c) My knees often feel like 10 degrees hotter than the rest of my body temperature after the surgery. This is normal according to Dr. K.
(d) I still have numbness and some bruises around my leg even after 15 weeks of surgery. This is normal according to Dr. K as well.
(e) Because I cannot bend my knees and I like to sleep on my side, I have a hard time getting good sleep. This is normal according to Nurse Stacey.
At the end of the journey I want to say thanks to Dr. K and to NACG. Without them, I never dreamed to have such surgery in my life time. I am proud to say that I am finally “Not A Cow Girl”!

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Doctor/Surgeon Information

I wish I have a list of doctors world-wide who perform I-Balance Tibial Osteotomy for the readers of this blog or anyone who is interested in tibial osteotomy to correct bowed legs and fix physical and emotional pain. Fortunately the readers who found the surgeons in their areas kindly shared the contact information and I thought it would be helpful to post a list of the surgeons who would perform tibial osteotomy and keep updating as the list gets longer. If you are reading this post and would like to add a doctor/surgeon, please do leave a comment! Thank you!

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Washington D.C. (US)
Dr. Klimkiewicz (Dr.K who was my surgeon)
Georgetown University Hospital
Link to Profile Page

Oregon (US)
Dr. Scott Grewe
Orthopedics Northwest
Link to Profile

California (US)
Dr. Zack Vaughn
Standford University Orthopaedic Surgery
Link to Profile

Connecticut, New England Area (US)
Dr. DeBerardino
University of Connecticut Health Center
Link to Profile Page

Denver, CO (US)
Dr. Tom Hackett
The Steadman Clinic
Link to Profile

New York, NY (US)
Dr. Tom Youm, HJD
NYU Hospital for Joint Diseases

New York, NY (US)
Dr. Orrin Sherman, HJD
NYU Langone Medical Center

Minnesota (US)
Dr Elizabeth Arndt
Link to more info

Minnesota (US)
Dr Brad Nelson
Link to more info

Minnesota (US)
Dr James Gannon
Link to more info

Minnesota (US)
Dr Andrew Arthur
Link to hospital website

Bristol, Bath (UK)
Dr.Jonathan Eldridge
Circle Hospitals
Link to Profile Page

Glasgow, Scotland (UK)
Dr.Colin Walker
Glasgow Sports Surgery Service, Southern General Hospital
Link to Profile Page

Kuala Lumpur (Malaysia)
Prof. Aik Saw
University Malaya Hospital
Link to Profile

Prague (Czech Republic)
Dr. Vladimir Hospodar
Malvazinky Hospital
Link to Hospital Website

Istanbal (Turkey)
Dr. Ugur Haklar
Acibadem International Hospital
Link to Hospital
Email Dr. Haklar

India
Center for Advanced Orthopedic Surgery, Aurangabad, India
Link to Hospital Website

Japan
Dr. Toma (藤間) at Nara Iryo-Center in Nara prefecture
Link to hospital website
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Also you may contact Dennis O’Keefe, a regional manager for Arthrex, Inc. in the Northeast U.S. and Eastern Canada. (The iBalance System is an Arthrex product.) He might be able to connect you to another Arthrex representative or a surgeon in your area. His email address is Dennis.OKeefe@arthrex.com He is super friendly and a great help. He has connected many people to the surgeons who operate with I-balance system.

I hope the list gets updated and longer soon! Good luck, everyone!