KNEE ARTHRITIS - Cartilage plug transfer :

Repeat Oats - - Posted by kathleenj (kathleenj), 6 May 2004

Well, here I go again.  I had an Oats done in Dec and now five months later things still arent going well.
I have been having some pretty bad 'ice pick' shooting pains for the past few weeks.  After trying some Bextra for a few weeks  to no avail my OS decided to do an xray.  Sure enough the graft had shifted and needs to be redone.
This is so disheartening.  I hate having to start all over again.  It feels like everything I have gone thru the past 5 months was for absolutely nothing.  I just recently got my vmo firing and have been able to get around pretty well.  I was looking forward to a fun activity filled summer but now I will be starting from scratch with no weightbearing all summer long.  Talk about depressing.  
My poor kids...they had to miss out on so much winter fun and now the summer fun as well.  
I am sorry if I have depressed anyone.  I just needed to vent.  
Posted by violin1 (mj/usa), 7 May 2004

Kathleen--

I am so sorry to read this; how can your graft have shifted after 5 mos?  I thought that the bone was solid after the 6 weeks of nwbearing....to have to go through it all again, you have my fullest sympathy and empathy.

Mary Jane
Posted by kathleenj (kathleenj), 7 May 2004

Thank you for responding.  My OS is not really sure how or when the graft shifted.  He did an xray at about 8 weeks out and things were looking good at that time.  Somehow after that point I did something to shift the graft.  I thought that the bone would have been healed by that time as well, but I guess it wasnt.  
I started work again shortly after that so I suppose I may have overdone it or did too much too soon.  
At least I will know better this time.  I have had a day for this to sink in and I have come to terms with the fact that I need to do it all over again.  I am going to be much more diligent about things the second time around.
Thanks for your kind words.  It is nice to know that people out there understand what I'm dealing with.
Posted by mtnbikcowboy (mtnbikcowboy), 7 May 2004

hi, kathleen, my sympathy's.  I have gone thru two oats myself.  one was march of 2003 with an autograft then march of 04 with an allograft.  I dont know about you, but I found it imperative to find out why the first one didnt work.  I understand you indicated the graft shifted, but maybe to know why.  If it couldnt be determined, in my case,  I had a hard time letting the same doc do another.  I also found that knowing what is to come has helped a bit.  I was able to prepare a little for some of the things I didnt think of the first time.  Like doing a little shower work to make things easier to enter and exit.  Hope all goes well, try to do all the fun stuff you can before you go in again.....
A.
Posted by masconsumer (masconsumer), 11 May 2004

 Good luck Kathleen.  I know how you feel.  I am now almost 7 months post surgery and still have those "ice pick" shooting pains you are talking about.  I am also still having to use a cane and dread walking.  I used to love to shop but now I dread anything that is going to cause me to have to walk a lot.  I am very disappointed in my surgery.  However, I did have a lot of damage to my knee and my OS has said it can take up to a year to heal so I'm giving it a year.  What else can I do?  Like you, I had my surgery in the winter thinking by the spring/summer I'd be out in the yard and be doing the things I really like.  NOT!  Well, hang in there!  My OS has said that he can go back and put in more plugs but I really don't know if I'll feel comfortable going through this again.  My only other option is TKR and I don't want that either.  Anyone out there having more than one surgery for this I would interested in knowing if it helped or not.  Some days I'm like Kathleen and feel this has been a total waste of my time.  But, then I realize nothing is a sure thing and they can't guarantee any surgery is going to help.  Good luck!
Posted by JG (JG), 12 May 2004

Kathleen,

How long were you NWB for the surgery in Dec 2003?  
Also, I am not sure what is meant by shifted? Most often the grafts are press fit so there is very little room to "shift".  Or are the grafts compacted into the hole or crushed?

I had a "mega-mosaicplasty" in April 2003 (18 x 10-15mm grafts in total - 5 MFC and 13 trochlea) .  The one thing that both my MD and PT told me was that I couldn't even touch my toe to the ground for 8 weeks and I was to take 4-6 weeks PWB before FWB.  They said the grafts take a long time to heal.  I stuck to the protocol but ultimately I had a hard time believing that it would take 6-12 month to heal fully.  

Well, now I am 13 months out (I didn't even check in the my OS from month 6 to 12 because he said it would need that much time to heal), I had my first MRI post procedure and the MRI show subchondral cystic bone.  This can mean two things...the grafts aren't doing well or the grafts aren't healed yet.  I had a scope about 3 weeks ago and the graft look fabulous despite my OS leaning towards the grafts not doing well.  However, he did say it might take another 6-12 month to fully incorporate.  

Prior to the surgery, I was having that deep bone pain at the graft site in my medial joint (I've had it for about 4 months).  That is why he thought the MFC grafts weren't healing.  As it turns out, I had really bad capsule constricture.  He ended up doing a lateral release, medial capsule release, anterior interval release, debridement, and lysis of the adhesions.  It made a huge difference in the way my knee feels.   Prior to surgery it was like having size 10 feet but wearing size 5 shoes.  Now it is like have size 10 shoes for size 10 feet.   The deep bone pain is gone.  The only problem I am having is the swelling from the LR.

If I were you, I would insist on a scope before going through another OATS.  I was really bummed about the cystic subchondral bone showing on the MRI and his comments of my knee being the worst of any 36 year old he has had in his practice.   We actually laughed about the bad knee comment...I've had way too many visits with him.   The scope is the best way to see what is going on.  I put very little faith in most radiological diagnostic tools for articular cartilage problems.  It really might be worth it to have it scoped, find out what is really going on, and then developing a game plan.

Good luck...Janice
Posted by kathleenj (kathleenj), 12 May 2004

Masconsumer,
I am sorry that you are still having problems. It stinks when you cant do all the things that you want to.  I had planned a summer with vacations and other activities with my kids.  I just found out my surgery is scheduled for the 10th of June so now I need to cancel our vacation and sell some Red Sox tickets.  
Hang in there, there has to be a light at the end of the tunnel, right?

JG,
I was NWB for 4 weeks and then partial for another 2 weeks or so.  I had a really hard time getting to FWB and it is still difficult now, which of course is because the graft shifted.  From what I understand, the plug is compacted in but there is also a little gap left so that it can fill with bone and form a solid fit.  This is why it takes so long to heal.  I have read alot about rehab protocols and it seems as though nobody really knows for sure how long to be NWB.  I suppose I wasnt long enough because things seems ok after 8 weeks and now five months later the graft has shifted.  I believe it happened shortly after I started work again which was in March.  
My surgery is scheduled for June 10th at which time my OS will do an arthroscope first so see exactly what he is dealing with.  He did an xray and although articular cartilige cannot be seen, the plug is definately sticking out.  It is as clear as day.  After the arthroscope he will proceed to the open procedure to do the OATS.  

Thank you for your comments.  I am trying to be optimistic about this.  
Posted by JG (JG), 14 May 2004

Hi Kathleen,

I would totally encourage you to go NWB for longer this time.  It is easier to stay on crutches an extra month than go through the procedure again.  So you must be having an autograft.  How many plugs?  

Good luck...Janice
Posted by kathleenj (kathleenj), 14 May 2004

Janice,

I will definately be NWB for a longer time this time around.  I am having an autograft, not sure how many plugs.  The first one was about 10mm but in order to fix this one my OS may need to go larger and do a few smaller plugs instead.  Not really sure yet. He needs to get in and see exactly what kind of shape the surrounding cartilage is in.
Thanks for the words of advise.  I hope that you are coming along ok after your scope and I'm glad that the knee is feeling better.

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