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[liltunechi]

Hey everyone

I underwent LON for Tibias in the beginning of June. My aim was 3cm.

The Dr told me that during the surgery he will leave a gap of around 0.4cm.  I lengthen for only 6 days then had to stop for personal reasons. 

Basically, it was 13 days after my first surgery when I got the external frame removed.

I am now 3 weeks since the removal.

Currently walking around 1 hour a day on a walker (divided into six 10 minute walking sessions) and do the physio I have been instructed.  7 sets of exercises, 3 times a day.

Currently I do have pain in my knees but the Dr said it’s because I’m still in the early stages. I’m just scared that I hope I don’t develop chronic knee pain.

My question is, how long until I will be able to walk normally and sit and stand and do most basic things again?  I have never been the athletic person so I don’t care too much about extreme athleticcm, I’m just talking about normal function. 

Also when will the vast majority of the pain go away?

I will include my latest X-rays. They are from yesterday. Do they look good?

https://pasteboard.co/yYZfLPgyupCB.jpg
https://pasteboard.co/XDIzNozeMDUb.jpg
https://pasteboard.co/6YsxqP1YjX5y.jpg
https://pasteboard.co/nuq1fNRGDFdc.jpg

Thank you all so much. Again, before bashing me, it was extreme personal reasons that I had to stop the surgery.

Thanks guys, I just hope I can be normal again and not feel the pain.

[Maison]

Your tibia appears to have an procurvatum deformity.
Has your doctor made any comments about the deformity?

https://slidetodoc.com/presentation_image_h/f064d33effba29136edbe00c0b9b73f7/image-17.jpg
https://custom-images.strikinglycdn.com/res/hrscywv4p/image/upload/c_limit,fl_lossy,h_9000,w_1200,f_auto,q_auto/845312/3e325ae1e46947deaaf7c0f2f6fbd1b8_nli8iy.png

You should consult with your physician, but you may need to install the frame again to correct the deformity.

[liltunechi]

Your tibia appears to have an procurvatum deformity.
Has your doctor made any comments about the deformity?

https://slidetodoc.com/presentation_image_h/f064d33effba29136edbe00c0b9b73f7/image-17.jpg
https://custom-images.strikinglycdn.com/res/hrscywv4p/image/upload/c_limit,fl_lossy,h_9000,w_1200,f_auto,q_auto/845312/3e325ae1e46947deaaf7c0f2f6fbd1b8_nli8iy.png

You should consult with your physician, but you may need to install the frame again to correct the deformity.

I just asked him now. His response was :

No, you have slight translation deformity. When your newly formed bone fills the gap your translation will disappear.  Translation deformity occured because we ended the lengthening earlier. New bone will fill your gap. Your joint angle is normal so you should just wait.

[Maison]

I just asked him now. His response was :

No, you have slight translation deformity. When your newly formed bone fills the gap your translation will disappear.  Translation deformity occured because we ended the lengthening earlier. New bone will fill your gap. Your joint angle is normal so you should just wait.

It looks to me like you have a 4-5 degree deformity in your tibia.

It is not a serious deformity and the deformity may become less noticeable in the future.

By the way, do you intend to do another bone lengthening once your personal problems are resolved?
If the deformity bothers you in the future, you can have it corrected at the time of revision surgery.

[liltunechi]

It looks to me like you have a 4-5 degree deformity in your tibia.

It is not a serious deformity and the deformity may become less noticeable in the future.

By the way, do you intend to do another bone lengthening once your personal problems are resolved?
If the deformity bothers you in the future, you can have it corrected at the time of revision surgery.

Thank god it’s nothing serious. And most likely I won’t do this surgery again. The pain and mental torture is too much for me, you can call me weak etc, that’s fine.

When you say ‘the deformity bothers you’ do you mean in terms of aesthetics or pain?  Because I I really don’t want pain. One thing I realised is that I have a very low tolerance for pain and that’s why I’ll never do this surgery again.

Thank you brother

[Maison]

My main concern about your deformity is a cosmetic issue.
Since it is not a major deformity, I think it is unlikely that you will develop chronic knee pain or other problems in the future.

However, I am not an expert and you should listen to the opinions of other doctors or members of this forum. If revision surgery is performed to correct the deformity after consolidation, it is very painful because of the osteotomy required.

[liltunechi]

My main concern about your deformity is a cosmetic issue.
Since it is not a major deformity, I think it is unlikely that you will develop chronic knee pain or other problems in the future.

However, I am not an expert and you should listen to the opinions of other doctors or members of this forum. If revision surgery is performed to correct the deformity after consolidation, it is very painful because of the osteotomy required.

That’s good news then. I could give a damn about how it looks cosmetically. I never wear shorts anyways lol.

I wanted to ask you however, back to my original question, what should be the expected timeline for my recovery?  When should I be off the walker, and be able to walk normally without pain without any assistance? I’d love to hear a rough timeline.

I walk 1 hour everyday.  Everyday I try to add an extra 10 minutes.

I do my 7 sets of excercises 3 times a day as instructed by my physio.

[Maison]

That’s good news then. I could give a damn about how it looks cosmetically. I never wear shorts anyways lol.

I wanted to ask you however, back to my original question, what should be the expected timeline for my recovery?  When should I be off the walker, and be able to walk normally without pain without any assistance? I’d love to hear a rough timeline.

I walk 1 hour everyday.  Everyday I try to add an extra 10 minutes.

I do my 7 sets of excercises 3 times a day as instructed by my physio.

Is it the knee, not the osteotomy, where you feel the strong pain?

[boklecrt]

Thank god it’s nothing serious. And most likely I won’t do this surgery again. The pain and mental torture is too much for me, you can call me weak etc, that’s fine.

When you say ‘the deformity bothers you’ do you mean in terms of aesthetics or pain?  Because I I really don’t want pain. One thing I realised is that I have a very low tolerance for pain and that’s why I’ll never do this surgery again.

Thank you brother

Only people who haven't had the surgery would call you weak or a wimp for backing out at 1 cm.

This surgery is something else entirely to the comfortable coddled life the majority of people have been accustomed to so you know yourself best how you have reacted to the stress of the surgery and if your decision was to quit early thats your prerogative.

With that said, unfortunately, even 1cm is enough to start the long and uncomfortable process of being able to walk normal again, let alone run. My suggestion is to attempt moving from walker to crutches as soon as you can handle it as only crutches will help you get back to normal walking. So, a lot of crutch walking until one day you are comfortable enough to support yourself on one crutch, and then one day just like that you will feel confident enough to pick up the crutch from the ground and walk with the crutch hovering above the ground.
This is how you will get back to normal. We cannot give you a time frame as every one is different. But 2 hours of walking per day is the standard

[liltunechi]

Is it the knee, not the osteotomy, where you feel the strong pain?

I feel pain in the osteotomy area but what I feel in the knee I wouldn’t call sharp pain. It’s just annoying tenderness. Very nagging. Feels sore.  The Dr told me it’s because of how early the surgery is, so I am hopeful.  I just hope it doesn’t sustain and I hope I don’t develop any chronic knee issues.

What do you think?  How long would you say it’s normal to feel a nagging soreness and tenderness in the knee area after this surgery?

[Maison]

I feel pain in the osteotomy area but what I feel in the knee I wouldn’t call sharp pain. It’s just annoying tenderness. Very nagging. Feels sore.  The Dr told me it’s because of how early the surgery is, so I am hopeful.  I just hope it doesn’t sustain and I hope I don’t develop any chronic knee issues.

What do you think?  How long would you say it’s normal to feel a nagging soreness and tenderness in the knee area after this surgery?

Perhaps the pain in the osteotomy area will get better in about another month as the bone healing progresses.

The problem is the knee pain.

As you may know, as has been discussed in this forum several times, knee pain after tibial intramedullary nail surgery is a common complication.
It is said that the pain may heal or it may be permanent.

I have no clear knowledge of the frequency of permanent pain, but someone said 15%.

http://www.limblengtheningforum.com/index.php?topic=65413.msg177719#msg177719

I wish you all the best in your recovery.

[boklecrt]

I feel pain in the osteotomy area but what I feel in the knee I wouldn’t call sharp pain. It’s just annoying tenderness. Very nagging. Feels sore.  The Dr told me it’s because of how early the surgery is, so I am hopeful.  I just hope it doesn’t sustain and I hope I don’t develop any chronic knee issues.

What do you think?  How long would you say it’s normal to feel a nagging soreness and tenderness in the knee area after this surgery?

you currently have 4 broken bones and had both your lower kneecap tendons dissected with a scalpel in order to hammer a foot long steel rod into your tibias

wait 3 months and then report on what pains you feel and then we will try to see what can be done about it

[Sambollio]

Honestly I’ve been in the LL community for over two years and have heard so many LON horror stories along the way. I’d consider it a blessing in disguise that you stopped after 1cm.

[liltunechi]

Thanks guys. I’m pretty confident that my ankles and legs will be back to normal. I only lengthened 1cm… if that.  Maybe even only 0.8cm. Barely anything.

I’m just worried about potential long term chronic knee pain.  I truly hope I don’t get it.

But then again, after doing some more research, inserting a nail into the tibia is a pretty common surgical treatment for tibial injury’s. Surely, if it’s performed a lot by surgeons outside of LL then it’s should be too much of a worry? 

Finally, would you guys recommend I get the nails removed one day? Or should I keep them in and the screws forever?

[liltunechi]

And finally, how bad can the chronic knee pain be? What does it feel like?

Is it constant or only when walking or exercising etc?

Is there anyone in this forum that developed chronic knee pain?

[171in2022]

Most orthopedic surgeons would suggest leaving a regular IM nail in if there are no complications associated with the it. Re-operation for removal carries it's own risks.

However, most CLL surgeons advocate for IM nail removal. CLL surgeons rarely work in public health systems though so you have to consider their vested interests; removal usually = $. There's risks if you leave them in and risks if you remove them, so it's really a personal choice based on how your legs feel later. If you don't notice the nails then I would say leave them in. 

[liltunechi]

So, do you guys think I shouldn’t worry too much then?

Since I only lengthened 1cm.

I am 5 weeks post op, and walking with a walker. There’s pain in my knees when I move my legs and walk and also pain in calves when I walk.  Is this normal ?

And when should I expect this pain to go away?  I just want to be able to walk and do normal daily things without pain

[Maison]

As boklecrt says, you will need to wait about 3 months from the surgery.

If you get another new xray, please upload it.

[djimbo9]

What kinda person thinks it's a good idea to pay all this money, do this   to your legs for a measly 3cm... just wear height insoles if all you wanted was 3cm

[motoboarder]

What kinda person thinks it's a good idea to pay all this money, do this   to your legs for a measly 3cm... just wear height insoles if all you wanted was 3cm

you didn't read before you speak did you?

OP said
"Thank you all so much. Again, before bashing me, it was extreme personal reasons that I had to stop the surgery."

[motoboarder]

I lengthened both segments simul with tibia +4cm, and my doctor cleared me for walking after a little over 2mo after stop lengthening. I think you could recover faster than this. Keep staying healthy, relax and eating nutritiously.

In early stage, my new bone also appeared like yours. You have good callus, so it should be fine. One question I'd have for the doctor is about the new bone growth that spilled over to the side (in 1 of your x-ray). Because the 1cm gap maybe a bit too small, will new callus be absorbed back to where they're supposed to be?

[Maison]

https://pasteboard.co/yYZfLPgyupCB.jpg
https://pasteboard.co/XDIzNozeMDUb.jpg
https://pasteboard.co/6YsxqP1YjX5y.jpg
https://pasteboard.co/nuq1fNRGDFdc.jpg

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333649/

One of your lateral x-rays does not show the top edge of the nail.
According to this paper, if the nail is not protruding from the tibia, then the probability of permanent knee pain is not high.
I understand your concern, but it seems to me that all you can do now is just wait and see.

[boklecrt]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333649/

One of your lateral x-rays does not show the top edge of the nail.
According to this paper, if the nail is not protruding from the tibia, then the probability of permanent knee pain is not high.
I understand your concern, but it seems to me that all you can do now is just wait and see.

correct, the nail should be hammered below the top edge of the tibia bone
ive seen xrays here of nails sticking out of the tibia - that would rub on the tendon from the back until the nail is removed not to mention the long term damage of rubbing in the tendon


to add to your post

another factor for minimizing knee pain is how the tendon has been dissected. you want a surgeon to be very very careful to cut along the tendon fibers vertically without cutting into the fibers themselves

 


furthermore avoiding removal of the nail is advisable as that would require going the same route through the old incision. perhaps remove only the screws after consolidation

[liltunechi]

Thank you brother,  but I’m sorry I didn’t understand.

Basically is that good news for me or bad?

Based on my X-rays and the study you linked, is the likelihood of me getting chronic knee pain high or low?

Thanks again!

Here are some more x rays where you can see the top of the nail :

https://pasteboard.co/CCxhiu7CK8ir.jpg
https://pasteboard.co/blD9P4OdUIGE.jpg
https://pasteboard.co/y4z4HwjXhtl7.jpg
https://pasteboard.co/gWaYUCDz8OK5.jpg

[liltunechi]

.

[liltunechi]

correct, the nail should be hammered below the top edge of the tibia bone
ive seen xrays here of nails sticking out of the tibia - that would rub on the tendon from the back until the nail is removed not to mention the long term damage of rubbing in the tendon


to add to your post

another factor for minimizing knee pain is how the tendon has been dissected. you want a surgeon to be very very careful to cut along the tendon fibers vertically without cutting into the fibers themselves

 


furthermore avoiding removal of the nail is advisable as that would require going the same route through the old incision. perhaps remove only the screws after consolidation

I am 6 weeks post op and still feel a lot of sharper knee pain and pain in my calves

The pain is exactly where the incision was made on my skin so the pain is coming from my tendon

It’s very sharp and localised. I feel it when I move my legs or bend them or move them a certain way. Sometimes when walking on walker too.

Would you say it’s still too early to worry about it and that this pain will go away?

My Dr told me the pain is from the healing that is happening and because of inflammation. He said it will go away.

A transpatellar approach was used btw

What do you think?

[thankscience]

It might also be from the nail hitting the tendons which exacerbates the pain. It's possible that you will always have a little bit of pain until you get the nails out. But 6 weeks post op is still too early to tell if it is chronic.

[liltunechi]

It might also be from the nail hitting the tendons which exacerbates the pain. It's possible that you will always have a little bit of pain until you get the nails out. But 6 weeks post op is still too early to tell if it is chronic.

How can the nail be hitting the tendons if it’s buried in the middle of the bone ?

[liltunechi]

Update:

Moved onto walking with crutches.  I don’t walk a lot though, only around 30 minutes a day and the rest of the time I’m just laying in bed or sitting down.

I can walk with one crutch too, but I’m going to stick to using 2 crutches for another 1-2 weeks. Then move to one.

Pain in my legs has decreased a good amount.  However, knee is still there. My right leg knee is better than my left knee. I would say since I created this thread, my overall knee pain has gone down by 10%.

I hope it gets better and better.

Tomorrow I will be getting X-rays, I will post them here.

In order to see if a screw or nail isn’t causing the knee pain, what type of scan should I get? CT scan?

[boklecrt]

Update:

Moved onto walking with crutches.  I don’t walk a lot though, only around 30 minutes a day and the rest of the time I’m just laying in bed or sitting down.

I can walk with one crutch too, but I’m going to stick to using 2 crutches for another 1-2 weeks. Then move to one.

Pain in my legs has decreased a good amount.  However, knee is still there. My right leg knee is better than my left knee. I would say since I created this thread, my overall knee pain has gone down by 10%.

I hope it gets better and better.

Tomorrow I will be getting X-rays, I will post them here.

In order to see if a screw or nail isn’t causing the knee pain, what type of scan should I get? CT scan?

dont worry 30 minutes of non stop walking is quite alright, both ankles should be sore after

make sure to stand for 10-15 minutes in one spot 2-3 times a day too to put body weight on the legs

so what happened with the xrays?

[akali]

I believe it will get better and better but what did your doctor say about this pain? Is it okay to have knee pain like this? How about your bending, is there any problem about the bending?