Knee Patient Stories

Told by Guy, Patient of the Droitwich Knee Clinic

Figure 1: Both legs are
twisted kneecaps point
inwards.

Pain around my kneecaps started when I was 16 years old. My right knee was originally the worse, and over the next 20 years I had more than a dozen operations on that knee. Over the years several orthopaedic surgeons said that the underlying cause of my problems might be the twisted rotational alignment of my legs, where the kneecap is rotated inwards relative to the foot and hip.

But correcting this rotational misalignment by conventional surgery was always thought too dangerous or too difficult.

Having not had much success over the years with the various conventional operations on my right knee, I was very well aware that the problem could be difficult to help by surgery. However by the time I was 36 years old my left knee had become much worse. Over a period of a few months I consulted several orthopaedic surgeons. Some of them suggested a conventional operation such as a lateral release, but I was reluctant because this had not helped my other knee. At the London Knee Clinic, Mr Strover referred me to his limb reconstruction specialist colleague Mr El Shazly in Droitwich, to see if my rotational misalignment might be corrected by limb reconstruction techniques.

Figure 2: Sheffield Ring
Fixator applied to left leg
to correct the rotation.

Whilst the proposed operation seemed very logical, it would also be an unusual operation for anterior knee pain. Some time was therefore spent seeking advice from limb reconstruction specialists in other countries, and planning the operation in detail using CT scans and X-rays. When the planning had been completed, a whole morning in the operating theatre was booked for the surgery. At the operation, a circular frame called a Sheffield Ring Fixator was attached around my lower leg bone (the tibia), extending up to the lower part of the knee.

Through a very small cut in the skin, a complete horizontal division of the tibia was made just below the knee. The lower part of the tibia was then rotated 15 degrees in the operating theatre, partly correcting the twist in my leg. At the end of the operation, the upper and lower parts of the tibia were held precisely in position by the circular frame. The frame was attached to my leg by several pins and thick wires – a bit like the spokes of a bicycle wheel, with the leg in place of the wheel hub, and the spokes passing straight through the leg.

After the operation I was able to go home later the same week, with the frame holding the upper and lower parts of my tibia in position around the unhealed division through the bone. But the rotational correction was not yet finished. Over the next three weeks I gradually rotated the lower part of the tibia another 10 degrees, by making a small adjustment to the frame with an Allen key three times a day. At the end of this period, with the rotation of the tibia now corrected by 25 degrees, the frame was locked and left for another 8 weeks to allow the division in the tibia to heal in the new position.

The frame does restrict your mobility, and it was unpleasant at first, but I gradually got used to it as the weeks passed. I was glad that I was working from home after the operation, although it is possible to get around on crutches. I had been told that infection around the frame was a possible temporary problem, but I had none. My only complication was that for some weeks after the operation, I was unable to move my big toe, probably because a nerve passing close to my tibia had been trapped by the frame. But this gradually recovered, with no lasting ill effects.

When the frame was removed, the rotational alignment of the leg had been fully corrected.

There were no metal plates left in the knee, as there might have been with a more traditional operation, and also no large scars. Most important of all the anterior knee pain, which had been slowly getting worse for nearly 20 years, was much improved.

Figure 3: With the frame removed, my left leg is straight, the knee is no longer twisted, and no large scars; other leg unchanged.

This outcome was very different to my other knee, where initial conventional operations, which did not correct the rotational misalignment, led to a sequence of operations of gradually increasing severity. I was pleased with the result of my limb reconstruction, in fact so pleased that I made a donation of shares worth £32,000 to the Knee Foundation as a way of saying thank you. With this money the Knee Foundation has been able to purchase four arthroscopic workstations which has helped junior doctors develop their skills in arthroscopy, using life like knee models.