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Old 08-06-2012, 01:25 PM   #1
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Success rate for microfracture surgery for OCD of talus

Does anyone know what the success rate is for microfracture surgery for OCD of talus? I am scheduled to have this procedure done on 8/21/12. Had the preop appt. today and the surgeon said “if this does not work” and went on to describe what would be done next. Sounded just horrific so I am hoping for a really high success rate.

 
Old 08-06-2012, 02:10 PM   #2
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Re: Success rate for microfracture surgery for OCD of talus

I'm pretty sure my OS said it's about 85%. I'm afraid I'm not a good example; I've had this surgery twice and it didn't work the first time, and I don't think it has worked on the most recent attempt (Feb 2012), though too soon to say for definite. It depends on all sorts of things, including the size of the lesion. As is often the case though, you may not find a lot of success stories here, as those with successful outcomes are out running around and not posting! Good luck with your surgery, I really hope it works out for you.

 
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Old 08-06-2012, 02:31 PM   #3
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Re: Success rate for microfracture surgery for OCD of talus

Also heard 85% success rate, though success is probably defined as significant reduction in pain or other symptoms, not necessarily "good as new" or elimination of all symptoms. As Amethy5t said, depends on lesion size (smaller is better). Have also heard it depends on age (<45 is better), skill of surgeon (more experience with this procedure is better), BMI (<35 is better), post-surgical rehab process, and tobacco use (non-smoker is better).

 
Old 08-06-2012, 03:20 PM   #4
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Re: Success rate for microfracture surgery for OCD of talus

Also, if you read the studies on which those 85% rates are based, you'll find out that the results are usually based on a follow-up time of less than three years post-surgery -- sometimes a LOT less!

My own (completely informal and utterly unscientific research) indicates that 85% of microfractures are successful for about 2-3 years, at which point the fibrocartilage starts to break down again. Rinse and repeat.

 
Old 08-06-2012, 03:24 PM   #5
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Re: Success rate for microfracture surgery for OCD of talus

I'm really hoping that I am one of the lucky ones. This will be my third foot surgery and I have to say, this is the first time that the surgeon talked about the next step if this does not work and does not relieve the pain. Both of my other surgeries the surgeon did not even talk about "what if it does not work". When he described what the next step would be it really, really shook me up.

 
Old 08-06-2012, 05:28 PM   #6
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Re: Success rate for microfracture surgery for OCD of talus

How big is your lesion? You might want to ask him if there are any specific factors in your case that make your particular injury less likely to be successful with this surgery.

It's tough to hear, but he's being responsible and realistic by telling you now about future possibilities. He's also giving you early warning in case you go through this and wind up in pain again less than a year later, which certainly happens.

It all depends on your specific injury, body, and other factors, so no one can say or know for sure. I certainly HOPE that you are one of those golden one-stop winners who never have trouble again!

I've had two (or three?) microfractures, an OATS, and now another microfracture. I'm pretty positive this will not be my last surgery. I've spent a good portion of my recuperation time researching what my next options might be, and even watching some of the surgeries online (I'm not squeamish). I wish you well!

 
Old 08-06-2012, 06:43 PM   #7
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Re: Success rate for microfracture surgery for OCD of talus

I also watch the procedures online so I know what is being done. Makes me understand the pain better! The MRI was done last September and I thought it was small. At the time, he gave me a Cortisone/Lidocaine injection which helped for a while. Due to issues with my other foot, this one was put on hold. I think at this point I am lucky with this doctor because this is all being done through workman's comp. He repaired my peroneal tendon (also workman's comp) in November and has really fought with them and been on "the patient's side". I guess his concern is because I cannot be on my feet longer then two hours before the incredible aching and swelling begins. At this point, there really is nothing which is helping with pain/swelling. He fully explained that if this does not work, my fibula would be fractured and the ligaments would need to be reconstructed. Due to the extensive work that would ultimately need to be done, scoping first and hope for the best makes sense.

 
Old 08-06-2012, 06:59 PM   #8
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Re: Success rate for microfracture surgery for OCD of talus

So, it sounds like your problem is more one of stability, then? Too much play in the joint, so they have to tighten it up? He didn't say anything about an OATS? If not, then that's a good thing, because the cartilage damage lesion is the factor that causes this injury to linger, and if that's not the critical problem in your case, that's terrific!

I haven't had to have any ligament work done, so I have no advice in that department.

 
Old 08-07-2012, 07:25 AM   #9
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Re: Success rate for microfracture surgery for OCD of talus

I have also heard the figure 85%.

I had my microfracture for a posterio medial talar dome leasion of 11 x 6 mm three years ago (7/31/09). I agree with some other posters that success is considered a reduction in symptoms, and not necessarily good as new. The area of my lesion waxed and waned with discomfort and pain over the 3 years. Prior to my microfracture I was limping pretty regularly and had massive shooting pains and catching if I stepped the wrong way.

My biggest problem since the surgery has been synovitis and inflammation throughout the joint. I'm not sure if this is because of an imperfect OCD repair or excess scar tissue causing impingement, or what. A cortisone shot usually gives me many many months of a pretty decent ankle, so I'm hesitent to jump into another surgery.

I will tell you, however, that my next surgery will be the Denovo NT procedure. I will not do OATS (and now thankful my original OS refused to go that route even though I thought we should). Purposely breaking the medial malleolus for access is a big issue and will defintely cause arthritis to come on sooner as opposed to later in the joint. The Denovo procedure is showing remarkable success for this condition short term, although long term data is somewhat limited because it is a newer procedurre.

Good Luck

-Bob

 
Old 08-07-2012, 02:53 PM   #10
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Re: Success rate for microfracture surgery for OCD of talus

I know the damage is the cartilage. He did say I have a lesion in the joint and that the cartilage had to what he referred to as a pothole. I am really hoping that by doing the drilling the constant swelling and aching will go away. The DeNovo procedure - isn't that considered experimental? Will insurance cover it?

 
Old 08-07-2012, 06:50 PM   #11
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Re: Success rate for microfracture surgery for OCD of talus

The Denovo is being covered by insurance at least from the folks I've talked to. One surgeon I've met with recently has offered to do it on me, so it's really in my court on my next move. Do a search on this site on Denovo, there is a lot of posts. Also on the knee board and other health boards showing some promise. I would not consider this procedure experimental at this point, but it has only been around for 4+ years or so...

The drilling you refer to is also called microfracture, which is what I originally had done on my OCD. They remove the broken cartilage, drill or pick into the subchondral bone to generate blood flow, which clots and fills up the pot hole. It essentially gets filled with scar tissue like material, not hyaline cartilage.

 
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Old 08-08-2012, 04:34 PM   #12
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Re: Success rate for microfracture surgery for OCD of talus

This was the first time I left a preop appointment and felt like there was a real possibility of a procedure not working. I am truly hoping that it does work because I really do not want my fibula to be fractured and then because of the work being done, needing ligament reconstruction. I have to goggle the Denova procedure to see exactly what is done.

 
Old 08-08-2012, 10:51 PM   #13
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Re: Success rate for microfracture surgery for OCD of talus

Apparently some insurance companies still consider OATS (or cadaver graft) experimental. Though it seem from this board that over the last few years it's getting easier to get it approved either initially or upon appeal.

Some insurance companies will cover the DeNovo NT procedure by treating it as a MF or OATS-type graft, but not the DeNovo material itself, in which case you pay the difference. From what I've heard, DeNovo NT usually requires open ankle but there are cases where traditional OATS would require open ankle and malleolar osteotemy but DeNovo NT only requires open ankle, no osteotemy.

I definitely had a pothole in my talus cartilage. My pod gave me a photo of it after the surgery; picture posted in my original "Drill Baby Drill" thread. Edit: Not enough time has passed since my surgery for me to pronounce it a success or failure. It's been one year--check back in 2 more I say.

Quote:
Originally Posted by Missyluke View Post
I know the damage is the cartilage. He did say I have a lesion in the joint and that the cartilage had to what he referred to as a pothole. I am really hoping that by doing the drilling the constant swelling and aching will go away. The DeNovo procedure - isn't that considered experimental? Will insurance cover it?

Last edited by LivesNearStore; 08-09-2012 at 01:32 AM.

 
Old 08-09-2012, 12:39 AM   #14
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Re: Success rate for microfracture surgery for OCD of talus

You can Google Zimmer DeNovo to not only read about the exact procedure but watch a video of one, as well. Pretty cool, as long as you're not squeamish!

Both OATS procedures -- autograft, which comes from the patient's knee, or allograft, which comes from the ankle of a cadaver -- have been around long enough that very few insurance companies will consider them experimental.

Quite a few will deny the cadaver version, however, which is yet another reason why it's always best to consider having an orthopedic surgeon ankle specialist rather than a podiatrist do your surgery. A podiatrist is not allowed to perform the secondary operation on the knee to obtain the autograft.

The DeNovo is still pretty new, and many insurance companies will approve it for knees, but not ankles yet, because there's no real proof that it works long-term -- not enough time has passed. Many still consider it experimental for ankles. Of course they'll say anything in order not to pay, right? If the alternative is paying for a more expensive (but approved) surgery, they might give in.

 
Old 08-09-2012, 01:37 PM   #15
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Re: Success rate for microfracture surgery for OCD of talus

I will definitely have to keep it in mind and I will goggle the procedure. I have actually watched all the procedures I have had online before having them done - for me it helps me understand why it hurts! I even watched the calcaneal osteotomy before I had it done. I am having the microfracture done in a little over a week. Just got my call to schedule the preop testing and now it really feels real. Waiting for the panic to set in even though this will be the third visit to the OR for my poor feet!

 
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