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Old 05-08-2009, 11:23 PM   #1
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Ankle Allograft VS fusion

I have been on a long journey reading these posts and also finding how to treat my end-stage ankle arthritis. I'm 44 yrs. old with 3 young kids. Last year my ankle started hurting and now it's the size of an elephant and can't walk anymore. Debridement did not work. I'm really miffed because I appealed my case all the way to the state and my doctor who is a pioneer of the procedure, wrote a very compelling letter stating that a fusion would leave me crippled. The decision was to uphold Blue Cross's decision because an allograft would be no more successful than a fusion which I don't want to have due to other foot issues. So, I was wondering if anyone out there can compare/contrast their results of having an ankle allograft vs a fusion. If you've had a fusion, how has your life changed? Thanks.

 
Old 05-09-2009, 05:32 AM   #2
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Re: Blue Cross denies Ankle Allograft - may need fusion

What was the allograft going to be for? I have BC/BS and they at first denied my autograft for OATS. I had to appeal a few times and then finally they would agree after much work on my part. THere was someone on this board that had an allograft and the insurance paid everything Except for the actually allograft, in this case it was bone. So, the majority of the surgery was still covered. That might be an option you could look into.
Man, I thought that at the state level most of these are in favor of the patient. That really sucks.
__________________
Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
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Old 05-09-2009, 06:03 AM   #3
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Re: Blue Cross denies Ankle Allograft - may need fusion

I have an ankle fussion and I am certantly not crippled. I can walk fine and am active. It beats being in pain. All os that I saw said that the allogragh would not last and would only lessen pain a bit. With my job (teacher) I would be having the fussion 2 to 3 years down the road anyway. The recovery is long but not as long as OATS. From what I have read on this board I am glad I went with fussion.

Darryl

 
Old 05-11-2009, 09:14 AM   #4
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Re: Blue Cross denies Ankle Allograft - may need fusion

I'll throw my two cents in. I had an autograph, not allograph but it feels great and I basically have no pain. Yeah, it took 9 months to recover but that's small potatotes really. Reading this board it seems that OATS is not very successful/hard recovery but I would read the posts carefully. A lot of OATS people here have had additional reconstruction of tendons/ligaments and that is was is really hampering their recoveries. Most of the people having problems will not say that their grafts have failed, actually they are well incorporated. It's other ankle issues that are holding them back. So I think a graft is a good option. I had BCBS and they covered it all. Maybe the donor tissue they may not? I think someone paid $7,000 out of pocket for their donor tissue but that not a huge price for getting your foot back. We pay a lot more for a car and that doesn't really compare!! I've heard people who have had fusion say that they were out of pain and felt good so I also know that it is a good last option. But fusion can cause other joints to wear irregularly - like your knee, hip, so I think OATS is a better first option. I would keep fighting BCBS on it. Maybe even go ahead with the surgery and then let the chips fall where they may .... When it's all over, BCBS can't take your foot away!!

Abby

I don't know where you are at in CA, but Dr. Bertil Smith in San Diego assisted in my OATS surgery. Maybe he can help you.

Last edited by akirka; 05-11-2009 at 09:17 AM. Reason: addition

 
Old 05-12-2009, 03:45 PM   #5
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Re: Blue Cross denies Ankle Allograft - may need fusion

[QUOTE=DPart;3979765]I have an ankle fussion and I am certantly not crippled. I can walk fine and am active. It beats being in pain. All os that I saw said that the allogragh would not last and would only lessen pain a bit. With my job (teacher) I would be having the fussion 2 to 3 years down the road anyway. The recovery is long but not as long as OATS. From what I have read on this board I am glad I went with fussion.

Darryl[/QUOTE]

Darryl,

Did you have a triple athrodesis? That's what I would require.

 
Old 05-12-2009, 03:52 PM   #6
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Re: Blue Cross denies Ankle Allograft - may need fusion

[QUOTE=akirka;3981293]I'll throw my two cents in. I had an autograph, not allograph but it feels great and I basically have no pain. Yeah, it took 9 months to recover but that's small potatotes really. Reading this board it seems that OATS is not very successful/hard recovery but I would read the posts carefully. A lot of OATS people here have had additional reconstruction of tendons/ligaments and that is was is really hampering their recoveries. Most of the people having problems will not say that their grafts have failed, actually they are well incorporated. It's other ankle issues that are holding them back. So I think a graft is a good option. I had BCBS and they covered it all. Maybe the donor tissue they may not? I think someone paid $7,000 out of pocket for their donor tissue but that not a huge price for getting your foot back. We pay a lot more for a car and that doesn't really compare!! I've heard people who have had fusion say that they were out of pain and felt good so I also know that it is a good last option. But fusion can cause other joints to wear irregularly - like your knee, hip, so I think OATS is a better first option. I would keep fighting BCBS on it. Maybe even go ahead with the surgery and then let the chips fall where they may .... When it's all over, BCBS can't take your foot away!!

Abby

I don't know where you are at in CA, but Dr. Bertil Smith in San Diego assisted in my OATS surgery. Maybe he can help you.[/QUOTE]

Can you tell me what was involved in an autograft surgery vs allograft? I am seeing Dr. Bugbee at Scripps in La Jolla. I live in the bay area so have to fly down to see him.

 
Old 05-12-2009, 04:37 PM   #7
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Re: Blue Cross denies Ankle Allograft - may need fusion

Hi,

Was this for ankle or knee? My doctor, Dr. Bugbee, says this is not technically OATS so the lingo gets a little confusing. I've seen your postings before. Are you recovered now?

Last edited by Administrator; 04-12-2011 at 10:21 AM.

 
Old 05-12-2009, 04:43 PM   #8
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Re: Blue Cross denies Ankle Allograft - may need fusion

Hey there,
Allograft uses a donor bone to put in the ocd area. An autograft uses a plug or more from your knee to fill in the defect. The procedure in the ankle is the same, it is just where the plugs came from that is different. Autograft= you Allograft= donor.

Mine was called Mosaicplasty because he took more than one plug, but it was the same as OATS, just they use more smaller plugs rather than one bigger one. Same thing, really, just different names.

My OATs surgery did fine. The plug incorporated. It is the other things I had going on and my osteotomy (where they cut through my tibia to get to the defect) that has not healed correctly. I see my dr. tomorrow morning. So, if I only had OATs, then I would say I was doing great, but I had ligament and tendon issues as well and they aren't doing so well.
__________________
Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 05-12-2009, 04:45 PM   #9
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Re: Blue Cross denies Ankle Allograft - may need fusion

No I have my tibia fused to my talus. I do know some one that had triple done and is very happy and active. I am not sure what allograft or autograft would do for arthritis. But I am not a doctor. You need to do what you feel is right. All three OS's that I saw said they would do the allograft or autograft, but did not recomend them for me.
Darryl

 
Old 05-12-2009, 05:05 PM   #10
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Re: Blue Cross denies Ankle Allograft - may need fusion

[QUOTE=girlwithbadankl;3982613]Can you tell me what was involved in an autograft surgery vs allograft? I am seeing Dr. Bugbee at Scripps in La Jolla. I live in the bay area so have to fly down to see him.[/QUOTE]. I did find your doctor when I was doing research and thought about calling him.

My condition: I have no cartilage left in my ankle at all from post-traumatic arthritis. Broke and sprained many times. It is also unstable so they were going to do a ligament tightening.

Melissa

 
Old 05-12-2009, 05:09 PM   #11
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Re: Blue Cross denies Ankle Allograft - may need fusion

What was your initial condition? I don't have great knees (very minimal cartilage) either so I'm not sure they would be able to take it from my knee. I have a condition called hyper-flexibility or lack of strong cartilage throughout. I have tendon issues too. The back of my ankle is killing around the achiles. So many issues which is why a fusion may be the best option but I have middle foot arthritis which will get worse with a fusion.

Last edited by Administrator; 04-12-2011 at 10:20 AM.

 
Old 05-12-2009, 05:12 PM   #12
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Re: Blue Cross denies Ankle Allograft - may need fusion

[QUOTE=DPart;3982653]No I have my tibia fused to my talus. I do know some one that had triple done and is very happy and active. I am not sure what allograft or autograft would do for arthritis. But I am not a doctor. You need to do what you feel is right. All three OS's that I saw said they would do the allograft or autograft, but did not recomend them for me.
Darryl[/QUOTE]

Hi Darryl,

Lots of questions. Can you be a little more specific regarding "active"? What activities can you do? Do you walk with a limp? Can you walk barefoot in sand or uneven surfaces? Does your ankle still swell after standing a while? Did your leg shorten due to the surgery? I can guess this but guess I will never be wearing anything but flat shoes again after a fusion, right?

 
Old 05-13-2009, 04:23 AM   #13
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Re: Blue Cross denies Ankle Allograft - may need fusion

Melissa,
I also have hyper-mobility. I have had previous surgeries for shoulder instability, need one for my hips because of torn cartilage since they sublux, and have had my ankle fixed for instability twice now.

My history in a condensed version.
I'm active, a karate instructor and a runner.
I did have a grade 3 sprain back in 2006 from karate. I landed on it sideways from a jump in the air. It had issues before, but that pretty much sealed the deal on the ankle.

Surgery #1 fixed a torn peroneal tendon, a subluxating peroneal tendon, found 2 OCD lesions and had then drilled (stage 4), had a Brostrom-Gould procedure for the instability, and then had joint cleaning up of synovitis, bone spurs, and other arthritis type stuff.

Recovered from surgery 1 and had a good year before things went down hill fast again.

Surgery #2- exactly 23 mos after surgery #1. I had a Brostrom again, with a periosteal flap reconstruction (they took a sheath around my fibula and made ligaments because mine were not good anymore). I had 2 tears in my peroneal tendon repaired, I had the OATs procedure where they took plugs from my knee (they take the parts from a non-weight bearing part of your knee that doesn't need the cartilage.) I had tenosynovitis and had that cleaned out with a tendon release, and then had more synovitis cleaned out. I had other cleaning up type stuff as well for my ankle was full of scar tissue. I also had my 2nd OCD area drilled and microfractured as they could only do the OATs procedure on one of my ocd's. I think that was it....

Do you have diagnosed OCD lesions or talar dome fractures? That is what the OATS procedure is for. If too much cartilage is gone, then it may not be possible to do that. You need to ask your dr. about that.

As for the hypermobility, my dr. said he had to do the perosteal flap repair (first they were going to use an allograft (cadavar tendon) to use as my ligaments) because if the instability wasn't fixed then the OCD areas on my talus would never get better because of the movement in the joint. So, that is why I had both done at the same time.

I was told after my surgery that I would be able to return to all activities except for sparring in karate.
__________________
Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 05-13-2009, 01:03 PM   #14
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Re: Blue Cross denies Ankle Allograft - may need fusion

Thanks - are you still expecting to make a full recovery? Did they ever recommend fusion for you but decided to go this route instead?

Last edited by Administrator; 04-12-2011 at 10:20 AM.

 
Old 05-13-2009, 02:54 PM   #15
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Re: Blue Cross denies Ankle Allograft - may need fusion

Melissa,
I saw my dr. today and he was not optimistic. The OATs did well, but he was very short with me and told me that basically my ankle was going to suck forever. No mention of fusion ever. I'm supposed to go back in 6 weeks but I have a 2nd opinion appt. tomorrow afternoon with a DPM. My regular dr. is an Ortho surgeon. There is only one other ankle specilist here and he demands to read your records first before he decides to take your case. I'm frustrated and depressed right now. My dr. has obviously given up on me even though I haven't.
Like I said though, the autograft is doing well, it is the osteotomy and tendons, both PTT and peroneal that are doing poorly as well as my foot is stuck at 90 degrees now due to scar tissue. My dr. told me that is what happens with more than one surgery.
__________________
Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
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