Questions about ankle and surgery in Australia

[JasWong]

I write from Singapore and I have a chronic ankle pain on the anterior part of my right ankle. It is painful when I stand and more so when ankle is dorsiflexed. I suffer either from ankle impingement or thinning cartilage. I have undergone 2 ankle surgeries over the last 8 weeks but I feel that the surgery was not thorough. 1st surgeon did an open osteotomy of spurs and 2nd surgeon did an athroscopic debridement of large amount of synovium build up plus open osteotomy of spurs. Perhaps he didn't do a debridement of tissues that could have irritated the synovium or joint capsule as he claims never to have done that since he don't believe in meniscoid lesion. He says my cartilage on talus is ok and ligaments are fine. Talus cartilage looks smooth. My ankle feels slightly better but there is a lingering pain on one particular spot anteriorly and it feels like tissue impingement or cartilage worn off. I don't think it is from spurs.

There is only one foot and ankle surgeon in Singapore and he is overhwelmed with other patients to properly diagnose me (as with most cases here since our govt spends the lowest on % GDP on healthcare). I hope to go to Australia for help but am not too familiar with your healthcare system.

1. How much would it cost me to do an arthroscopic ankle surgery and how much is charged for consultation?

2. Should I have doubts and questions, when I make and appointment, how many days before I get to see the doctor?

3. Would surgery be safe since i've undergone 2 open surgery over the last 8 weeks? Any danger with that?

4. Assuming spurs were removed, can meniscoid lesion cause impingement even when there are no spurs?

5. If my ankle cartilage is thin or damaged on the tibia head, are surgeons able to repair that?

6. I read about the use of a) MACI (by Verigen) and b) cartilage regrowth using Plasma Rich in Growth Factors (PRGF). Can any of this method to repair cartilage damage on ankle especially on the tibia head? I've attached a url link from a spanish website on the use of PRGF for your reference. Apparently, the recovery period of patients using PRGF for cartilage damage is 1 week and used widely for sports related cartilage injury.

http://translate.google.com/translate?hl=en&sl=es&u=http://www.traumatologiaveterinaria.com/notic.htm&prev=/search%3Fq%3Dramon%2Bcugat%2Bcartilage%26hl%3Den%2 6lr%3D%26ie%3DUTF-8

7. Who do you recommend I consult for a complicated ankle condition like mine?

Thanks for your time in reading this, I'd be happy to hear any replies on my email or here. jas.wong@pacific.net.sg

Jason
Singapore

[injuryupdate]

Lots of questions, and you are very well read and informed, but the most important info (that will cut your list of questions in half) - do you have a tibial side articular cartilage lesion? If so, that is your main problem, and if not, as you correct point out you have anterior impingement/meniscoid lesion which should be easier to treat.

With all of the info you have, it sounds like the surgeons know what they have been doing, and you might turn the corner sometime soon and not need to come to Australia after all. However, please give more info and I will answer more questions.

[podsportsmed]

I write from Singapore and I have a chronic ankle pain on the anterior part of my right ankle. It is painful when I stand and more so when ankle is dorsiflexed. I suffer either from ankle impingement or thinning cartilage. I have undergone 2 ankle surgeries over the last 8 weeks but I feel that the surgery was not thorough. 1st surgeon did an open osteotomy of spurs and 2nd surgeon did an athroscopic debridement of large amount of synovium build up plus open osteotomy of spurs. Perhaps he didn't do a debridement of tissues that could have irritated the synovium or joint capsule as he claims never to have done that since he don't believe in meniscoid lesion. He says my cartilage on talus is ok and ligaments are fine. Talus cartilage looks smooth. My ankle feels slightly better but there is a lingering pain on one particular spot anteriorly and it feels like tissue impingement or cartilage worn off. I don't think it is from spurs.

There is only one foot and ankle surgeon in Singapore and he is overhwelmed with other patients to properly diagnose me (as with most cases here since our govt spends the lowest on % GDP on healthcare). I hope to go to Australia for help but am not too familiar with your healthcare system.

1. How much would it cost me to do an arthroscopic ankle surgery and how much is charged for consultation?

2. Should I have doubts and questions, when I make and appointment, how many days before I get to see the doctor?

3. Would surgery be safe since i've undergone 2 open surgery over the last 8 weeks? Any danger with that?

4. Assuming spurs were removed, can meniscoid lesion cause impingement even when there are no spurs?

5. If my ankle cartilage is thin or damaged on the tibia head, are surgeons able to repair that?

6. I read about the use of a) MACI (by Verigen) and b) cartilage regrowth using Plasma Rich in Growth Factors (PRGF). Can any of this method to repair cartilage damage on ankle especially on the tibia head? I've attached a url link from a spanish website on the use of PRGF for your reference. Apparently, the recovery period of patients using PRGF for cartilage damage is 1 week and used widely for sports related cartilage injury.

http://translate.google.com/translate?hl=en&sl=es&u=http://www.traumatologiaveterinaria.com/notic.htm&prev=/search%3Fq%3Dramon%2Bcugat%2Bcartilage%26hl%3Den%2 6lr%3D%26ie%3DUTF-8

7. Who do you recommend I consult for a complicated ankle condition like mine?

Thanks for your time in reading this, I'd be happy to hear any replies on my email or here. jas.wong@pacific.net.sg

Jason
Singapore
times new roman navy


REPLY: PODSPORTSMED re: Jason's ankle surgery

Jason,

Thank you for your enquiry. You have amassed a deal of knowledge about your ankle condition, and seem frustrated with your progress 8 weeks post surgery. Let me assure you that you are most likely on track to make a full recovery. The type of surgery you have experienced will take upward 16 weeks to make an objective assessment of your progress. The symptoms you are currently experiencing are in keeping with the surgery you experienced.
If you need to come to Australia, there are a number of very experienced foot-ankle orthopaedic surgeons that may assist you. Costs for ankle surgey vary, dependent upon a number of factors. The surgeon would discuss all aspects of surgey, provide a full list of fees, outline potential complications, realistic outcomes and other treatment alternatives.
However, at this stage of your rehabilitation, be patient, liaise more with the surgeons that are treating you and discuss your concerns. If you are not already doing so, consult a physiotherapist who is familiar with foot-ankle surgical rehabilitation, ensure that you limit the volume and intensity of weight bearing activity, and wear cushioned-stable footwear i.e. athletic joggers.
If 4 months post surgery and having undergone a reasonable period of supervised rehabilitation, the ankle has not responded, seek further investigation (MRI, CT scan etc) and evaluate.

Good Luck

PodSportsMed

[injuryupdate]

This page will give you an idea about costs of arthroscopic surgery in Australia, but I agree that you shouldn't rush in:

http://www.injuryupdate.com.au/issues/surgerycosts.php?menu=issues

[Bob]

Not bad value when you look at the scheme of things, esp with insurance etc.

How much would the average AFL/Rugby League team budget each year for surgical procedures/MRI etc??? They don't seem to hesitate to pop players in for a bit of a clean up.

[injuryupdate]

I would guess that the average NRL or AFL team would order 50 MRI scans per year, costing perhaps $20,000, with more still spent on other types of scan (CT, bone scan, ultrasound, plain X-ray). The ones just listed get a Medicare rebate so the cost to the clubs is minor, but clubs should be paying full dollar for MRI scans. Some may be getting specialists to signs the forms but this is a bit of a rort.

With respect to surgery, I would estimate the average club would have 15-20 operations a year, which perhaps would average $2000 in gaps each. For details of numbers, see: http://www.injuryupdate.com.au/images/research/NRLinjuryrates.pdf