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Ankle / Denovo NT

« on: February 27, 2018, 01:10:08 PM »

Hi all,

For those of you researcher types, I'm curious about your thoughts regarding Denovo NT.

I had surgery two years ago on my right ankle (MF, Biocartilage and BMAC at the Hospital for Special Surgery.) After all my research, this seemed to be the cutting edge treatment. My surgery has not been fully successful and in addition, I likely have the same condition in my left ankle.

As I start thinking about surgery #2 (someday- I'm not ready yet) -- I'm wondering about Denovo NT. I have read several success stories over the last few years but Denovo has fallen off the radar as far as news/updates/trials. I know at HSS my surgeon did not believe it was the best route for long-term success.

But...many people who have it (esp as a 2nd surgery) say it was superior to MF and that they knew right away that their ankle was improved.

Thoughts from anyone? Why isn't Denovo NT in the news anymore (and by "in the news" I mean for those of us that dig around the internet looking for every scrap of info there is to find about OCD.)

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Ankle / Post surgery journal: MF/BMAC/Biocartilage for OCDs in right ankle

« on: February 06, 2016, 05:24:43 PM »

Well here I am, one day shy of being two weeks post-op. I had surgery on Jan 25 at HSS with Dr. Kennedy. This is the thread I'll use to post updates and questions for others. Here's a recap of how things went.

By way of reminder, I was diagonosed in July with a 5mm x 7mm medial OCD in my right ankle. Closer inspection of the MRI revealed a small (non-symptomatic) 4mm x 4mm OCD on the lateral side as well as a compromised ATFL ligament. In addition, I had a bone spur on the front of my ankle.

Preop appointment: Thankfully I arrived in NYC early for my preop appointment on the previous Thursday. Had I not done that, I would have had to reschedule my surgery as the biggest snowstorm on record (nearly) descended on Manhattan two days prior to my surgery date.

So about the preop appointment. Dr. Kennedy had me update my MRI the week before surgery. During the preop appointment he advised me that my ankle had deteriorated over the past six months. The medial lesion was now measuring somewhere near 1cm. This stunned me as I had remained nearly completely inactive for the six months prior to surgery - no running, hiking or even going for walks longer than a couple blocks. Dr. Kennedy let me know that there was a possibility of converting to OATS but he wouldn't know until he actually got a view inside my ankle. My lesion is a shoulder lesion and his concern was that for bigger lesions the repair could just "fall off" if the lesion was too big. He told me he felt there was only a small chance of needing to do OATS but wanted me to be prepared just in case. He also told me that the lesions had become cystic (they weren't before) and that he would have to do a bone graft from my heel.

Surgery: I've never had surgery before and I'll reiterate here what I've read many places: HSS is a class act as is Dr. Kennedy and his team. I felt confident that I was in the best hands and this did a lot to alleviate anxiety and fear. After the surgery was completed, Dr. Kennedy came and talked to me. He did not have to do OATS; in fact, the MRI over-estimated the size of the medial lesion. It turned out to be 6x8x2. The lateral lesion was 4x4x2. Bone grafts were not necessary for either. He MF'd both OCLs, used Biocartilage and BMAC on both sides, fixed my ligament and removed the bone spur.

One other thing of note (and I intend to ask more questions about this at my 6-week follow-up): Dr. Kennedy said that it was apparent that the injury had existed for quite some time. Given that I've never sprained my ankle and that this injury seemed to appear out of nowhere a year ago, I had speculated that it was from a recent (but unknown) event. Following the surgery, we now know this is most certainly not the case. Apparently my talus bone was very hard to drill into, so much so that he had to use something different than the traditional tools he usually uses. He was able to make the bone bleed and felt confident that other than my feeling more post-op medial pain, the surgery would have the same estimated 90% chance of success. In any case, the condition of the bone cleared up the mystery. I've apparently been hiking and running on a non-symptomatic deteriorating ankle for years.

Post-op: Here's a quick list of how things have gone along with some questions for folks who have been here.

I had a nerve block post-op and didn't start feeling any pain until about 36-hours after surgery.

The worst of the pain was days 2-5 and even then it was not unbearable with the pain meds. I was able to sleep 6-8 hours each night. (Unlike others though, I have not been sleeping a lot. I'm awake and working from bed during the day and am lucky to sleep a full eight hours at night.)

I've pretty much been off the pain meds now (including OTC meds) since day 9. I did however feel like I needed them up until Day 9. I've read accounts of people who were off them much earlier and have wondered what it means that I needed them longer. I did have surgery on three sides of my ankle (and a more intense drilling on the medial side) so perhaps this accounts for it. Is there anyone else who needed meds for over a week?

Currently the only real discomfort I have is an on-again/off-again numbness and tingling that occurs mostly at night. It seems to me that my foot/heel just gets weary of being in the same position and falls partially asleep. I've also had some heel discomfort inside the splint. This comes and goes. At times I've also been able to feel the medial wound area. Is this familiar to anyone else?

I've been elevating 23+ hours a day, only getting up for the occasional bathroom or kitchen trip. During the times where I'm really uncomfortable (mostly at night) I do find that I'm repositioning A LOT. I'm guessing this is normal but have wondered if I've had too much movement for the early days of being post-op. I'm most concerned about Biocartilage graft adhering and not messing that up. Any thoughts about this? Is it that fragile of an environment that shifting your leg a million times an hour could disrupt it? (This is my paranoia in full force here.)

I think that's pretty much it for now. I get the stitches out Wednesday and am put into a boot for two more weeks of non-weight bearing.

Would love some thoughts on the above from others who've been here before me.

Thanks, Christina

PS- The knee scooter is a dream. I haven't used crutches once.

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Ankle - Future treatments / HYALOFAST for hyaline-like cartilage

« on: January 20, 2016, 06:56:21 AM »

Not yet approved in the US but looks like a study is starting soon.

Anika Therapeutics, Inc., (NASDAQ: ANIK) announced the enrollment of the first patient in its pivotal HYALOFAST® FastTRACK Phase III clinical study. http://www.streetinsider.com/Corporate+News/Anika+Therapeutics+(ANIK)+Enrolls+First+Patient+in+FastTRACK+Phase+III+HYALOFAST+Study/11180428.html

Dec 29, 2015: The HYALOFAST FastTRACK study is a prospective, randomized, active treatment-controlled, evaluator-blinded multicenter study to establish the superiority of a hyaluronan-based scaffold (HYALOFAST®) with autologous bone marrow aspirate concentrate (BMAC) in the treatment of articular knee cartilage defect lesions. The study will enroll approximately 200 patients at up to 30 sites in the U.S. and Europe.

HYALOFAST is a biodegradable scaffold that is used to enable cartilage regeneration in patients suffering from cartilage defects. European clinical data demonstrates that patients treated with HYALOFAST plus autologous BMAC in a one-step, minimally invasive arthroscopic procedure were able to successfully regenerate hyaline-like cartilage. HYALOFAST is CE Marked in Europe and is available commercially in 18 countries with more than 6,000 uses to date.

“HYALOFAST is an exciting, emerging product in our pipeline, representing Anika’s expansion into the rapidly evolving field of regenerative medicine in the orthopedics space,” said Dr. Charles H. Sherwood, President and Chief Executive Officer of Anika Therapeutics. “We have seen very positive clinical outcomes in the treatment of knees and ankles internationally using HYALOFAST. We believe the FastTRACK study will give us the pivotal clinical data to support a marketing application for an indication for the repair of cartilage defects of the knee in the U.S.”



HYALOFAST® Hyaluronic Acid Based Matrix Supports Regeneration of Hyaline-like Cartilage: http://www.anikatherapeutics.com/products/orthobiologics/hyalofast/

"HYALOFAST is a non-woven 2×2 cm or 5×5 cm biodegradable hyaluronic acid-based scaffold for hyaline-like cartilage regeneration. It is used for the entrapment of mesenchymal stem cells (MSCs) to arthroscopically treat both chondral and osteochondral lesions in the knee and ankle."

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Ankle / Questions about flying after MF surgery

« on: January 11, 2016, 03:44:01 PM »

Hey everyone,

I'm scheduled to have MF surgery January 25 at HSS with Dr. Kennedy. One of the things I still haven't settled is how I'm getting back home to Colorado.

Initially, the plan was for my friend who is going with me to drive me. I had preferred not to fly; however, the prospect of being a passenger for 1,800 miles post-surgery and navigating hotels now seems even more daunting.

So my questions are:

1. Who has flown post surgery?
2. How many days did you wait before flying?
3. How did it go? Were you able to elevate your leg? (I'm thinking I'll buy a first class ticket to do this...but can you even elevate your leg in first class?
4. What precautions did you take? i.e. pain meds, compression socks, etc.
5. Any advice for navigating the airports?

Thanks for any insight!
Christina

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Ankle / Observations about my consultation with Dr. John G. Kennedy at HSS

« on: August 26, 2015, 03:32:42 PM »

Hi everyone,

Last week I flew from my home in Colorado to see Dr. Kennedy at HSS in NYC. I've done an obsessive amount of research after being diagnosed with a medial side defect, right ankle, uncontained (on the talus shoulder), non-cystic, approx 15mm x 8mm in size.

After educating myself, I decided I only wanted to be treated by one of the (seemingly few) leading surgeons for this type of injury. I made three phone calls: to Dr Eric Giza who is not currently accepting new patients, to Dr. Lew Schon with whom I have an appointment on Dec 15 (a four-month wait), and Dr. Kennedy who was able to see me within one week (and is available to do my surgery in early October). 

So far, my experience at HSS has proved to match the rave reviews you read about online. Dr. Kennedy was thorough, patient, educated and caring. His staff, on the day of my appointment and in subsequent phone calls, have been thorough, responsive, respectful and sympathetic.

Before meeting with Dr. Kennedy I had a hunch that he was not a fan of the Zimmer Denovo NT treatment and this turns out to be true. He mentioned that there are two avenues for treatment of OCD lesions: repair (microfracture) or replace (grafts).

For my defect, he recommended microfracture with BMAC (from my iliac crest) and Biocartilage. He says he has a 90% success rate with this line of treatment and is very confident that this is the current best treatment for repairing OCD defects of my size/condition. He emphasized that his confidence is entirely and only placed in evidence-based treatments that show results-- and to that end, both his research and the evidence point to this being the current best treatment (he mentioned that other leading ankle surgeons are transitioning to this belief as well). For larger, more complex defects he is a big believer in OATS and is considered one of (if not the best) for this surgery.

I have read so much that is negative about microfracture that it's been difficult to wrap my head around proceeding with this treatment. Dr. Kennedy did indicate that methods of how to microfracture have evolved in recent years and that in years past it's possible more damage was done to patients during the surgery but that is not the case now. Also the addition of BMAC to the microfracture procedure seems to be the biggest change in the success of this procedure.

I am moving forward with Dr. Kennedy and expect to have a follow-up phone call with him in the next week or so to ask some questions that have come up since I met him in person.

Would love to know any feedback others have about microfracture + BMAC. I'm happy to answer any questions from others too. Dr. Kennedy was the fourth surgeon I've seen- the first two were inexperienced with this type of injury and the third was a Denovo NT advocate based in Denver.

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Ankle / Researching Denovo NT options & outcomes

« on: July 29, 2015, 12:19:29 PM »

Hello everyone,

I'm hoping to get some feedback from those familiar with the Denovo NT procedure.

A little background- Recently diagnosed with an OCD, medial side, right ankle, uncontained (on the talus shoulder), approx 15mm x 8mm.

I've seen three surgeons, but only one with whom I would consider treatment- Dr Alan Ng in Denver, who has performed 90ish Denovo procedures with a 90% success rate. I liked Dr. Ng but given the seriousness of this condition, I am planning to get second options from other Denovo NT specialists.

So my questions today are-

1) If you've had a successful Denovo procedure, who did you see and how was your experience.

2) Is there anyone here whose lesion was on the shoulder (uncontained)? This new news about my OCD location is the most disheartening to me at the moment. I've done some research and have found some limited information that says uncontained lesions have less successful outcomes.

Dr Ng, while evaluating my MRI, said quite clearly that my OCD was in an unfortunate spot. I was really disheartened initially but later her seemed very positive that he could fix it and that I'm a good candidate for Denovo. I'm not sure how to interpret his initial reaction, the data I've found online, and then his subsequent optimism that he's has many successful outcomes with similar OCDs.

By the way, his plan for me is --

Arthroscopic procedure with Denovo NT but no bone allograft. He's said one of the things learned with previous Denovo treatments is that your own bone actually grows back so doing a bone implant (from my hip, etc) is not necessary and can actually cause problems later. This concerns me as well because I do have bone loss and quite a large uncontained gap between the bone loss and cartilage.

Would so appreciate any feedback and insight about experienced Denovo surgeons and any difficult/shoulder talus procedures.

Thank you! -Christina