Eleanor, a nutritional therapist, has always been very active and sporty throughout her life but recently had to manage the grinding sensation she felt behind the patella (kneecap) due to wear and tear. The osteoarthritis in a single compartment of Eleanor’s knee joint was treated with annual hyaluronic gel injections.
A minor fall whilst skiing 20 months ago triggered further deterioration and subsequently any long walks or tennis matches resulted in knee pain and swelling. This was interfering with all activities of Eleanor’s life – she would even struggle on the stairs and had intermittent night pain.
Eleanor sought treatment and an NHS X-ray showed a perfectly healthy joint, so she organised her own MRI scan, which revealed a small medial meniscal tear. Eleanor was advised that at her age (59 at the time) she would not be offered a knee arthroscopy as a published review had revealed too many arthroscopies were proving unsuccessful in her age group with many patients going on to have joint replacement surgery within two years. Eleanor was advised to keep exercising and keep the leg muscles strong.
Unfortunately, the advised exercise regime just resulted in Eleanor’s knee swelling and increasing pain because the cause was not being addressed. As the year progressed her walks became shorter, the tennis matches stopped, a limp was becoming noticeable, she was gaining weight, losing leg muscle and feeling very depressed. Eighteen months later further NHS consultations offered her a choice between a total joint replacement or steroid injections, but nothing in between. The first option felt too drastic for what was a single compartment of degeneration, the second option would just buy a few weeks of pain relief but, was just postponing the need for a knee replacement.
Eleanor had been researching mesenchymal stem cells as a possible treatment for the torn cartilage in her knee and assumed she would have to travel to the United States, when she came across The Regenerative Clinic in London, where Professor Wilson is a consultant. She explains: “What I like about the doctors here is that they properly investigate you – as an individual – they listen to your story, your health history, your lifestyle and devise a treatment plan tailored to you. If you have a good ‘biological age’ they also factor that in.”
A long leg X-ray revealed that Eleanor had a slight bow-legged misalignment, exacerbating what was now a single compartment of cartilage degeneration on the inner (medial) side of her knee. This had no doubt been accelerated by the lack of quad and gluteal muscles, from the loss of activity/exercise following the ski injury. Eleanor understood a high tibial osteotomy (HTO) procedure could correct the alignment, take the pressure off the weight bearing damaged cartilage, and enable her to get back to normal exercise, sport and activity levels.
The plate and pins inserted into Eleanor’s knee during the osteotomy enabled weight bearing with crutches very quickly as she explains: “This is a big operation and one needs to factor in 6 weeks off work, with regular icing to control swelling, and hydrotherapy to maintain joint mobility. After 7 weeks I can potter without crutches, and without a noticeable limp, but need the assistance of a crutch to walk more than 200m. After the initial 4 days of pain relief I managed on regular Ibuprofen and the last X-ray has shown really good healing. The weight bearing axis is now central to the knee joint, rather than off centre, and my range of mobility good. I’m looking forward to getting back to Pilates soon and maybe tennis in a couple of months. I love that I still have MY joint and intend to keep the muscles strong to look after it!”
Professor Wilson concludes: “I am delighted with the excellent result from Eleanor’s high tibial osteotomy. An osteotomy is particularly suitable for younger osteoarthritis patients who are too young and active for a knee replacement. The greatly reduced pain patients feel after treatment often means they can return to living normal lifestyles soon after surgery, which is particularly beneficial to patients such as Eleanor. Five weeks following her procedure Eleanor is doing remarkably well. She is using one crutch to just take things steady, but she has got very little pain and her wounds have healed nicely with minimal swelling to this area and to the calf. The alignment X-ray looks spot on today. I am going to see Eleanor again in two months with a further AP and lateral view.”