I'm sorry to say that I just found out I need to join the OATS club :( and need your advice and expertise ... your help and advice got me through the drilling, and I just learned on Friday that I now need OATS...

I had drilling of an talus OCD (7mm x 9mm x 5mm deep) back in October 07 and since I'd say January, the pain when walking has gotten worse than it was before the drilling.

We took an MRI of my ankle and it did fill in with cartilage, but my OS said that the quality of the cartilage matters and that it must be soft and that is what is causing my pain as he doesn't see any other reason I should be in such pain. Just to make sure though, he gave me a shot of lidocaine in the joint and said if I didn't have any pain, then the pain was definitely the OCD ..needless to say I had the best 6 hours of the last year and walked like a human, went up stairs like a human and pain free for those 6 hours (but boy did I pay the price when it wore off - yikes!)

I need to go back to my OS to talk about details but what I do know so far is that I will need an osteotomy and he said a cast/NWB for 8 weeks and he will be taking the plug from my knee.

For those of you who had this, can you help me with the following questions:

1- how long were you kept in the hospital and how did they control pain? (for drilling they kept me overnight and gave me morphene shots in my hips every 4 hours .. don't want that again.

2 - for those of you who had drilling ... how does the pain compare to that?

3 - Did you go from a cast to a boot? and if so, how long for each?


I honestly don't know what questions to ask him as I was not only stunned from hearing this, but partially excited that my foot felt so good with the lidocaine in it.

If anyone has a list of questions they put together that would be great as I honestly don't know what I don't know.

Thanks you all for your help once again ... I was hoping not to join this club, but looks like I will be a member :(

Hi Kimberp

My son age 16 had failed OCD Drilling in April 2006 and had a 9mm allograft inserted in April 2007 via Osteotomy Diagonal through medial profound of Tibia with three screws)

Daniel had anesthesia put a very small catheter in behind his knee which blocked out the nerves in his ankle. Not sure what you do about pain in the donor knee site. Because of his age the OS wanted to use a donor cadaver bone instead of a autograft. Both are pretty common surgeries now and the cartilage is hyaline catilage so once its healed your good to go. He was 6 weeks NWB which if I remember was actually closer to 7 weeks. He started PT in June for about 4 months and stated ice skating again in October. When I look back I think the second surgery was a little more discomfort than the first but the recovery was lees painful over the months. The cut through the Tibia heals very quickly (6 weeks like a broken bone and its fine.

Best wishes for your surgery and a return to Full Activity.

Hi Kimberp

I'm 14 weeks out from OATS, knee to ankle graft. I had 2 plugs, 10mm and 8 mm taken from my knee. I was in the hospital 2 days and never had morphine. They gave me shots of demerol and lots of oxycotin. I was such a zombie that I couldn't stay awake long enough to feel pain. But my pain was not too bad. They did put a drainage tube in my knee which was gross and probably the most uncomfortable thing I experienced. However, I had no bruising, small swelling because they did that. My foot had a nerve block before the surgery and it lasted a long time. I then had to ride in a car 2 days (9 hours) to get back home. I was still looped on drugs and so it wasn't too painful. Just keep up with the pain medication and don't try to be tough and you'll do good. I really have to say I didn't ever experience terrible pain, just hot burning.

My Dr.'s seem to be pretty extreme compared to others on this site. Maybe because my defect was so big, but I was NWB 12 weeks. I had a cast 6 weeks and then a boot for another 6 weeks. It was absolutely wonderful to get out of the cast and into the boot. So far my knee is good - it gets stiff in the morning and is tender to kneel on, but walking is fine, I don't notice it.

Let me know if I can help with any other questions!

Abby :)

SkatersDad - I have to admit, I've read all the stories on how Daniel is doing and am glad to hear that he is back to his youthful active self. Thanks for the information on his experience .. the more I know the better I can ask questions.

Abby - Unfortunately for me, we found out at the time of my drilling that for some reason I cannot get the nerve block done. 5 doctors dug around in the back of my knee for what seemed like hours and last thing I remember was crying asking them to stop .. I ended up getting an epidural. (I ended up finding out the my nerve was too 'deep' for them to reach) so unfortunately the nerve block is out for me, which I assume means another epidural.

The drain in my knee does not sound pleasant but I am glad to hear that the pain isn't tremendously worse .. I am also a bit concerned about having a cast since when I had the splint after the drilling, I experienced some panic attacks as I felt a bit claustrophobic ... not sure how I am going to handle that .. perhaps ask for anxiety meds for 8 weeks?

I made an appt with my OS to learn the details on Friday and hope to plan the surgery for mid August.

I will keep everyone posted on this continuing 'saga' but am glad to hear Abby that you are doing well. I have been keeping up on your experiences and what I have read had certainly helped.

Thanks again SkatersDad and Abby and I will certainly keep reading (and maybe posting more questions after Friday!

Kim

hey kimberb, sorry to hear that you need OATS.
I haven't had OATS myself but from what I've gathered on this board,

- some people stay in the hospital for a few days afterwards to recover
- people are generally NWB for 3 months (12 weeks)

I'm not sure about how bad the pain is but with the medication I think you can endure it. Goodluck.. let us know how it goes. we're here to support.

Thanks Airjaw ;)

I'm glad to hear you haven't had to join the club.

Kim

Hey Kimberp,

You know , the only side-effect from my surgery is that my foot is very numb. Also the outside of my leg. This could be from the surgery itself or the nerve block, or the tourniquet they put around your leg during surgery. The surgeons themselves are kind of baffled because they said they didn't really cause injury to the nerves. But they are pretty hopeful it will all return to normal in the next year. As I think about it, I guess I wasn't really considering the risks of these blocks before surgery. Even though the risk is low, the trade off of a few hours of pain relief compared to possible nerve damage to me is not worth it. If I were to do surgery again, I would ask them not to block it. So in the end, I think it's probably good you're not having it done.

I don't suffer from claustrophobia, but I have to say, I definitely experienced some panic moments with my cast. Even the slighest swelling would be so uncomfortable that it drove me crazy. Pain medications really helped ease the tight sensation and big bags of ice on my cast. I know you're not suppose to put anything down your cast, but I had this blunt metal BBQ skewer I would scratch with. :DI would get it really cold and just set it in the foot of my cast and that was a big relief to the hot burning feeling. I don't think I'll tell my Dr.'s about that ......

Anyway, good luck on Friday!

Abby :)

Abby,

I'm sorry to hear about the nerve issues you are having... do you think that is why you are having that 'hot burning' feeling? (I know they say burning is usually nerves.) And you said, in retrospect maybe I should be glad my nerve is too deep.

I have a few more questions (sorry, I am the type that needs to know every little detail ;)

- how big is the incision(s) around your ankle?
-and your knee?
- when I leave the hospital, the cast is just up to my knee and my knee is just bandaged? Do I need to keep my knee straight for any length of time while the stitches are in. (if you tell me the cast will go above my knee, my panic will really kick in ;)

- if the stitches are under the cast, what happens when the stitches need to come out? Do they cut the cast off and put on another one?

Sorry my anal retentive side is showing ;) ... just not really into surprises and the more I know the more I'll be mentally ready for this.

Thanks for all your help and sharing your experience .. it really is helping!
Kim

Hey Kim,

There's the burning/electricity that comes from nerves and then there's a hot burning that is just from healing after surgery. The hot burning went away at about 5 weeks. My nerve burning is definitely less than it was and so that gives me hope that it will resolve over time ...;)

Both my incisions are about 3 inches. The ankle one looks like it may almost be invisible/no scar. The knee one however is an ugly scar. I think the difference is that they wanted me to move, exercise my knee right away and I think that caused the scar to thicken/stretch out while it was healing. My ankle incision was in a cast - no air - no movement and so it healed really well.

Don't panic - it's a below knee cast with just an ace bandage around your knee. But you can't get your knee wet or shower it until it heals over because of the risk of deep infection.

You will get your cast off at 2 to 3 weeks to take out the stitches. They cleaned my leg with a cool alcohol wipe - very refreshing! Then you get a new cast! So you can choose a different color ... My leg only had 20 minutes to the air, but it was wonderful....

Happy to answer questions. It helps so much to know what to expect. Especially - this is a big surgery, not to take lightly.

Abby :)

Abby,

Thanks for your patience with me :)

I am happy to hear about the scars not being as big as I'd thought they'd be .. but have to admit, not looking forward to the burning.

It's interesting that you ended your message with the fact that it is a big surgery because that is the last thing my OS said to me, but for some reason I am equating a big surgery with a longer hospital stay so I am not sure I am taking this as seriously as I maybe should be (does that sound strange?) Or perhaps I am trying to minimize it in my mind so I really don't panic??

Admittedly having a cast is still bothering me and I will ask for anxiety meds, but my fear is that if they don't work it will be only me (I guarantee my husband will sleep through it) at 2am when I wake up in a sweat ... and search through my husbands power tools in an attempt to take it off myself. (the logical part of me knows not that it is a stupid and dangerous idea, but in the midst of a panic attack, not sure that logic will kick in)

Thanks again for all your help and support. I no longer feel like I am the only one going through this and someone actually understands this and how it completely consumes your life.

Thanks again ;)
Kim

Hey Abby,

I forgot to ask you in my last post ...

did your OS have any concern about your Achilles tendon? Since I was in a boot for 6 months before my drilling he had a concern that my achilles may have shrunk and mentioned tendon lengthening surgery as maybe the reason why my ROM didn't come back.

Now we know that it wasn't the case because the pain stopped my ankle before the achilles was stretched at all, but when I had the lidocaine injection on Friday, my ankle did move to the point where it felt like the achilles was limiting the ROM.

Was that ever an issue with you? I'd hate to go back for a third procedure!

Thanks, :)
Kim

Hey Kim,

Thanks for asking Abby so many great questions! I too need to know all the details. I am having my OATS on May 19. I wish you the best of luck Friday and I will be anxious to hear how you are managing when you are able to type. I will also be looking for any and ALL advice.

Abby,
Glad to read you are doing well (aside from the nerve stuff). Take it easy in PT, don't push too hard and keep updating.

Margaret

Margaret,

Sorry to hear that you are a 'club member' too. ;)

I am glad my questions are helping you as well. Did you have a list of questions you asked your OS before planning your surgery? I have started to put together some for Friday but I know as soon as I leave, I'll think of 10 more.

Please let us know how your surgery goes and I wish you the best of luck. I know before my drilling I got a little anxious a few days before the surgery .. if you need to talk, we are here!

Thanks, ;)
Kim

Hi Kim and Margaret,

It is cool to be able to talk to people that understand! This is such a weird injury - it's hard to explain to others.

This is a big surgery because it involves 2 joint surgery sites. So you have double the issues for risk of infection, non-union, and just a long time in therapy and healing. If you think about it, most orthopedic surgeries are outpatient so a 2 day stay nowadays is a long time. And most surgeries today are arthroscopic so an open surgery in 2 places is pretty big. But it's not brain surgery so I don't want to overexaggerate!

There's a guy at my office who ruptured his achilles 5 weeks ago and had surgery. He just got out of his boot today and is walking around. So I'm starting to walk around and I had my surgery 9 weeks before his - so that's another reason why this is a big surgery.

My achilles has never been an issue but my foot was only totally immobilized 6 weeks. After the hard cast came off, they wanted me to stretch my foot up and down everyday and that kept my tendon from getting shorter. I won't lie, I stretch against the wall now and later my achilles is sore but I'm sure it will get back to normal soon.

I went to the gym the other day to exercise and it was a crackup! I wanted to ride the bike 10 minutes on level 0 but I was going so slow that the machine would turn off/pause and screw me up! It was all I could do to bike fast enough to keep it on and that was a grandma pace. Then I went to do leg lifts at the weight machine, the lowest weight setting being 10 lbs. I thought, no problem, but I couldn't come close to lifting 10 lbs! I thought I knew how weak I was but I didn't have a clue. So it's hard to even take PT slow and easy, but you've got to start somewhere I guess!

Talk to you later!

Abby :)

Abby,

Thanks for the reality check, you make some good points. I guess part of the reason I didn't view it any differently than the drilling is that I was in the hospital for 2 days for that (to manage the pain since I couldn't have the block) so in my own way, I viewed them the same. Thanks for setting me straight! ;)

I admit I had a chuckle to read your adventures at the gym as I can certainly understand. At PT after the drilling I attempted the bike and the same thing happened to me .. I just gave up and looked at the clock to gauge how long I was on for, and I could only handle 5 minutes at a time.

Are you in PT now? Should you be trying to lift 10 lbs? (sorry my mother hen is kicking in ;) I'd just hate for you to overdo it .. but I understand as it is certainly something I would try too.

Kim :)

Hey Kim,

I've never had drilling so I don't know what it's like - sounds pretty painful too! Speaking of pain, yesterday the PT had me stand on a stair edge and stretch my achilles down and then raise up on my toes. Such a small movement but I'm hurting today. And he had me step up and down on a 3 inch step and I could barely do it with my knee weakness - it was very funny! I told him it was like the people on the biggest loser who can't do one squat and by the end are doing 50, with 100lb weights. Yeah, the 10 lbs the other day was pushing it, but I had no clue how weak I was!

By the way, I don't know if you have an osteotomy with drilling, but that is another reason why the OATS procedure is big.

Later,

Abby :)

Kim,

I didn't need to ask about insurance coverage but I have read it is something to be concerned about since some carriers won't pay for OATS.

Here is the list of questions I asked when I met with the surgeon (my surgery will be on my right ankle/knee-2 surgeons - one for each joint):

How long is the surgery?
Overnight hospital stay?
Pain management in hospital and at home?
Will I have a cast on the ankle? How long?
What goes on knee post-op?
Where and how large incisions?
How many post-op doctor appointments and when?
How long NWB?
When able to drive?
What can I expect for physical limitations after surgery?
How long recovery and what will be involved? PT - how much and how long?
What type and how much hardware to repair tibia?
What are chances of tibia not repairing and then what?
Might hardware become symptomatic and screws need to be removed at later date?
What is the success rate of this procedure?
What is the life expectancy of the procedure?
How many OATS have you done and how many with the knee surgeon?
What if OATS fails - then what?
Will current range of motion be increased or decreased after recovery?
When can I regain my normal activities?

Do I need to prebank blood?
What are the possible complications?
What is the size, depth, and location of lesion?
Do I need to be concerned about causing more damage to ankle prior to surgery when skiing and skating?


Obviously I wrote these down and also wrote down my Dr's answers. I am really glad I have it all written down because I have gone back to it many times for answers I had forgotten.


I still have a pre-op so please share your list questions when you can as I am starting a new list myself for that appointment. Good luck.

Margaret




Margaret,

Sorry to hear that you are a 'club member' too. ;)

I am glad my questions are helping you as well. Did you have a list of questions you asked your OS before planning your surgery? I have started to put together some for Friday but I know as soon as I leave, I'll think of 10 more.

Please let us know how your surgery goes and I wish you the best of luck. I know before my drilling I got a little anxious a few days before the surgery .. if you need to talk, we are here!

Thanks, ;)
Kim

Hi Abby,

I just finished an hour on the exercise bike and read your post. I am glad you are improving. How is your achilles today after getting up and moving around a bit? I imagine it was grim but I hope you will report that once you got moving today, some of the soreness wore off.

Be honest!

I have read so much from people about PT and pain - some say you should be sore, some say you shouldn't. While I am getting anxious about the procedure, I am more worried about the PT.

Hope you are having a good day today!

Margaret;)

Hey Abby,

I feel your pain ... sometimes PT had me in tears a few hours after I was done (my PT was convinced I had a doll of him that I would stick pins in when this happened ;) He was nice though, said I could call him to yell at him whenever I needed to.

Even the standing toe raises were hard for me, forget about adding a step to the mix! (At least we can have a sense of humor about this, huh? :)

An osteotomy wasn't necessary for the drilling but you are right, another factor to add into my next procedure. I need to ask him if he is going to put another plug into the new lesion that has developed on my tibia - exactly opposes the OCD. (I figured since he is going to break my tibia I would think he'd fix that as well.)

Please keep me posted on how PT goes ... did they say how long you'd be going?

Thanks again for everything ;)
Kim

Margaret,

Thanks for the list of questions! You definitely have some on there that I need to ask as I completely forgot about the osteotomy as a separate 'thing' and I focused just on the OCD. (I didn't even ask about the knee) My OS is going to love me tomorrow .. walking in with my 3 pages of questions ;)

I was reading about insurance coverage for OATS and from what I read, it seems that the hesitation by the insurance companies seemed to be more for OATS as a first procedure, not as a second. I would assume that if a doctor can justify not drilling first (or basically say they know 100% it wouldn't work) that the insurance would approve it. The coverage is of course a question I have on my list for tomorrow and I'll let you know what he says.

If anymore ideas for questions come up after tomorrow I will let you know.

Thanks ;)
Kim

Hey guys,

So, Margaret - honestly, once I get moving the soreness does get a little better but really, the pain relief comes from Ibuprofen. It works great if I take it every 6 hours during the day. I didn't need to take anything while I was still NWB, but I do now. But it's not crying pain, just very sore and stiff and achy - but a little Advil takes it all away :D

Really, my PT is very gentle and I'm doing small movements. It's just with 12 weeks of NWB, there's no getting around the soreness. I'm scheduled for 4 weeks PT - if I want to go longer I think my Dr.'s would be fine with that. It's great to have the icing/electrical stimulation at the end - that is suppose to help with soreness.

Kim, if you're worried about insurance, ask the Dr.'s office to do a pre-service review with your insurance company. I was paranoid so they did this for me and it was no problem. The insurance sent a letter 3 weeks later stating the procedure was approved. Wow, you have another lesion on your tibia? I'm not sure what they do for that? You'l have to let us know what they say.

Good luck guys. If it helps, I thought I would be so nervous the day of my surgery, but I actually felt a little at peace, knowing I was doing the best thing I could to improve my foot and quality of life.

Abby :)

Kim,

I didn't need to ask about insurance coverage but I have read it is something to be concerned about since some carriers won't pay for OATS.

Here is the list of questions I asked when I met with the surgeon (my surgery will be on my right ankle/knee-2 surgeons - one for each joint):

How long is the surgery?
Overnight hospital stay?
Pain management in hospital and at home?
Will I have a cast on the ankle? How long?
What goes on knee post-op?
Where and how large incisions?
How many post-op doctor appointments and when?
How long NWB?
When able to drive?
What can I expect for physical limitations after surgery?
How long recovery and what will be involved? PT - how much and how long?
What type and how much hardware to repair tibia?
What are chances of tibia not repairing and then what?
Might hardware become symptomatic and screws need to be removed at later date?
What is the success rate of this procedure?
What is the life expectancy of the procedure?
How many OATS have you done and how many with the knee surgeon?
What if OATS fails - then what?
Will current range of motion be increased or decreased after recovery?
When can I regain my normal activities?

Do I need to prebank blood?
What are the possible complications?
What is the size, depth, and location of lesion?
Do I need to be concerned about causing more damage to ankle prior to surgery when skiing and skating?


Obviously I wrote these down and also wrote down my Dr's answers. I am really glad I have it all written down because I have gone back to it many times for answers I had forgotten.


I still have a pre-op so please share your list questions when you can as I am starting a new list myself for that appointment. Good luck.

Margaret

Hey margaret, do you mind sharing the answers for those questions?
That would be helpful.. thanks.

Happy Friday! :)

Well I am back from seeing my OS armed with my 3 pages of questions and I still have to say ... my OS is awesome. He is so patient down to the last detail of every question, even draws me pictures so I understand everything completely.

Here's what I learned about my OATS procedure, scheduled for August ...

- Having drilling previously does not have any effect on the success rates of the OATS procedure, neither raises it or lowers it.
- No real risk of nerve damage with any part of this surgery
- I will be getting an epidural with a pump through the IV after surgery (he said the usually keep the epidural in (yikes!) for pain management afterwards, but I won't do well being numb for a few days
- The procedure (with osteotomy) will take 2.5 hours - will be done on a Monday morning and if all goes well, I will leave Wed pm
- I won't come out of surgery with a cast on, will be the split/bandage I had after the drilling. Before I leave to go home I will get the cast or he said he would give me a boot if the integrity of my bones were good ... but I couldn't take it off at all. My knee will be bandaged as well.
- the plugs from my knee consist of bone and cartilage and are taken from the outside part of my knee, through a 1 - 2" incision. (taken from NWB part of knee)
- I will be in the cast (or boot) for 8 weeks .. and xray will be taken before I am allowed to PWB
- for the osteotomy, my tibia will be put back together with a metal rod - I did ask if that would have to come out eventually and he said maybe - everyone is different - it may or may not bother me but if it does, the procedure to remove isn't bad (on feet next day)
- I can take a shower provided I am covered from above my knee down - knee and cast/boot can't get wet.
- said I would need probably 6 -8 weeks of PT afterwards
- asked if I had to limit activities for the rest of my life and 'baby' this ankle - answer was yes
- said some people do develop issues at the donor site - believes in my case the odds are in my favor and by taking plugs out does not contribute to the possibility of arthritis later on (an xray will also be taken prior to the surgery to look at the bone/cartilage in my knee to make sure it is enough / good enough to use) - we didn't talk about the options if it wasn't but we don't forsee any issues as I've never had a problem with my knees.

Ok, this is my brain dump for today .. I feel good about what I heard and will start compiling my next list of questions as I think of them.

Thanks,
Kim

Hey Abby,

I forgot to mention above ... I did ask also about coming out of surgery with the drain in my knee and he said he doesn't do that unless there is a need, but since he uses the tourniquet, he doesn't think/nor has he ever had to use it. YAY! ;)

Thanks again for all your help .. now I just have to wait until mid August (my choice) which seems like forever away. I am sure the nerves will start to kick in end of July.

Kim :)

Kimberp - when you say 'baby' the ankle, how much will your activities be limited? Did your OS say whether you'll be able to run, skate, hike, etc? Appreciate your asking questions.

Puck -

When he said I needed to 'baby it' I honestly didn't qualify it further as we were in the middle of my list of 25 questions and I was a bit overwhelmed about the whole process. I think I had a reality check on just how big the surgery is ... I was concentrating on my ankle and wasn't really thinking about my knee and the osteotomy .. admittedly, I got a little freaked out.

What part of the process are you at? Did your OS say you needed OATS? Did you have drilling already?

Kim

Hey Kim,

That was an awesome list of questions and he sounds like he was great answering them. My very first appt. w/my OS lasted about an hour with all the things we talked about. The Dr.'s know this is a big surgery so they want you to be super-informed. One of my questions was - will I be able to do a jumping jack. :bouncing:It sounds funny but that to me was a measure of impact that I wanted. I think it's a mystery/ individual result what the final abilities will be for people. I remember one girl on here said she can run again, but she can't ski. That's weird because running is alot more impact. Carol can ride her bike and walk, but she still has a lot of limitations. I was a runner for 20 years but I can give that up if I can go hike and jump off a log or cross a rocky stream. I also did gymnastics but I think I'll stick to trampoline now.

I'm gonna have to ask my Dr.'s next time I see them if they had any complications with my knee. They acted like it was normal, but they did take about the largest amount of tissue possible from my knee. I'm starting to wonder if my foot numbness is totally from my knee (block/tourniquet) surgery. Anyway, I went outside yesterday and did some raking and yard clean up for an hour. That felt really good! And my cat was excited to see me outside!

I ordered 2 pairs of new tennis shoes off of ebay because my shoes are so old and feel like cardboard! I hope that they will let me walk longer without so much soreness.

Sorry this is so long. Glad you had a good appt.

Abby :)

Thanks Abby :)

My OS is great in explaining things and I think everytime I am with him, it is for at least an hour because he not only explains it at a level I can understand, but I even get drawings and he breaks out the occasional plastic foot model so I understand everything. He has a very comforting and relaxing way about him ... and even humors me when I make my nervous jokes ;)

I was glad to hear that he doesn't use the drain in my knee .. you did get me concerned about that.

I am glad you were able to get out and garden ... I am so looking forward to doing anything normal!! (even yardwork ;)

Thanks again ;)
Kim

Hi again all

Well, i had my final prognosis today from OS...bit of a shock really! My foot is still rubbish after 2 op's. ( I had PTTD surgery, and drilling for a 2 by 1 cm defect of the medial talus. My PTT is now inflamed all the way up my leg, and it seems my achilles tendon is too ( tendonitis) The OCD area has never settled, and although i have grown a layer of fibrocartilage, it has a defect in it. So i still get the clicking and the catching, not as bad as it was, but still breathtaking pain! It hurts to walk on the whole time, and is worse after resting it??

He says oats isnt an option, as he feels the success rate is poor, and my age is against me. He even feels a fusion wont take the pain away, as there is just too much damage in my ankle. Even paying privately here they wont consider ankle replacement till i am nearer 60 ....so another 10 years to go!

Anyone got any suggestions?? Does anyone know why fusion wouldn't work??? I am totaly confused.

Mazzie

It might be you've got too much bone loss for fusion?

So, you're too old for one operation, but too young for the other? There are doctors who will consider doing ankle replacements in younger patients, I know of several people, including our own Happyfoot, who had it done. If he insists that it's the only surgery that will help, maybe you can get it done.

I have heard that OATS is not recommended if you're over 50. Some physicians hesitate at 45 yrs. old. I think if you're younger it's a good option. My PT says he hates to see people with fused joints because it tends to wear out other joints, such as your knee. I hope HappyFeet can help you because she loves her new ankle replacement and she pretty young!

Abby

How long does OATs usually last?

Can you get a second OATS surgery after the first one?

Does the longevity of OATS depend on how active you are with the ankle?

Sorry to hijack the thread, just some random thoughts i had

I have heard that OATS is not recommended if you're over 50. Some physicians hesitate at 45 yrs. old. I think if you're younger it's a good option. My PT says he hates to see people with fused joints because it tends to wear out other joints, such as your knee. I hope HappyFeet can help you because she loves her new ankle replacement and she pretty young!

Abby


Hi Abby

Seems at 47 i am too old for Oats, and too young for ankle replacement. ( In this country anyway) I also thinks its a bit ironic that i have a defect...IN my defect! Hey ho.
He doesn't think that fusion will solve the pain and all the problems i have, which i don't understand.

I know about Happyfoot, and her surgery has worked wonders, trouble is, no one knows just how long it will all last as its all so new. I know she's aware of this, and at her age, i would of done exactly the same as her. Trouble is i am alot older, and wont heal so quick, and of course operations can get more rsky the older we are. So they are looking for one last fix i guess.

Oh i hate it all at the moment, i just wanted a get out clause from the pain really.( without waiting 10 years)

Mazzie

Did you read "ankle replacement or fusion for rheumatoid arthritis" thread? Lady in London about your age just had a replacement.

Maybe it's not right for you, but I would at least talk to a surgeon who is willing to consider it. Because you are neither old nor young, being physically active is important to maintaining your health, and if you can't be physically active, replacement could be harder to recover from in 10 years than it is now.

Mazzie,

I'm really sorry to hear your frustration with all this. I think in the US if you could not have OATS, they may do an early joint replacement. To me, if the joint replacement only lasted 10 years, it would be worth it to be relieved of the pain. However, the combination of Dr.'s and insurance advice makes it so hard! My dad waited 10 years before he could get a knee replacement because he was 'too young'. He finally had it done at 64 yrs. old and feels like a new person. He healed really well at that age so you're pretty young! So if you were old enough, what would be the Dr.'s one last big fix for you?

I decided to do OATS now because I'm turning 40 this year and I thought, now or never - I'm getting old!!:dizzy:

Abby :)

Thanks Jane and Abby

My big fix is the replacement, as OS doesn't seem to think there is another option. I've been so fed up about all this, but reading other peoples views ( like yourselves) makes me realise I have to go and get a second opinion. So thats my next step, and i have got that underway. If next doc says same thing, then i guess i'll either have to lump it or go abroad.

Thanks for your views ladies, you have inspired me to not give up with this.

Mazzie

Hi everyone, I'm new to this board, however i've been on others the past 20 months or so. Just a quick recap on my injury. I was injured at work coming down a ladder.(I'm a firefighter in the chicago area) The injury was oct 06. I had a severe ocd lesion to the medial talar dome.(a class 4) I then had a scope with the drilling to regenerate cartilage and fill lesion. After 4 months of pt i came to a standstill at about 75 percent. I slowly got worse after that. Nighttime and morning were horrible with extreme pain and hobbling. Most of that i think is due to arthritus developing around the lesion. Anyhow at this point i knew i was in a serious situation. I then researched and saw several top docs in chicago, and settled with Dr. Armen Kelikian from norhtwestern. He stated i would need the oats using fresh cadavar due to size of lesion being to large to take bone from me. So i had the surgery april 10th and i'm about 5 weeks post-op. My cast was taken off at 3 weeks after removal of stitches, and i'm in a boot type open cast for another 5 weeks still non weight-bearing of course. I think i'm doing pretty good, but as you all know only time will tell. Just thought i would join the discussion with being faced with such a similiar situation as you guys. My oats sounds real similiar to skaters-dads son since i had the cadavar bone graft. Hope my recovery goes as well as his appears to have gone. I'll keep you guys up to date, and hopefully help anyone else who has yet to go through this surgery. Good luck to all. Stay positive and keep puishing forward. Joe

Hi Joe,

I'm almost 16 weeks out and am feeling pretty good. At 5 weeks I was still having to put my foot up most of the time but it started to get noticaeably better at 6 weeks. People ask me if my foot feels better than it did before the surgery but it's too soon - I can't really answer that. My whole leg/foot hurts too much from PT, but it's a good hurt. I can say that I haven't experienced the stabbing, take your breath away pain I had before so that makes me hopeful.

I did a little too much this weekend and my foot finally yelled at me yesterday. I went to 2 retirement parties, plant shopping, church, cleaned the house, cleaned the car, made a pie, did laundry, etc ... Stuff that grandmas do with no problem, but I hit the wall last night. No amount of Advil was helping so I broke down and took a leftover hydrocodone. 30 minutes later I felt so much better.:D

Today I can press my finger to my ankle and it will leave a big dent in it - a little swollen I think ..... So, time to lay on the couch and do nothing tonight!

Joe, I'm glad you found this forum!
Margaret and Kim - how's it going?

Abby :)

By the way, I got these shoes online because they looked wider than normal tennis shoes. They are Nike Air Hisix and they are a crack up. To me they look like bowling shoes with all the colors, but they are actually 'skate' (skateboard) shoes. So I wasn't sure if I looked dorky or cool in them, but it was verified when I went to PT. The 25 yr. old receptionist saw me and said she loved my shoes. Later she said she was going to steal them ..... so I guess I'm really hip. Plus, they are wide at the top so they don't irritate my ankle.

Then I ordered a 2nd pair of wide shoes - some New Balance walking shoes - and they are very comfortable. They have the complete opposite effect however, since I look down at my feet and I see my grandma's feet. At least they don't have velcro straps ......;)

I am facing ankle fusion surgery, was wondering if it is worth it.

For some fusion is worth it, perhaps you'd want to start your own thread and explain a bit more about your situation

Hi Joe Flash 3

It sounds like you and Daniel have had pretty much the same type injury and treatment. Once you start PT they will start moving the joint and the sonovial fluid in the joint will start nourishing the new cartilage, so if your 5 weeks post op it sounds like your progressing very well. Daniel had his graft on April 17 and I remember purchasing a annual pass at the zoo in August. We would walk quite a bit besides his regular PT. He went back to skating in October (cheated a little in September) and is doing about 2 to 3 hours a day of very rigorous figire skating with no complaints. We feel that he has been very, very lucky to get this second chance at sports and possibly being normal, but he protects it pretty good when not in a skating boot as we are all afraid if he sprains it again what might happen. His OS doesn't seem too concerned and encourages him to go for it, so I guess he knows best.

Good luck and keep us posted.

Thanks for the response akirka, and skaters dad. I'll keep everyone posted on my progress. Right now i'm basically confined to my lazy-boy with foot elevated most of the day. I've been trying to do the up and down flexion that my doc said i can now do to try and loosen up the ankle. Wow does that ever hurt, and i can barely move it in either direction. I think most of the pain seems like its my achiles tendon. Its so tight from the first 4 weeks of no movement in the cast. Talk to everyone later. Joe

Hey Joe,

Glad you have a Lazy-Boy. I think a lot of my pain right now comes from my achilles too. I just started driving my standard transmission Subaru the other day and I definitely feel the achilles strain (had surgery on the clutch foot). I still have very small movement if I try to move my foot inward - the PT says I have pretty hard scar tissue I need to break up. Ahhh, more pain!

Hey SkatersDad - Daniels recovery is giving me a lot of hope! I'm glad he's doing so well. I was thinking the other day that I might try a very short bike ride....:)

Hello, can anyone answer some questions for me? I had microfracture surgery 6 weeks ago for these 2 lesions and I just read an article about the type of lesion on my lateral side which said that this type of lesion shouldn't be drilled as the overlying cartilage was still intact.

I quote from the article:
What Are The Options For Treating Subchondral Cystic Lesions?
The final and most difficult type of lesion to treat is the subchondral cystic lesion with intact overlying cartilage and bone. In this type of lesion, the pain is from the constant compression of the cyst with activity but there is no overlying damage to the cartilage and bone. There is also a problem with mild sclerosis of the walls of the cyst that one must treat. In certain cases, an OATS allograft option is the best option. This type of treatment is best in large lesions with a major defect of over 1 cm with extensive depth. We try to avoid drilling of these lesions as the superficial cartilage and bone are intact and stable.

As one can see, this photo depicts the osteochondral lesion following the transplant.

The newest and most complicated treatment option is the use of retrograde drilling of the lesion. One would perform an arthroscopy of the joint and identify the lesion. Then using a microvector guide, the surgeon would drill a tunnel from the sinus tarsi region into the cystic lesion with a guide pin. Clean out the lesion with a small curette and debride the sclerotic walls. Then you fill the region with either allograft or autograft. We prefer the use of autograft and often harvest the material from either the calcaneus or distal tibia. It is important to pack the lesion fully to avoid further cyst formation. After performing this procedure, one should emphasize non-weightbearing for six to eight weeks and again use a CT scan to check healing.

Can anyone shed some light on this? I wonder if my DR knew about this? Because if he did and still went through with microfracture and potentially ruined part of my cartilage, I'd be upset. And if he didn't know, then I'd have to question why a Dr at the most up-to-date ankle center in the US didn't know.

Thanks.
#

There is a 7 x 12 mm osteochondral lesion of the medial talar dome.; Coronal image 15 identifies the presence of an overlying cartilage abnormality, likely a flap tear vs. fissuring of the overlying cartilage. The presence of a prominent subchondral cyst formation increases the probability that this is an unstable lesion.

#

There is a 6 x 10 mm osteochondral lesion of the lateral talar dome. The overlying cartilage appears intact.

Hey AirJaw,

Maybe when your OS got in there he saw that the cartilage wasn't intact. All my MRI's stated that I had no cartilage defect, but a large subchondral cyst. I too was concerned surgery would damage the good cartilage I had, but when they got in there, I had a very large tear that just never showed up on the MRI. You'll have to ask him what he found during the surgery.

Abby:)

Akirka, that's helpful. Thanks! I'll ask him this Friday

Had my appt with Dr Jeng today. He told me that even though it looked like the cartilage was intact on the MRI, he saw that the cartilage was damaged when he actually went into the ankle. So he ended up removing all of it and doing the microfracture drilling.

Other questions I asked him:

When can I start impact activities again?
-about 14 weeks after surgery

How long is rehab?
-6 weeks

Will the cartilage degrade faster if I pound on it more?
-Yes.

Same with the OATS cartilage?
-Yes

What do I do if OATS fails?
-There is nothing after OATS. you live with the cartilage if it gets damaged

Do basketball-playing patients with OCD return to playing basketball after getting OATS?
-Some probably do, some don't

What options are there to look forward to in the future?
-MACI, which is not approved in the US, and only used in Europe.

Do bone stimulators work?
-There is no proof that they can grow cartilage and the insurance companies won't cover it.


Sigh. Depressing, isn't it. There is a small part of me that still has hope for future advances to come up with a method for the human body to regrow cartilage.

My MRI came up clear too Airjaw, just some scar tissue on my ATFL ligament. But, low and behold, I still had pain after physio and the surgery revealed cartilage damage.

After OATs, ACI/MACI is the next logical step I would say, although I see it's not approved in US. I have a pretty small tear and have been advised not to run/do impact sports for AT LEAST 6 months. I would be more conservative about returning to activity if you want the results to last.

I am trying Prolotherapy for my ankles. I know it's massive in the US and has been proven to regenerate cartilage, proof is in the X-rays of those that did need joint replacement but didn't after Prolotherapy. Maybe worth a shot?? I go for my first session next week as they couldn't find a specialist last week.

I take it you're taking Glucosmine, Chondrotin and MSM? I know there's no solid data to prove they help form and repair cartilage, but what have we all really got to lose by taking these supplements anyway!

How's the partial weight bearing coming along? You were NWB for 6 weeks right? I'm 6 weeks post op and walking fine now with good strength in ankles, but pain is still there, although gradually improved the last 3 days.

Good luck.

Greg

Hey GregasGP, good to hear that your ankle is feeling slightly better lately.
I just started walking a few days ago.

I have heard of Glucosamine, Chondroitin, but didn't know what they were. My doctors haven't recommended them to me. I've also never heard of Prolotherapy. What do these do?

6 months without impact seems like a very long time to me, although when I think about it, I'm waiting about 3.5 - 4 months myself. I'm in a different situation with my fibrocartilage and I trust my Dr when he told me it was okay to test it out then.

I wonder if we can still get MACI after OATS. The way I look at it... if we can get several years for our ankle from drilling, 5-10 years from OATS or MACI, that would be definitely worth the risk and money. Perhaps we can even keep getting MACI every 5 to 10 years as long as we are still relatively young. Do they have MACI in England?

Hey AirJaw,

Here's something positive: I just helped my family move some boxes in their storage unit. I was standing on hard concrete for about an hour and I really didn't have any pain. My foot was tired, turning purple and swelling a bit:dizzy:, but that's just left-over healing from the surgery. Before surgery, it would have really hurt to stand on that concrete that long - that stabbing bone pain. So, I'm thinking that my OATS may be pretty sucessful ...:)

Well i'm finally at 8 weeks non-weight bearing after my talar allograft and doc sais osteotomy looks good and graft also. I can start to bear weight now in cam-boot. My ankle is still pretty swollen though, and the pain is pretty severe bearing weight for fist time after 8 weeks. I've been doing the plantar, and dorsal flexing since week 4, but now i can start side to side movement or anything i want. My achilles also seems tight along with entire ankle joint. I'm sure this will all improve with PT to start asap. Thats my update for now talk to ya all later. Joe

Hi Airjaw,

It's Gregasp/Sheefa here as had to change username.

I'm 8 weeks post-op and still in quite a bit of pain, same as pre-op to be honest. Whilst my inury was actually extensive, it was very, very minor cartilage damage and the surface was thoroughly debribed. I had to have a MF for that small tear, but it really was tiny apparently hence the 2 weeks of NWB only, although I did 3-4 in the end.

Glucosomine/Chrondrotin/MSM supplements have helped people with arthritis and are good for maintaining joint health. I have been taking them since surgery and the improvement, if any, should start to show now. Typically it's around the 6-8 week mark.

Prolotherapy is supposed to be brilliant for ligament damage and cartilage damage too. It's not proven, nor is it a traditional well know practice, but again I'll do anything to try and combat the pain.

6 months without running/impact is a long time, but I really don't care. I've wiped off playing football or running again this year and I just want to get better and function normally with every day activities. The worst for me is pain when resting, NEVER or very little when moving about or running (pre-op of course!). Now this is becoming so hard to deal with as I can't sleep, focus at work and my relationship is suffering as I don't feel like doing anything! PMA I know.

If the Microfracture doesn't work, I'm going down the MACI procedure (they do both in England) and my surgeon is a specialist in these. In fact as I have identical pain in both ankles and they think there is a tear in the right too, I might try MACI straight away in the right and compre MF to MACI!! That's probably a good double study as no other factors, age difference, ability to heal, etc would come in to play.

Perhaps having two dodgy ankles does have some benefit................?!

Good luck and hope you're doing well.

Greg