Orthopedic

Orthopedic Project

Calling all bad ass orthopedic surgeons! I have a mangled leg that defies all conventional orthodoxy. Review the proposal, see if you can help, and check out my progress.

In brief: Since a semi-truck ran into me in 1989 my leg is a unique structural mess. Despite my deficiencies I am determined to I to lead a active life. I believe the right orthopedic procedure can help if I can find the right doctor.

Proposal

I have been told the combination of my injury complexity and high level of function does not lead to an easy path for treatment. The purpose of this page is to open my medical case to a wider audience of professionals for comment. Ultimately this project will move forward if I find the right professional whom based on there experience believes there is a high likelihood of improving my situation through surgical intervention. If you have something to contribute I would love to hear from you. Otherwise please pass my case on to a colleague or your professional network!

Goal: Improving the short/long term utility (functionality and durability) of my lower right limb.

Background: My right lower limb has suffered massive trauma and resulting growth deformities. Fortunately, despite this, the limb has adapted remarkably well. With the help of orthotics, the limb is relatively high functioning with a low level of pain. I had 8 surgical interventions during the first 7 years, but have had nothing in the last 18 years. I am curious to the possibilities further benefit of surgical intervention at this time.

Problem: In general the limb is structurally and functionally deficient. These facts lead to various complicated functional problems that can be generalized into the following categories:

Medial/Lateral Knee Instability: Due to the vacancy of the lateral structure of the knee (missing lateral femoral condyle, lateral tibia plateau, all lateral ligaments and tendons) the knee only has soft tissue resisting valgus motion. Instability increases as the knee goes into flexion.
Knee Valgus: Due the abnormal medial knee growth the leg is in valgus at extension, the valgus is correctable up to 15 degrees where is encounters a hard stop. The valgus compounds the knee M/L instability
Abnormal Knee Flexion: Flexion is described by extreme knee valgus (~40 degrees) and extreme external rotation at the hip (60 degrees). The femoral condyle is not rolling on the tibia plateau. Flexion is limited to ~90 degrees.
Poor Knee Extension Strength: Due to the vacancy of multiple quadriceps and the abnormal path of knee flexion, extension of the knee is difficult.
Apparent External Leg Rotation: Abnormal twisting of the tibia and femur give the leg an apparent uncorrectable net external rotation of ~45 degrees. The foot is comfortable sitting externally rotated at a 45 degree angle on the ground. Keeping the foot in this position makes walking, running and jumping difficult.
Poor Ankle Function: While the ankle wasn't directly damaged in the accident, peroneal never palsy and forced compensation for the malalignment of the knee has lead to significant ankle deformity. The ankle axis is rotated ~80 degrees externally. Dorsiflexion/eversion strength and range of motion are severly limited. Foot is characterized by extreme supination and inversion

Leg Length Discrepancy: The right limb is shorter by 1 3/4"
Difficulty Utilizing Orthotics: Because of the abnormal orientation/mechanics of the knee and ankle the utilization of orthotics is limited. If the leg more "normal" mechanics orthotic technology could be more readily applied. Vid 1 - Dynamic w/o brace. Vid 2 - Dynamics w/ brace.

Aim: Design surgical procedure(s) that will improve the utility, function and/or durability of my limb. Addressing the abnormal valgus, rotation and leg length in an effort to:

Improve the structural stability of the leg in flexion and extension
Increase the longevity of the knee, ankle and hip joints
Improve the mechanics of the knee and ankle joints for addition function (range of motion & strength)

Proposed Procedures w/ Orthopedic Evaluations: (What other have recommended)

Oseotomy / Re-Alignment: I believe this route holds the most promise. Some combination of valgus correction, rotation correction and leg lengthening to address the structural deficiencies in whole or in part. A secondary aim would be to position the joints in a better orientation to promote long term durability. The opinion I have received thus far are that given the extremely abnormal dynamics and "fantastic equilibrium" (high function, low pain) my leg has achieved, designing a procedure to help without potentially causing unintentional harm would be difficult. Do you think differently? Most recent professional evaluations: (10/07/2014) Dr. Saam Morshed + Dr. Kristina Olson @ UCSF
Knee Reconstruction: Knee Arthroplasty (artificial knee) / Allograft (cadaver bone). Opinions I have received thus far are that because of my relatively high level of activity, functionality and limited remaining skeletal structure, my limb w/ a knee reconstruction could not match the current level of functionality and longevity. Do you think differently? Most recent professional evaluations: (12/08/2011) Dr. Stuart Goodman @ Stanford Medical ; (09/18/2011) Dr. Michael Reis @ UCSF

Other: Need more info? I have every medical record from 1989 -2014 available. I can also provide additional videos for evaluation upon request.

3D Leg Reconstruction (10/01/2014)

(More 3D Renders Available)