KNEE ARTHRITIS - Cartilage plug transfer :

Oats Versus Partial Knee - - Posted by NJDan (NJDan), 15 August 2002

I have a choice between Oats and Partial knee going in to surgery.  What are the pitfalls and benefits of each?  I am 35, had my kneecap removed 4 years ago and have a degenerative cartilage on the inside knee.  Pain is constant and I wear a knee brace daily to control the pain and allow movement.

Any ideas?

Thanks

Dan
Posted by JG (JG), 12 March 2003

Dan,

Sorry for the length, but here is my 2 cents.

If I were in your shoes (which I am), I would go for the OATS (or some other type of cartilage resurfacing procedure) before the PKR.  

In August of last year, I had LR/menisectomy on my left knee.  During surgery OS discovered tri-compartment arthritis (PF [trochlear area], medial, and lateral).  This was much worse than he expected based on MRI and my fuctional status.  I recovered very very quickly (never used crutches and was cycling with pace within 10 days) and today am very active - hard cycling about 45 - 60 min - 5 times per week, run 30 to 45 min (5.5 mph pace) 4 times per week, swim 3 times per week, and strenght train.  

My OS is very very surprised that I can walk comfortably, much less be active.  Basically I was given two options - wait until I was non-functional for a TKR or a osteochondral allograft (using mosaicplasty type procedure).  I am 35 and could not imagine waiting until I was whatever age to get a TKR.  TKR was just not an option given an alternative procedure was available - osteochondral allograft.  

I made the decision based on a number of factors.  First, I heal really well.  Second, I am relatively fit.  Third, I am very fuctional.  Fourth, I am fanatically about rehab and very disciplined.  Fifth, I have health meniscus.  Sixth, I have no joint space narrowing.

The way I look at it.  I have a chance to get better for a long time (maybe forever) with osteochondral allografting.  The rehab is difficult - weeks non-weighbearing, lots of time in PT, etc. - so committment is key.  With TKR, I will recover quicker, but can expect revision after revision and with my young age (like you), I will eventually run into serious problems at a later age because there is a limit to the number of revisions you can have (due to bone loss during procedure).  No way do I want to deal with that at 60 or 70.  The cartilage resurfacing procedures give you a chance at being better for a long, long time and worst case scenario, you are converted to a knee replacement.

Good luck...Janice
Posted by admin (The KNEEguru), 16 March 2003

OATS may mean you have to use crutches for several weeks but offers some chance at restoring the joint surface. Some people do, however, have some problms at the donor site where the cartilage plugs are taken. A PKR removes part of your knee joint, so for the rest of your life you are bound to a prosthesis (artificial component).
KNEEguru
Posted by admin (The KNEEguru), 16 March 2003

This story might interest you -
http://www.knee1.com/community/patstory.cfm/21/1626
KNEEguru
Posted by martiniswiller (martiniswiller), 20 March 2003

Hi Dan,
I don't have any experience with PKR's, but I did have an OATS procedure last September and though I am not 100% yet, it has helped with my pain immensly.  It was quite an ordeal (it was 10 weeks on crutches for me, plus 4 weeks on a CPM machine).  If you have any specific questions about OATS, please feel free to ask here or IM me and I will be happy to help in any way I can.  Good luck in making this huge decision.  Arm yourself with facts!

Lesley
Posted by violin1 (mj/usa), 20 March 2003

Hey Dan!

I had my OATS operation 6 months ago and am very pleased with the results so far.  I have almost no pain, never have had at the graft site itself, only pain is at the donor site.  That seems to still be a bit sensitive.
I was lucky that my defect was on the small side so I could be my own donor.  But larger defects can be fixed with allografts, too.
I was on crutches for 6 weeks, no weight-bearing at all (I also had a brace ankle to hip for whenever I went out) I used a wheelchair a lot, in and out of the apartment. It was a real life-saver.  Then another 2 weeks until I could get rid of the crutches. I was also using the cpm machine for 3-4 hours during these 6 weeks and I think that was THE factor that restored my ROM so quickly.  I did 2 separate sessions of PT--the first 3x/week for 4 weeks.  Now I have just finished 4 sessions (1x/week) which helped enormously with the vmo and the tight IT band.
My surgeon in NYC is an OATS specialist--go for that second opinion and see what he says.
I would definitely try this option before doing the PKR.  If the OATS should fail, it still is an option that you can consider.
Any surgery  has it pros and cons and I had to think long and hard before doing this.  But I am very glad that I did it. Sometimes we are lucky and get make the right decisions.  
Feel free to IM me at anytime for more information.
Take care and good luck to you!!!
Mary Jane
ps/ I hope the hernia op went well.

This old Forum was so valuable that we have kept it as an archive. It is just for reference. If you want to ask questions or offer advice, there is also a current Bulletin Board which you can access from our home page.