Advice what to do Bowing leg tibia and fumer

[Mazen69]

I am 43 years old male patient osteomey case , having a problem of Rickets diagnosed at
age of 14. correction on my left femur was conducted as shown in Fig.1. directly after that
operation I suffered from blood collapses ( anemia) then it disappeared and afterwards I
had suffered from ITP (low platelets count). I was treated with predniselon (cortisone) which
was taken for several years. I am now take no treatment and my platelets count are stable
around 180-230. During the last five years and with sharp increase in my weight from 55
to 68 kg (height 153 cm), I started to have problems walking specially on my right leg
specially when taking upstairs. There is a large friction in my knee. It seems that certain
damage has occurred on the knee. I have taken x-rays for both of my legs, and I have
noticed that my right femur and tibia are bowing too. X-ray for right tibia (AP) and femur
(lateral) and MRI for the right knee are available. I was advised that different orthopedic
specialists to look at my problem at the same time as it involve bowing and knee problems.
Full x-ray and MRI are available up on request.
Rt. Knee MRI report
1) Subarticular osteonecrosis of the femur and tibia is seen more prominenet in the
medial aspect concomittent with bone marrow edema of the medial femoral condyle
and thinning of the cartilage covering the femoral condyle and tibial plateau is noted.
2) The medial and lateral menisci of the knee joint are intact. No tear is seen.
3) Joint efusion is noted.
4) The anterior and posterior cruciate ligaments are intact.
5) The soft tissues surrounding the knee and imaged vascular structures are normal.


1) what is the overall diagnostic problem of my right leg ??
2) what are the possible medical options to taken to correct the problem of my leg ??

[Mazen69]

By next Monday I will complete six weeks  from the day of my operation high tibia osteotomy with bone implant.   my surgeon  told me that he needed to make a 22mm opening  to make my leg in straight line  and that he used tomofix  system (Ti plates) and  artifical bone.  Also he told that my knee is in bad shape  and TKR  is  expected in 5 years.   I am now at home recovering  and I walk using walker  until now .       Frankly speaking,  I am afraid to walk by myself  (it seems I have forgotten how to walk..!!!) .   I saw my doctor   four weeks  ago  take out the stitches.    In the literature I have read that  patient can walk after the four week and others after 8 weeks.   I will try to see my doctor  in the next two  weeks.  But what do you advice in my case  can I start walking normally   or is it too ealy..!!   waiting for your kind advice .

Many thanks  

[Mazen69]

Dear Dr Kaul

thank you dearly for replying to my case.  But what type of ortheapedic surgent I should see,  and will correcting the bowing in the femer or tebia or both will help in gaining control of my leg in a much better form as I am having clear walking problem, talking the stairs.  it seems that my knee is not helping to performe well.  


I can send you the x-ray images on your private email if you would like that..!!

waiting for your kind adivce.

Mazen

[S. Kaul, MD]

Hi there!

The MRI describes degenerative changes of the knee joint which are likely to be progressive with areas of dead bone just below the joint forming surface and associated inflammation. The condition can be managed conservatively in mild-moderate cases with rest/ limiting weight bearing, anti-inflammatory medications and physiotherapy to strengthen the muscles around the knee joint. In progressive/ severe cases surgical options may be considered. I would suggest discussing the situation, the suggested management plan and the expected prognosis in detail with your treating orthopedician.
Hope this is helpful.

Take care!