Correcting Knee Deformities After Tibial Plateau Surgery: Solutions

Tibial plateau fracture treated surgically resulted in a varus deformity (bow-legged)?

In 2021, I underwent surgery on my left knee, where five screws and a plate were used for fixation.
Now, three months later, I have noticed that my thigh is turned inward, the left side of my popliteal fossa is flat against the bed, my calf is turned outward, and my heel is aligned properly.
I also have a leg length discrepancy.
Whenever I sit or stand, my calf muscles feel stiff, and I experience congestion and numbness in my calf and foot.
What remedial measures can I take?

Zhu, 50~59 year old female. Ask Date: 2022/05/27

Dr. Shi Guozheng reply Orthopedics

To determine if a fracture has healed, if it has healed, active rehabilitation should be undertaken.
In the future, if there are joint issues following the fracture, further treatment should be considered.

Reply Date: 2022/05/27

More Info

After undergoing surgery on the tibial plateau, it is not uncommon to experience complications such as knee deformities, muscle stiffness, and discomfort. Your description of the knee deformities, including the inward angulation of the thigh and outward angulation of the lower leg, suggests a potential alignment issue that may have developed post-surgery. Here are some insights and recommendations regarding your situation.

Understanding the Deformities
1. Knee Alignment: The inward angulation of the thigh (genu valgum or "knock-knees") and the outward angulation of the lower leg (genu varum or "bow legs") can lead to an imbalance in the knee joint. This misalignment can cause uneven weight distribution across the knee, potentially leading to further complications such as osteoarthritis or chronic pain.

2. Muscle Stiffness and Circulation Issues: The stiffness in your calf muscles and symptoms of numbness or tingling in the foot could be indicative of muscle atrophy or poor circulation. This can occur due to prolonged immobilization or lack of proper rehabilitation post-surgery.

Recommended Solutions
1. Physical Therapy: Engaging in a structured physical therapy program is crucial. A physical therapist can provide targeted exercises to strengthen the quadriceps and hamstrings, improve flexibility, and enhance overall knee stability. This may include:
- Stretching Exercises: Focus on the quadriceps, hamstrings, and calf muscles to improve flexibility and reduce stiffness.

- Strengthening Exercises: Incorporate exercises that target the muscles around the knee, such as leg raises, squats, and step-ups, to build strength and support proper alignment.

- Balance and Proprioception Training: Exercises that improve balance can help in stabilizing the knee joint and preventing further deformities.

2. Orthotic Devices: Custom orthotic devices or shoe inserts can help correct alignment issues and provide additional support to the knee. These devices can redistribute weight and alleviate pressure on specific areas of the knee joint.

3. Bracing: A knee brace may be beneficial, especially if you experience instability or pain during movement. However, it is essential to consult with your orthopedic surgeon or physical therapist to determine the appropriate type of brace and duration of use.

4. Regular Monitoring: Keep regular follow-up appointments with your orthopedic surgeon to monitor the healing process and assess the alignment of your knee. If deformities persist or worsen, further interventions may be necessary.

5. Pain Management: If you experience significant pain, discuss pain management options with your healthcare provider. This may include non-steroidal anti-inflammatory drugs (NSAIDs), physical modalities like heat or cold therapy, or other pain relief techniques.

6. Lifestyle Modifications: Engage in low-impact activities such as swimming or cycling, which can help maintain fitness without placing excessive strain on the knee. Avoid high-impact activities until you have regained full strength and stability.

When to Consider Surgery
If conservative measures do not yield satisfactory results and the deformities continue to affect your quality of life, surgical options may need to be explored. This could include realignment procedures or osteotomies to correct the deformities and restore proper knee function. However, this decision should be made in consultation with an orthopedic specialist who can assess your specific condition and recommend the best course of action.

Conclusion
In summary, addressing knee deformities after tibial plateau surgery requires a multifaceted approach involving physical therapy, potential use of orthotics or braces, and regular monitoring by healthcare professionals. Early intervention and adherence to a rehabilitation program can significantly improve outcomes and help restore function to your knee. Always consult with your healthcare provider before starting any new treatment or exercise regimen to ensure it is safe and appropriate for your condition.

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