Journal for Left Ankle Denovo Surgery on Jan 14, 2015

[BLT]

Hey I thought I'd go ahead and start a thread to track the progress of my surgery here in case anyone is interested. Since there is not much personal info about this type of surgery, I wanted to do my part to contribute.

My OCD started back in 2006 when I had a terrible ankle sprain. On November 11th of 2010, I went in for MF surgery, and initially recovered very well. In March of 2011, I returned to traveling. I went to Taipei and was able to walk all over the city without any major ankle issues (occasional inflammation occurred, but it was expected and easily forgotten). In September of 2011, I was able to go back and do some jogging, the Beach Body Insanity workout, as well as running a 5K. Unfortunately around June of 2012 the pain returned. My only guess is that the scar cartilage formed from the MF surgery didn't hold up to my activities. After several months of pain, I started using ankle braces to help with alleviating the pain, but it was only a partial fix. The pain was always on the back of my mind and started to affect my day to day confidence. My mental bandwidth was slowly dominated by thoughts of this pain.

I finally decided to bite the bullet, so on January 14th of 2015 I had the surgery. My insurance didn't cover the "Denovo related" parts of the surgery so I had to pay that out of my pocket, which was approximately $11,000. I'm not rich, but the possibility of having my left ankle back was worth the cost. Thank you VISA and MasterCard with 0% APR. Luckily my visits and equipment for recovery are completely covered by insurance.

It's now Feb 1 and I am about 2.5 weeks post-op. I'm still not weight bearing and won't be until 6 weeks post-op. But I feel like the recovery is going well. I can feel my ankle is less and less swollen by the day. I'm also no longer in a cast, and instead am using a splinter cast. It's essentially a partial cast that only covers the back of my calf and extends out to my toes to keep my ankle in a 90 degree position. I take off the cast about four times a day to do simple vertical flexing motion (no horizontal). The flexibility is improving each day. I'm also improving on my crutching ability. I decided not to pick up anything special for moving around. As for cleaning myself, I feel good knowing I am not using more water than needed for my towel baths.

At this point my mind has completely hung onto hope and optimism for the results since I've essentially shut the door on the past pain.

Thoughts? Suggestions? Comments? Please share!

[casper1955]

Good luck and please let us know your progress

Where did you have the denovo procedure performed?

[BLT]

Good luck and please let us know your progress

Where did you have the denovo procedure performed?

The procedure was performed at the Southern California Orthopedic Institute (SCOI). Dr. Richard D. Ferkel performed the surgery.

[Namelike]

Hey, sounds like we've got pretty much the same story. Former athlete, OCD in 2010, microfracture in 2012. I was back to full activity and feeling 100%, then after about 3 months I was back to pain that was worse than ever. I had DeNovo done a little over 7 weeks ago. I have 1 more week non-weight bearing then will be in a boot until 3/16. Best of luck! Let me know if you have any questions about recovery.

[jnj15]

BLT and Name:
How large were your lesions? They weren't on both sides of the ankle, were they? I have large lesions 15mm on both my talus and tibia. Doctors tell me my prognosis is not good, especially due to the tibial lesion. I'm obsessing over mine, and sometimes get really down...I'm still way too young for TAR or fusion. The only good news is I'm not really in pain from daily activities but it's hard to get around the likelihood that I won't ever be active again...

[Namelike]

Initially before my first surgery I think mine was 12x9. It grew by the time I had my third surgery and I'm almost sure it was up to 15. I had only one lesion.. Here is my MRI: http://imgur.com/a/fZZg5. I'm confident that this last surgery will work, but like you I have been obsessing over it for the past two years. Stay confident!

[BLT]

BLT and Name:
How large were your lesions? They weren't on both sides of the ankle, were they? I have large lesions 15mm on both my talus and tibia. Doctors tell me my prognosis is not good, especially due to the tibial lesion. I'm obsessing over mine, and sometimes get really down...I'm still way too young for TAR or fusion. The only good news is I'm not really in pain from daily activities but it's hard to get around the likelihood that I won't ever be active again...

Unfortunately I forgot. The doctor told me but I didn't have a pen to write it all down. He said it wasn't small, but not horribly big either. He was confident a Denovo surgery was sufficient enough to fix me up. It is only the left side of my ankle, and neither is it a kissing lesion. When I saw the video of him pouring the Denovo into the lesion, seemed like he did a thorough job.

I'd keep asking more doctors if you are down, specifically one that is world renowned for these cutting edge procedures. But sometimes the best surgeon for a specific procedure thinks everyone should get that procedure. I just wouldn't give up so easily.

[BLT]

Hey, sounds like we've got pretty much the same story. Former athlete, OCD in 2010, microfracture in 2012. I was back to full activity and feeling 100%, then after about 3 months I was back to pain that was worse than ever. I had DeNovo done a little over 7 weeks ago. I have 1 more week non-weight bearing then will be in a boot until 3/16. Best of luck! Let me know if you have any questions about recovery.

Ha! Sort of, but not really - I'm not really an athlete. But I've become more physically active since I've learned what it feels like to no longer have that option. So if I understand correctly, you are NWB for 8 weeks? For me it's 6 weeks, but on the visit he may choose not to have me weight bearing yet (in which case I would hope he extends my disability timeframe). For now all I'm really doing is keeping the weight off and a few times each day I take off the splinter (like a half cast) to flex my ankle up and down ONLY. During the last visit he felt my ankle was getting too stiff and wanted me to work it a bit. The nice thing about this is that I can actually feel the healing progress.

However, I'm still ultra conservative. There's been one too many surgeries on this ankle and I want this to be the last one. My goal in the short term is to let this ankle heal to it's best potential and not let anything disrupt it. I will only go back to my weight lifting routine after Dr. Ferkel absolutely signs off on it. Luckily I'm not much of an avid runner, so I don't miss it at all.

[BLT]

It's now Feb 16th, and I'm exactly 10 days away from being cleared for limited weight bearing. Since my last update, my routine hasn't changed too much, but my vertical range of motion is very good. I've been lucky enough to not fall from using crutches and I've gotten enough help from family members throughout each day. I still feel swelling, approximately a 4 or 5 on a  scale of 1 to 10, if I do not keep my foot elevated. My only fear at this point is if the Denovo didn't adhere to my lesion. Although I suspect this isn't an issue because of the hard cast on my foot for the first two weeks; hopefully it was more than enough time to keep any cartilage from floating out of the lesion. But then again this is possibly just my head playing with me.

My appointment is on the 26th, and I think that's when most people here would be interested in what happens, and to what extent am I allowed to walk. To be continued...

[casper1955]

Good luck with your appointment.  We are anxiously awaiting to hear your results. 

[Namelike]

Ha! Sort of, but not really - I'm not really an athlete. But I've become more physically active since I've learned what it feels like to no longer have that option. So if I understand correctly, you are NWB for 8 weeks? For me it's 6 weeks, but on the visit he may choose not to have me weight bearing yet (in which case I would hope he extends my disability timeframe). For now all I'm really doing is keeping the weight off and a few times each day I take off the splinter (like a half cast) to flex my ankle up and down ONLY. During the last visit he felt my ankle was getting too stiff and wanted me to work it a bit. The nice thing about this is that I can actually feel the healing progress.

Correct, 8 weeks. Then 4 weeks in a boot. We're being ultra conservative, but I also had more done than the DeNovo (tendinitis/tarsal tunnel release). Good to hear you're coming along.

[BLT]

Alright guys, I had my visit today with Dr. Ferkel. Just an FYI - Dr. Ferkel will take forever because he spends a good amount of time with each patient. Expect to wait anywhere between 1 to 1.5 hours beyond the original appointment time. The only exception is if you're his first patient, in which case he'll be on time. Plan accordingly.

Nothing too dramatic happened today. My splinter was swapped out for a walking boot that goes all the way up just below the knee caps. I will be limited weight bearing for two weeks with crutches. During the first week I will use two crutches to assist when weight bearing on the left ankle. On the second week I use only one crutch. Starting on the third, I stop the crutches all together and simply walk with the boot until the next visit, which is another four weeks from now.

Originally I was optimistic and hoped I could stop the crutches all together, but it's still too painful, and honestly I've forgotten how to walk. It makes sense that I continue with the crutches. So it'll be a total of 8 weeks post op before I'm free of crutches. In my perspective, since I've experienced this recovery process before from MF surgery, a huge portion of my life returns when the crutches are done with, and that'll make me very happy. Because from there I can comfortably go out and do many daily activities, I just can't exercise yet other than physical therapy. Physical therapy will start in a little over a week.

Please post any questions or comments you may have!

[BLT]

Just another quick update - limited weight bearing has made it much easier to get around in the house. I feel safe using my foot in a boot to balance myself when standing (the weight is still mostly on my right foot). A small part of my life has at least come back. I can move around in the kitchen to get things much easier.

[casper1955]

Congrats.   

[BLT]

I've got another two days before I'm ordered to stop using crutches all together. I have to say, I cant' wait. Since starting physical therapy this past Monday, after each session it's much easier to notice improvement. I remember on the first day of using one crutch it was so difficult and painful in areas of my foot that were still swollen; luckily the pain wasn't in the ankle.

Since Monday it's been much easier. I had to learn the technique for using only one crutch, and I noticed initially I was doing it wrong because my right neck was starting to become sore. The key thing was to keep my body straight. I have a bad habit of slouching so it was quite an adjustment initially. My PT has been extra conservative, he felt with so much "trauma" to my ankle being conservative would be best. But he's really good with his hands, so even just the "massage" he gives me already improves my range of motion.

Another interesting tidbit is he is very familiar with Dr. Ferkel's work because he has had several patients from him. He feels he's probably one of the best ones to go to for ankle surgery, and that SCOI (Southern California Orthopedic Institute) is one of the best organizations for orthopedic surgeons. It made me feel much more comfortable hearing him say that. He also said that MF surgery is typically not successful, and especially for young folks because we have expectations of being very active again after healing. The activeness breaks the fibro cartilage and then the pain returns (as we have discussed several times on this forum). He says typically MF would be best for older folks who intend to do very little or no high impact activities to their ankle. So there probably is a time and place for MF, but he doesn't recommend it for young folks that intend to do high ankle impact activities. Unfortunately Denovo is new to him, so he didn't have much comment on it.

But it looks like I'll be using the boot until March 26th.