Brian Hunt has been dealing with chronic knee pain for almost 10 years. Since 2011, he has struggled to maintain his desired level of activity and been forced to avoid or modify activities and trips because of his right knee pain.
He had been through two separate arthroscopic surgeries with partial removal of the meniscus, or cushion, on the inside of his knee. His last surgeon told him he was soon to need a partial or total knee replacement as knee injections were no longer helping with the pain.
Brian came to OrthoIndy looking for a second opinion, as he has been a long time OrthoIndy patient and always felt comfortable with the care and comprehensive evaluation he would receive.
His goal was to get back to hiking and other strenuous activities.
After being evaluated by one of the sports physicians, he was referred to Dr. Stephen Greenfield, a fellowship-trained joint preservation and limb deformity specialist.
More than just arthritis?
Brian’s X-rays showed arthritis on half of his knee. Dr. Greenfield explained that because of the bowleg deformity, more weight was passing through the arthritic half of the knee, causing his pain.
Bowleg deformity can result from a congenital deformity or strictly due to arthritis and joint narrowing on one side of the knee. Similarly, knock knee deformity causes narrowing on the outside of the knee. In Brian’s case, he had early medial compartment arthritis of the knee.
“We spoke about options,” Dr. Greenfield said. “There are two philosophies of care for someone like Brian. He could have either a partial knee replacement or a high tibial osteotomy. The osteotomy would take the pressure off the arthritic part of the knee and shift the weight to the healthy portion of the joint to avoid a knee replacement for as long as possible. For someone wishing to remain active, the osteotomy has clear benefits.”
Brian’s films were also reviewed by a joint replacement surgeon at OrthoIndy. After considering his options and speaking with Dr Greenfield, Brian elected to have the osteotomy to offload the arthritis and keep his real knee.
“He was a great candidate because of his age, degree of bowleg deformity and desire to remain active,” Dr. Greenfield said. “Impact activity can cause failure of a knee replacement.”
High Tibial Osteotomy
Brian underwent a high tibial osteotomy in March of 2019. During this procedure, Dr Greenfield made an incision on the inside of the leg near the knee. He partially cut the bone and wedged it open until the healthy portion of the knee supported Brian’s weight. Once Dr. Greenfield achieved the desired correction, he used a metal plate to stabilize the osteotomy. He then used bone graft to fill the gap.
Dr. Greenfield prescribed six weeks of protected weight bearing and an aggressive range of motion exercise program. After radiographic healing was confirmed, he returned to weight bearing exercises.
At just over four months from surgery, he was hiking five miles a day in the mountains of North Carolina. By six months, “We (Brian and his wife) visited Iceland and hiked around fifteen miles a day with no pain in my knee,” Brian said.
Now, two years after surgery, Brian continues to feel better than he has in years. He is no longer dependent on anti-inflammatory medications. He has noticed a substantial improvement in his ability to work out and he is able to do things he has not been able to do in years.
Although he has since retired from law enforcement, now working as a full-time contractor, Brian comments his previous professional life would have no longer been possible with the pain he felt before surgery. With the help of OrthoIndy and Dr. Greenfield, Brian is confident he has gained years before he needs a knee replacement.
Brian encourages anyone suffering from knee pain to research your options. Joint replacement is often not the only solution. “Both bowleg and knock-knee deformity can result in early knee arthritis that can and often should be treated with this type of approach rather than strictly relying on joint replacement,” Dr Greenfield said.
Dr. Greenfield specializes in evaluating the mechanics and alignment of the lower limb to provide a comprehensive evaluation of options in order to maximize a patient’s ability to avoid a joint replacement. Please call (317) 575-2720 to schedule an evaluation.