KNEE ARTHRITIS - Cartilage plug transfer :
o.a.t.s--recovery/rehab - - Posted by violin1 (mj/usa), 17 July 2002
Hi!
I am facing an OATS procedure in September and would like to know how long can I expect to be out of commission---is how long before I am resonably mobile again? Is the pain level bearable
Is the rehab very grim? or it is managable? My OS told me 6 weeks on crutches.
Again, any and all info is greatly appreciated.
Thanks
Posted by badowns83 (Brad), 18 July 2002
MJ,
I had the OATS procedure done a year ago. It was not as bad as I had expected it to be. I would give you a few words of advice. #1 very important DO NOT WALK (no weight at all) before you have been cleared. bone needs to heal first. #2 take it easy when you do start walking. #3 do not walk on concrete floors alot if it can be avoided. # 2 & 3 caused me to caused my graft not to take. I work a very physical job and I was walking all day on a concrete floor (up to 4 miles a day way more than OS said I could) Now I am now facing a Osteochondral Allograft. Therapy was not too bad until I started having problems at around three months. I pushed my self way too hard thinking the harder I pushed the sooner I would be 100%. I am now worse off. I know that my work conditions caused my graft to fail. I felt ready to run at around 12 weeks, and at about 14 I could barely walk up stairs. I was asked to do alot of things I was not supposed to do at work and did not let it heal. I think the OATS procedure is a great thing (if done right), but you are responsible to listen to your OS. Do the level he/she says. More does not = healed faster.
My last bit of advice is to strengthen your leg as much as possible before hand. It makes a huge difference.
Brad
Posted by violin1 (mj/usa), 18 July 2002
Thanks Brad!
I intend to do exactly what my os says--I have great faith in him. The guy who did my first op (just a debridement and plica removal) was a real quack, so I feel lucky that I am now in good hands. I am much encourgaed by what you say and hope that all goes smoothly.
I am sorry for your misfortune and wish you good luck with the upcoming allograft.
mj
Posted by Danielle (Danielle), 20 July 2002
What is this O.A.T.S. procedure?? I'm trying to do some research because OS mentioned OATS to my father for his knees and didn't say what it was. I am not familiar with it at all and it sounds AWFUL!!
~*~Danielle~*~
Posted by violin1 (mj/usa), 20 July 2002
Danielle--
You can find a lot of info about oats on the kneeguru website. My op isn't until September, but from what I have read this is the only op that actually heals a cartilage defect--ie where there is actually ahole in the articular cartilage that lines the femur, also from what I understand it can only be done if the knee joint is otherwise healthy--no arthritis, no damage to ACL/PCL and meniscii. Theortically it sounds greats, I hope that it proves to be not too gruesome. I am going to try and get more info from my os next week.
Posted by admin (The KNEEguru), 24 July 2002
Here is the link to the relevant section of the KNEEguru main site:
http://www.kneeguru.co.uk/html/step_06_arthritis/step_06_tackling.html
KNEEguru
Posted by admin (The KNEEguru), 24 July 2002
Just to put the procedure into brief context:
OATS is an abbreviation for 'osteo-articular transfer system'. It is a procedure which offers a chance of restoring damaged joint surface in the knee, where a big chunk of joint cartilage is damaged. As you know, joint cartilage does not heal itself when it is severely damaged. Rubbing it down to smooth it over (abrasion arthroplasty) may allow a little bit of healing, but the cartilage does not re-form fully - it makes a second grade form of joint surface which is called fibro-cartilage. Because true cartilage is much better, surgeons now are trying to replace damaged bits by taking a core (like a small apple core) of healthy cartilage (together with its underlying bone) from a less important area and punching it back into the damaged surface. The issues are:
1. Yes, sometimes the results are good, but there is the chance of it failing - in which case not only the original part is damaged, but also the donor part which had previously been healthy.
2. Some people heal well in the previously damaged area, and then have symptoms in the donor area.
3. The chunk must be taken with care and repositioned with care, as it has to fit snugly or it might come out, or ride proud (elevated).
4. New alternatives are being explored - to grow cartilage from the patient on scaffolds and then implant them into the area.
5. Only very experienced units are undertaking OATS procedures and it is still being evaluated.
Posted by violin1 (mj/usa), 24 July 2002
Dear Kneeguru--
Thanks very much for your input---yours is an important voice to hear! I have been having a hard time finding critical opinions, or let us say, unbiased, opinions about oats. I was aware that sometimes the donor sites flare up, but since these are in non-weight bearing parts of the knee, and are therefore (at least as far as I can understand it) not subject to this kind of stress, how can they hurt
My lesion is 15x7mm right snack dab in the middle of the medial femoral condyle and my os says that's why it's causing so much trouble. He says that since the rest of my knee is healthy (no arthritis, ligaments, etc ok) I am a great candidate for this type of surgery. You mention other alternatives, but other than carticel (which my os says in his experience does not od well overall) what is there?
Finally, my os is on your list and is at the hospital for special surgery here in NYC. I think that it anyone has a lot of experience with oats, this is the place. I hope I am right!!!
Posted by badowns83 (Brad), 26 July 2002
Here are some sites I had looked up before and after I had my surgery. It has some very good information. As hard as I tried, I could only find a little information on why this could fail. Most of the reasons for failure appear to be surgeon not putting the graft in properly or donor site problems. I think you will get a lot of information, some of them are very techincal. As I remember most sites show the sucess rate in the 80 to 90% at like 10 years. I hope this helps.
Brad
http://www.jointjuice.com/pdf/cartilagesubstitutes.pdf
http://www.drmendbone.com/carttran.htm
http://www.isakos.com/innovations/oats.html
http://www.kneeguru.co.uk/html/step_06_arthritis/step_06_tackling.html
http://www.orthopodsurgeon.com/cartilage.html
http://www.stoneclinic.com/ocd/ocd.htm
http://www.aana.org/concepts/articles/ostauto_morgan.html
http://www.medmedia.com/oo1/54.htm
http://www.maitrise-orthop.com/corpusmaitri/orthopaedic/mo76_mosaicplasty/index.shtml
http://owl.orthogate.org/topics_knee.htm all kinds of knee topics
http://www.cartilagedoc.com/New/Video/KneePainCase.pdf
http://www.bioscience.org/1999/v4/d/frenkel/fulltext.htm
Posted by admin (The KNEEguru), 26 July 2002
Researchers are looking for other sites from which to 'harvest' the donor cartilage, such as the tibio-fibular joint (the joint between the shin bone and the thin bone on the outer side of the shin bone (research by Jerosch, Filler and Peuker (2000)).
Probably eventualy the new cartilage will be grown on a scaffold in the laboratory, using the patient's own cartilage cells.
Posted by violin1 (mj/usa), 26 July 2002
Hi Brad!
Hi Kneeguru!
Thanks for the sites--there IS a lot of info out there and I will read it carefully. Next week I want to contact my os and ask him some more questions. I find it always difficult to ask the right questions when I have my appts so I try and write down what I want to ask and have forgotten (like brace or no brace afterwards, or cpm or no cpm post op). Armed with all this, I hope that I'll be able to organize myself well enough to get through the post-op period of no weight bearing. I am worried about the crutches and plan to practice starting beginning of September.
Anyway thanks again!
Posted by PJP (PJP), 31 July 2002
I was just wondering if anyone has had both and oats procedure and an meniscus allograft, because I'm having them both done soon. Also I would like to know whats the best way to recover (besides rest and exercise) and some of your experiences?
Posted by martiniswiller (martiniswiller), 12 August 2002
Hi,
My OS is considering the OATS procedure, and I have done some research thanks to the kind post above with all the websites dedicated to this. I would like to know how this compares to the recovery of a Lateral Release- more or less painful? I have an appointment with my OS in 3 days, and I am trying to put together a list of questions for her, because of course the mind goes blank when it is time to ask questions. What do you feel are important questions to ask regarding this procedure besides recovery time, knee braces, and PT questions.
Thanks so much!
Posted by martiniswiller (martiniswiller), 15 August 2002
I went to the OS today, and I am now scheduled for the OATS procedure in late september. She said 6 weeks no weight-bearing, and no PT or strengthening. I will also be put on a machine for 5 hours a day that does passive range-of-motion. Does anyone have any experience with these? Also, any tips and tricks to living your life w/no weightbearing on one leg would be greatly appreciated.
Thanks!
Posted by violin1 (mj/usa), 17 August 2002
Hi!
I have no experiences to offer, but am facing the same oats operation on Sept. 16th...Perhaps we can trade experiences, misery loves company! My os also said no weight-bearing for 6 weeks and the cpm machine for about 3 hrs/day...
Good luck to you and please feel free to e-mail me at
mmiltner@earthlink.net
Posted by martiniswiller (martiniswiller), 18 August 2002
MJ,
I will definitely take you up on your offer to exchange horror stories! Since your are having your surgery 10 days before mine, it would be great to hear a little about your experience with recovery. I am most worried about the 6 weeks non-weightbearing. In the topic "Pain/Rehab problems", I posted a topic about how to deal without using one leg for so long. There is some really helpful advice there from really helpful folks- you should check it out.
Good luck, and keep in touch!
Lesley
(martiniswiller)
Posted by Ghostrider203 (Ghostrider203), 8 September 2002
Iv'e Had Oates on my right knee about 4 months ago to patch up a chondrocyte implant.
I was full weight bearing after 4 weeks
and of the crutches at that time.
I was told i could expect to be running within 4 months but that hasn't happened yet !
If I can be of any further help please don't hesitate to email me !!
Ghostrider203
Posted by violin1 (mj/usa), 9 September 2002
Hello Ghostrider--
Your post is good to read. My op is in a week's time and I am getting nervous about it, I have never had major knee surgery before. Never been on crutches before either. I am trying to think positive and your comments are a great help! Did you have to be on a cpm too?
mj
Posted by Ghostrider203 (Ghostrider203), 9 September 2002
I didn't have any CPM after my Oates and was in hospital for one day only.
I arrived at 7 in the morning on tuesday and was home by 5 o'clock in the afternoon on wednesday.
I had CPM after my patella tendon graft to repair my ACL and after my Chondrocyte implant to repair my femoral chondyle.
Of all the ops I have had On my right knee this was one of the least painful.
Posted by martiniswiller (martiniswiller), 9 December 2002
I just wanted to say that if anyone who is reading this post and are either scheduled for or considering the oats procedure, being 2-1/2 months out of it I would be glad to offer some insight. Feel free to IM me.
Lesley
Posted by Jack_Mark (Jack_Mark), 7 March 2003
KneeGuru, you said : "Probably eventualy the new cartilage will be grown on a scaffold in the laboratory, using the patient's own cartilage cells. "
Without holding you to anything, would you care to put a time on this happening ?
Thanks,
Jack mark
Posted by violin1 (mj/usa), 7 March 2003
Jack--
This procedure is already in place and is called ACI or carticel. It is for larger defects on the articular surface and involves 2 operations; one to harvest the cartilage cells and the next one about 6-8 wks later to implant them. There are several threads about this on Kneeguru.
Hope this info helps.
MJ
Posted by JessToni (JessToni), 7 March 2003
MJ,
I saw in one of your earlier posts that you are using a doc at the Hospital for Special Surgery...I was just curious who it is? I am having an allograft procudure done by a doc there soon and I used another doctor there for my past surgery.
Jess
Posted by violin1 (mj/usa), 7 March 2003
Jess--
My os at HSS is Dr. Thomas Wickiewicz. He is fantastic in my view. I am now 6 mos post-op from an autograft and my knee is really almost as good as new. In fact, as far as the defect goes, it IS as good as new. I still have a bit of pain at the site where the graft was taken, but everything else is fine. Almost full ROM, and my quads are almost back to strength (after 2 sessions of pt) and I am very pleased. I just got a report back from x-rays that were taken a couple of weeks ago, and the knee looks completely normal. HURRAY HURRAY!
Good luck with your allograft, when are you having it done? And just out of curiousity who is your os? If you need any info about post-op, etc, please feel free to contact me.
MJ
Posted by JessToni (JessToni), 7 March 2003
MJ,
Glad to hear you are doing well after the surgery. My doctor for this surgey is Dr. Rodeo at HSS. He was recommended to me by my last doc there who was Dr. Rose.
I am not sure when the surgery will be because they are waiting for the lab to find a graft for me. My defect was too large to use the autograft technique so i have to go with the donor graft. So i have been waiting since the end of nov for the surgery and praying that it will be soon.
Posted by scottrayden (scottrayden), 18 February 2004
Just wanted to give you my two cents. I'm a week out of OATS surgery and things are going well.
The pain is pretty much all gone except for the normal uncomfort with swelling. Not bad at all though. With my leg elevated it's fine but when it's down it gets tired very fast and the blood seems to rush to my foot so I try and have it elevated as much as I can.
I'm supposed to be 3 weeks non weight bearing and it's driving me nuts. Crutches are not fun. It can always be worse though right : )
I start PT tomorrow and from previous experience (tore my ACL twice in the last 5 years) PT really helps.
I'll post again when I'm about a month out to let you all know how I'm doing.
Overall though the surgery went great. I'm a very active person (love to play basketball and volleyball competitively) and think the surgery was neccisary.
Updated Tue Dec 2 2008