Recovering From Denovo NT surgery!!!!!

[surfbum]

I am 2 weeks out from the Denovo NT surgery.  I am excited about the hopeful outcomes, but a little nervous about not doing anything to hinder attachment and growth of the cells.  The cpm machine is driving me crazy.  I am a very active person, so being off my feet and on crutches has definitely been a change of pace for me.  How long did any of you feel the need to have to take the pain medication?  I'm not crazy about taking it for so long, but i am a bit of a sissy when it comes to pain.

I haven't had to take a single vicodin for pain. I've taken about 10 though to cure boredom and get a good nights rest ;-) Learn to love the CPM.

[Doggus]

I'm 3 months out from MPFL repair, Denovo NT and lateral release.  I had a similar protocol as most here with 6 weeks NWB.  That really puts you behind in PT but you have to let the cartilage set.  Like others, very surprised that I don't feel my pre-operative pain under my patella.  I was so used to it and keep waiting for it to come back.  So far, so great.  I actually tried a 1 legged squat last night to see how it felt which speaks volumes for my improvement.
As for post-op pain, I didn't need a narcotic after about day 6.  Lived on ice and naproxen and still take the latter twice/ day.  Use it if you need it but I find the anti-inflammatories work great. 
As for the guy or gal who was concerned about coverage for Denovo NT, I heard there is a clinical trial enrolling soon (maybe already?) for Denovo ET (actual stem cells.)  I was told that the people in the trial will be given a latter in the mail that says either "Denovo ET" or "microfracture" which is apparently the unblinded control arm of the study.  Don't know if this is true or not but that's what an OS told me.  It would be a total bummer to get microfracture in that trial.  I think it's weird that ACI would be covered since it's probably 2-3 times as expensive as Denovo and requires 2 surgeries.  Insurance companies will ahve to come around when clinical date regarding Denovo is available (assuming it's positive.)

[skierboy]

Mark--

How about an update on your recovery effort?  I can't wait for DeNovo to be determined by the major insurance companies to be an accepted, insurance-covered procedure and not simply "investigational".  Someone suggested that one could simply pay the $5000 price for the DeNovo juvenile cartilage material and simply have one's insurance pay for the physician and surgical facility & anesthesiologist.  Sorry, it doesn't work that way.  If insurance considers the material "investigational" only, it certainly is not going to agree to pay all the other costs of the procedure.  And if the procedure is not covered by your insurance at all, then the amount one has to pay is the gross amount charged by the doctors and the surgery facility -- not the reduced amounts that the insurance company has negotiated with the doctors/facility for covered procedures.  Thus rather than having to pay, say $1000 out of pocket for DeNovo, one probably has to pay $30,000--and all of that up front so that the drs. and facility don't run any risk of being stiffed.  On top of that, there is some evidence that medical insurance carriers like Blue Cross also have in their agreements with doctors and medical facilities a provision that actually prohibits them from accepting patients (even if the patients will pay 100%) for any medical procedure that the insurance carrier has determined is "investigational" only!

So one is screwed every which way!  The only hope is that Zimmer and the other proponents of DeNovo ET and NT can produce sufficient clinical studies with positive results to sway the insurers to rule this as an acceptable medical procedure.

[Doggus]

Skierboy,
I went to an out of network surgeon at an out of network facility.  I paid for 2 bags of Denovo ($4500) each.  My cash cost for surgery including surgeon, facility, Denovo, cadaver tendon graft and anesthesia was $15,000.   Don't assume your insurance wouldn't pay for some of the surgery- they usually have allowances up to a certain dollar amount for facilities, etc. 
Also, the Denovo portion was $9000 and could be more or less depending on how much product is needed based on area of cartilage defects.  Alternative treatment with ACI would cost much more.  Microfracture would probably be cheaper but that's a totally different surgery.
I doubt insurance will pay for an MRI 3 months post-op and I probably won't either!

[assert]

Mark, please post an update on how you are doing!!!

I am three weeks post op.  My insurance paid for the entire procedure.  I took the Norco pain pills for the first three days and then went to motrin for about a week.  I have very little pain now.  I am exercising the leg via "leg lifts" in order to keep my quad muscle somewhat strong.  Have also started to bend the knee, my doc expects me to be at 95 degrees in three more weeks.  I to am a very active person, the crutches are driving me CRAZY and I hate to depend on others for things that I currently can not do on my own thanks to my knee brace.  I am very hopefull in that the Denovo graft works, my doctor told me I will be back to 100% in 18 to 24 months.  Hopefully my doctor will release me in order to begin rehab in three weeks.  I get frustrated in that I can't go any cardio and get my heart rate up like I am use to doing.  Being in good physical shape has helped me so much with the crutches.  I am very thankful that I have always been the type of person that loves to work out and go to the gym.  I still go to the gym daily in order to do my leg exercises and lift weights.  My doctor told me NO MORE TREADMILL.  Bummer.

[markld]

Hello all,

Well I am almost 5 months post op and was hoping to be doing a little better by now, however I am doing fair for being 5 months as things could be a lot worse.
Part of the big unknown for myself is that I had a microfracture on this knee 3 years ago and don't know whether that's the reason for what seemsto be a slower than average denovo NT recovery.
I am definitely improving, but at a very slow pace. I am able to ride my mountain bike for about 20 minutes at a time,without pain, however I have delayed discomfort several hours later and into the following day, nevertheless it's improving..... My feeling is that the cartilage is still soft and needs to harden more.
I had mri at 3 months post op which showed good fill according to the radiologist report and my Doc stated that there was more fill at 3 months than my ACI had at 12 months which doesn't mean a lot considering the ACI was a failure in that there wasn't much cartilage present when I had Denovo done 5 months ago......
I really won't know how sucessfull this will be for at least another 6 months.
I will try to post back in another 2 months or sooner if there are any great revelations that take place. Until then if anyone has any questions, just leave them here or email me directly.

Mark

[Doggus]

Sorry you aren't still on good course with your recovery mark.  Your knee is complicated and no doubt slowing the process.  I think the key is to appreciate whatever improvements you are seeing and take in the feedback that your body gives you from your activities. 
To poster above, it's tough to not be able to do anything when you're laid up.  I remember at 6 weeks postop i was so ready to start cycling but didn't have enough range of motion to pedal all the way around until 8 weeks.  At that point it took another week to pedal fast enough to keep the computer program running on the bike!  However, have been able to do almost daily cardiovascular workouts since then.  At almost 15 weeks postop I haven't noticed any limitations in biking or freestyle swimming, have added the elliptical and even hiked for 30 minutes yesterday. Totally psyched about things but  still worried it could all get bad again in an instant. 

[markld]

Yeah, thats basically what I have been doing; just listening to my body and the knee seems to be responding rather favorably.
The last couple of days have been huge for me as I don't have much pain left at all in the knee. I even rode my bike the other day for a good 20 minutes with a couple of small hills and had no subsequent pain into the following day.......
I have very little swelling presently, the small amount that's present is hardly noticable.
I believe the key to success is now regaining my leg muscles which will take quite some time.

[Doggus]

Yeah, thats basically what I have been doing; just listening to my body and the knee seems to be responding rather favorably.
The last couple of days have been huge for me as I don't have much pain left at all in the knee. I even rode my bike the other day for a good 20 minutes with a couple of small hills and had no subsequent pain into the following day.......
I have very little swelling presently, the small amount that's present is hardly noticable.
I believe the key to success is now regaining my leg muscles which will take quite some time.

I totally agree and the one thing that sets me back a little is doing leg presses and strengthening in PT.  So I limit that to once/ week now. The bike and doing stairs when possible are my mainstays. 
Glad you are making progress lately.  I go from wildly optimistic about a full recovery to worried that I'm going back to the same boat the next day. I think it's the nature of the process.

[mikew]

Markld

Please udpate on the status of your recovery. I am in your same boat with to failed cartilage surgeries and now have to attempt a Denovo NT. Sounds like you are improving which is encouraging. Are you running yet? How about brisk biking?

[Pelle]

markl

Hope you receive notifcations when someone post on your thread. Was hoping for a 2-3year status?