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Failed DeNovo graft?


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Old 12-27-2013, 06:59 PM   #1
Toadlee
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Failed DeNovo graft?

I had a failed MF surgery last year for a small OCD and had the DeNovo graft done with a Brostrom stabilization in September. During the second surgery it was discovered that I had a lot of scar tissue which may have been causing some of my problems, so that was all cleaned out prior to implanting the graft.

The ligament repair seems to have healed well, but I still have problems walking; I still get shocks of pain if I step wrong, or walk downhill. I can finally walk down stairs normally most of the time, which is an improvement, but I wouldn't call it a successful outcome. I can only wear sneakers; all my other shoes cause pain and I end up using a cane again to keep the weight off it. I just had another MRI which shows the OCD is still present, having grown a bit. There seems to be more bone edema too, but scar tissue can be hard to see on MRI films, so that's still a question. Before I got the MRI, we were considering using cortisone to try to break up the scar tissue, but the dr. wasn't sure what effect that would have on the graft. Now that I know the OCD is still there, I'm not sure if cortisone is still an option, or what other alternatives I have. I'll be seeing the dr. next week to go over my options, but I'd like to get as much info as possible before hand.

Anyone out there have a failed DeNovo graft? Anyone know how cortisone reacts to it? Also, I'm only 3 1/2 months post-op; is there a chance that it just takes a long time for some people to grow new cartilage?

 
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Old 06-09-2014, 10:45 PM   #2
lguhsiesel
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Re: Failed DeNovo graft?

Hi Toadlee,

I'm wondering how your ankle is doing?

Also, did insurance cover your denovo graft? If so, what insurance did you/do you have?

I am scheduled for the same surgery on Friday with Dr. Ferkel and I'd like to get an idea of prognosis as well as precedent for the after-surgery insurance appeal with my insurance company. So trying to gather as much data as possible. Thanks!

 
Old 06-09-2014, 11:32 PM   #3
hardy
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Re: Failed DeNovo graft?

Cigna has a very well explained policy regarding OATS and DeNovo.

Seems unlikely that they would change their mind unless you can provide scientific evidence that DeNovo grafts work which they have not considered in their evaluation. I wouldn't count on it being covered...

Out of curiosity, why are you going down to LA if you live in Los Altos? Some of the world's best foot and ankle surgeons are in the bay area...

Last edited by mod85; 06-11-2014 at 01:04 PM.

 
Old 06-09-2014, 11:40 PM   #4
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Re: Failed DeNovo graft?

Thanks for your reply Hardy.

I'm traveling to Van Nuys because when I asked the surgeons here who they would go to have the surgery done on them, two said Richard Ferkel. I saw 7 surgeons in total and he does more than any of them combined.

I'll keep you posted after Friday, but for now, trying to find other patients that had the procedure done so I can duke it out with Cigna. If you can help in that regard, I would appreciate it.

Wish me luck on Friday. This will be my 4th surgery...

 
Old 06-10-2014, 06:17 PM   #5
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Re: Failed DeNovo graft?

The doc says the next review date is in 5 days, June 15th, 2014. But that doesn't mean they will change their policy.

lguhsiesel: Good luck Friday. I hadn't thought about having the surgery first then battling the insurance company after, but I suppose there's no reason you can't do it that way. You should probably get a few doctors to write letters explaining why DeNovo is the only viable option for you and that MF either failed or is unlikely to work. If the insurance company is very resistant, your backup plan could be to have them pay what a MF or OATS would have cost and you pay the difference.
Seems unlikely that they would change their mind unless you can provide scientific evidence that DeNovo grafts work which they have not considered in their evaluation. I wouldn't count on it being covered...
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Last edited by mod85; 06-11-2014 at 01:05 PM.

 
Old 06-14-2014, 06:43 PM   #6
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Re: Failed DeNovo graft?

I've been looking for DeNovo results just out of curiosity. I had an allograft one year ago to repair my OCD and I'm thrilled with it.

Ask the hospital/surgeon to bill you directly for the DeNovo part of the procedure and get the insurance to pay the rest. I had Premera through my employers and only had out of pocket costs of $2000 or so plus travel to and from Seattle.

Good luck on Friday and keep us posted on your recovery.

 
Old 06-16-2014, 06:14 PM   #7
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Re: Failed DeNovo graft?

Hi there,

I had my surgery on Friday at Valley Presbyterian Hospital with Dr. Richard Ferkel. The first night was AWFUL, not from the pain but from a bad reaction to the anesthesia. I had a leg nerve block which worked beautifully so I felt nothing except my leg feeling some pins and needles the first 48 hours. Needless to say, I was only on ibuprophen (because I couldn't tolerate the narcotics) for the first 2 days. By day three, no ibuprophen necessary at all, I had virtually no pain, leg just feeling heavy (the cast is super heavy).

So far, so good. My doctor says my lesion was big 15 mm x 5 mm, so I was a good candidate for de novo. This being my 4th surgery, and the fact that I am 43 years old.

Will keep everyone posted on my post-op and recovery. Thanks! Lucia

 
Old 09-08-2014, 12:26 AM   #8
Toadlee
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Re: Failed DeNovo graft?

Sorry, out of touch for awhile, just checking in. Its been a year since my denovo graft, wish I could say all was good, but my results are marginal. I'm not disabled, but the ankle isn't good. If I wear anything more than a flat, I get frequent jolts of pain, like I did when the OCD was untreated. Sometimes, even in flats, doing nothing, just standing, it can give me zing and I look pretty goofy dancing off that foot.

It had been getting better, but I suspect that scar tissue is pinching the joint, similar to the last time. I wonder if this is always going to be a problem. I know another graft recipient, hey, Umteddy, who had a asimilar outcome and just got another cleanout. Seems a poor treatment choice if it requires repeated surgeries.

Now my options are fewer: I cant afford to take any more time off work (2 extended leaves in 2 years? 3rd leave is out of the question), but at the rate its deteriorating, I'll be off that foot in another couple months anyway. And all my loose change has gone to the last surgeon, tapped out now.

Id love to hear from other denovo recipients to get a feel for real world outcomes. And any advice on other options greatly appreatiated.

 
Old 09-08-2014, 03:32 PM   #9
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Re: Failed DeNovo graft?

Toadlee, I hope your ankle continues to get better. My ankle got better after surgery then had occasional flashes of discomfort after any running or jumping (I try to avoid both activities). Now, 3 years later it's good most of the time but occasionally I feel some pain and worry the surgery failed, then the pain goes away and I assume it's just some early arthritis from the surgery. However I didn't have a graft, just the microfracture.

Have you had any X-ray, MRI or other imaging of your joint since the surgery?

Last edited by LivesNearStore; 09-09-2014 at 10:09 AM. Reason: fixed spelling problem on ankle

 
Old 09-08-2014, 03:57 PM   #10
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Re: Failed DeNovo graft?

For me, after having the second surgery just over month ago, it made a Huge difference... It alleviated the pain and issues I was having... It was a simple scope to clean out scar tissue and the recovery was quick... 3 weeks post op I was walking more comfortably and longer distances than I had for the first 11 months out of Denovo/brostrom surgery... I think the difference was switching doctors...

I think the reason for a lot of scar tissue development is the result of doing an open procedure and also the technique/experience of the doctor... If its truely just scar tissue causing the pain then it can be fixed (based on my experience)... Also, I think the reason the recovery is so long and up and down is bc the bone really needs a lot of time to heal... The cartilage firmness grows over time so if you do high impact activities (running/jumping/cutting) early on it could put a lot of stress on the bone underneath the cartilage...

Last edited by umtum; 09-08-2014 at 04:15 PM.

 
Old 09-08-2014, 05:08 PM   #11
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Re: Failed DeNovo graft?

Wow, Umtum, am I ever glad you posted that! I'm scheduled for a follow-up surgery to my July 2013 Denovo one on October 1, and also with a different surgeon. This one does everything through the scope, and says it's not uncommon for the juvenile cartilage tissue to also enhance the growth of scar tissue. He thinks he'll be able to clean that up and, if the underlying cartilage looks good, I could be walking the same day. If it doesn't, it'll mean more Denovo, and 4 weeks NWB.

As it is, I nearly am disabled, unless I'm taking Meloxicam. Without medication, the first few steps in the morning are excruciating, and I have pain after sitting even short periods.

Your post is a blessing.

Mark

 
Old 09-08-2014, 05:21 PM   #12
umtum
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Re: Failed DeNovo graft?

That's good to hear... I hope it resolves your issues... Walking right after surgery seems ambitious... I was immobile for 10 days and in a boot for another week or so... Also, I would ask your doc about scoping the subtalar joint bc a lot of scar can develop in that area as well and cause pain... Its the joint between the talus and the calcaneus... I had that cleaned up as well.. I didn't have any issues walking in the morning like you but it would be uncomfortable to put my foot down planted on the floor and it would start to ache... Also I had this pinching type pain when I walked and sometimes at rest... All that have resolved... Most importantly I haven't had an episode of that significant Ocd (bone aching type) pain... Do you have any tooth aching type pain?

 
Old 09-08-2014, 09:12 PM   #13
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Re: Failed DeNovo graft?

Not exactly. When it's really hurting, the pain emanates from the sinus tarsi and up my tibia. The first few steps feel like my leg is broken. It'll gradually get better, and a half hour on an exercise bike will make the pain go away completely, for as long as I'm active. Sit or lay down for a few minutes, and the pain is back. Sit or lay down longer, and it's back worse. Until I started the Meloxicam, it had been gradually worsening for months. I can "move the pain around" with ROM exercises, but I can't make it stop.

The MRI showed the sinus tarsi was "unremarkable", and an injection into that area had zero positive effect.

Mark

 
Old 09-08-2014, 10:15 PM   #14
Toadlee
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Re: Failed DeNovo graft?

Umtum,, I did have an arthroscopic denovo, not an open procedure. As the first surgery was also arthro and I had a lot of scar tissue, it wouldnt surprise me if I've just grown some more.
What I dont understand is why they didnt see that as a risk for another procedure. It seems kind of common, judging by what's on this site.

I havent been able to run, which was my primary goal. Igot about 2 weeks of practice before I had to give up and now even long walks are difficult. Dancing, aerobic classes, fuggedaboutit!

For me, the irony is Im still paying for it. Salt in the wound, not so metaphorically.

 
Old 11-13-2014, 12:27 PM   #15
Toadlee
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Re: Failed DeNovo graft?

Just an update, I had another arthroscopy a couple weeks ago and the denovo graft had failed. There was a lot of friable tissue and loose fragments, and exposed bone. There was also lots of scar tissue, which was making my ankle pretty stiff. I don't have the best insurance now, so about all I could do was try another microfracture, so I'm hoping this time it takes and I can get back to some semblance of normal activity.

I'm curious though, how many others there are with failed grafts? If you've had a failure, please post. My surgeon told me there've been reports of 'muffin top' where the graft kind of goes rogue, overgrows, then sheets of tissue sheer off and cause problems. Maybe denovo isn't a good choice for ankles?

 
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