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suebob30 07-20-2012 12:38 PM

surgery again for osteochandral defect!
Hello everyone, i have posted in recent months and thought i would post an update. As i said in earlier posts I had an osteochandral defect in my ankle surgically removed may of 2011. Well needless to say the problems came back. After seeing several drs and being refered to another podiatrist, i have had another mri and the hole that was left after drilling is actually getting bigger. So, now they want to do surgery again. The dr actually said he wants to try to drill but in case the hole is to big he wants to have cadaver bone there to "plug" the hole. My biggest concern is the time of nwb after surgery. After my arthroscopy last year the dr had me walking 2 days out and the new dr said that it was way to soon. He said i should have been nwb for at least 4-6 weeks. And with this next surgery he is assuming nwb at least 8 weeks depending on what he will have to do once he gets in surgery. Can anybody give me advice at what to expect? I'm a little nervous about another surgery too. It didn't work the first time so what says it will a second time? Any help would be greatly appreciated!!

LivesNearStore 07-22-2012 12:00 AM

Re: surgery again for osteochandral defect!
The most common NWB period after drilling/microfracture is about 6 weeks, at least from what I've read and heard. Some go as long as 8 weeks NWB, and my doctor had me bearing weight in a boot after just 2 weeks, which I thought was pretty aggressive, but not compared to your doctor! Note that before my doctor cleared me for WB he checked my ankle motion and took an X-ray of it. And then I didn't listen to him and kept using crutches to stay PWB (in the boot) until about the 4th week, and stayed in the boot for 6 weeks.

If your doc does a cadaver plug, how long you are NWB may depend whether they have to cut your tibia or fibula to implant the graft. If they don't cut either leg bone, your NWB period might be shorter. If they have to cut a leg bone, I think 6 weeks NWB is the minimum and it could be longer.

My non-expert opinion is that if your first surgery failed because you walked on it too soon or didn't get enough bleeding into the defect, etc., then a second drilling or MF might work. If it failed because the defect was too big for MF the first time around, then a second drilling is unlikely to work now that the defect is bigger. Disclaimer: I'm not a doctor.

Edit: If they cut the fibula or tibia, you will probably be in a split for 7-10 days, then a cast for 5-6 weeks, then a boot for some weeks after that.

pclare 07-22-2012 12:24 AM

Re: surgery again for osteochandral defect!
Yes, weight bearing too soon is probably why your last surgery didn't work, so keep your hopes up that this one will, and be glad that your new surgeon knows better.

The microfracture is a pretty minor surgery, but if he has to do the OATS while he's in there, that's major but will hopefully last longer, as well. I'm personally not convinced that any of these remedies are permanent. They certainly haven't been for me.

pclare 07-22-2012 12:34 AM

Re: surgery again for osteochandral defect!
[QUOTE=LivesNearStore;5024637]I didn't listen to him and kept using crutches to stay PWB (in the boot) until about the 4th week, and stayed in the boot for 6 weeks. [/QUOTE]

Wise move on your part. No harm can come from giving it longer, but the entire process can be destroyed by simply walking on it too soon. Add to that the fact that the lesion will only get bigger and become more difficult to fill the next time, and it really is unwise to not baby it from the start.

suebob30 07-22-2012 06:35 AM

Re: surgery again for osteochandral defect!
Thank you for the response...The dr said he wasn't sure if he would have to cut any other surrounding bones because the mri copy i took with me wouldn't work. So i have an appointment aug.1 so he can get another copy of it and look at it himself. In the mean time i have to get an afo brace and see if that gets rid of the pain while i walk. I haven't had much success with any braces at all so I'm not real optimistic about this one. I am just very discouraged about the whole thing! I have been dealing with this bad ankle since 2009 and nothing seems to be helping or fixing the problem!

pclare 07-22-2012 11:20 AM

Re: surgery again for osteochandral defect!
My OCD began on the medial side of my right foot, so the surgeon had to cut the medial malleolus in order to get to it, and then he transplanted two plugs from my right knee. That was done in December '04, so I got seven reasonably pain-free years out of it.

I could tell the trouble was starting again for a while, and I finally went back in for another "tune-up" (as I call it) when I couldn't take the pain of walking any more -- even with a boot on. It turns out the bone grafts had healed beautifully, but the cartilage still fell apart and the area was a mess.

He couldn't be sure if it was exactly the same area or not -- whether the transplanted cartilage fell apart or if it was the area adjacent to it, but the damage did seem to have shifted more toward the center of the talus, whereas it used to be right by the medial malleolus.

This time we tried microfracturing again (my third or fourth time -- I've lost count), and I'm starting my third week of non-weight-bearing frustration. I shouldn't complain, though, because at least the microfx post-op is pain-free, just tiresome for a normally very active person.

As for boots: I have about six different boots, and the only one that ever provided me with any relief is the Aircast XP Pneumatic Walker. I highly recommend that one, even if you have to buy it yourself (if you can afford to). I see them online for about $125. I've had my injury for over ten years, and that boot is the one I always go back to. That and the knee scooter I bought have made this far more bearable.

I hope you have better success with your ankle than I've had with mine!

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