The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - Osteochondral autografts and allografts (eg OATS & mosaicplasty) => Topic started by: Sam451 on September 19, 2011, 06:16:03 AM

Title: Fresh Allograft
Post by: Sam451 on September 19, 2011, 06:16:03 AM
I am curious what the wait time was for those of you who have had OATS with a  fresh allograft transplant?  My OS said anywhere from 1-6 months.   This will be my fourth surgery in two years and I am just anxious to get it done. Along with the OATS allograft I will have my MCL repaired.  I had a failed Microfracture April 2010, a failed OATS autograft Dec 2010 and the arthroscopy three weeks ago to confirm the fail. Thanks.

One more thing, did anyone have the allograft done arthroscopicly or was it an open procedure.

Title: Re: Fresh Allograft
Post by: etrusc0 on September 21, 2011, 05:42:22 AM
Its an open procedure.

When did you first suspect the autgraft failed?  How many months?

Surgically Oats is not an ACI but make sure your doc is one of the best.

Good Luck on the 2nd pass.  These are big surgeries.
Title: Re: Fresh Allograft
Post by: Sam451 on September 21, 2011, 03:47:01 PM
I suspected it failed about three months after the surgery. I know that's early but having had a prior fail of the microfracture I could tell it was heading the same direction.   I was getting major pain. It was worse after surgery. I now am walking with a cane. I was not prior to the last surgery. My OS just kept saying it was just heLing slow and wouldn't do any diagnostic testing to see if it was healing.

I switched to a new OS after in depth research and he did x-rays and had a bone scan which confirmed the total failure at 7 months out. I had an arthroscopy last month to confirm the damage. Now I am just waiting for the cadaver for a fresh allograft.  I know that this next surgery is going to be a big one. Two incisions due to the MCL repair. My OS has warned me it was going to be tough. I need it to work because my only other option after this is PKR or TKR. Not ready for that as I am only 39.

I was very active prior to this. I am already dealing with the fact that I won't be running the 20-40 miles per week let alone playing the sports I love.

Thanks for your reply!

Title: Re: Fresh Allograft
Post by: etrusc0 on September 21, 2011, 04:18:47 PM
I'm in a similar situation.  I had an allograft 6 months ago, ACI 6 years ago and MFX before that - I'm 35.

I also believe I am seeing one of the best docs in the US for Cartilage Repair.

However, I am also feeling like my graft may have failed.  I'll know soon - I'm at the doc today.  I find it promissing that an allograft is an option after a failed Autograft.  I do not want to go the PKR route yet.

Good Luck - I'll post how I make out tonight.
Title: Re: Fresh Allograft
Post by: etrusc0 on September 22, 2011, 03:56:50 AM
Not much to report, currently.  OS thought if the graft had failed my knee would be much more swollen.  Plus I am walking normally.  There are things that feel better, but the occasional pain has me worried.  Time will tell, going to wait the 6 more months.   I know more as I increase my activity - going up to the elliptical now.  It's funny I never realized how much I liked running until i couldn't do it anymore.

Let us all know how you make out, IMO there is not enough info on allografts on this forum yet.  There is much more on ACI's.  Which by the way my ACI recovery was 10 times more difficult then the allograft.  If he had not done the High Tibial Osteatomy and another TTO with the allograft I think recovery would not have been bad at all.

Title: Re: Fresh Allograft
Post by: Sam451 on September 22, 2011, 04:27:15 AM
I am glad that your OS thinks things are healing. :) I did not have much swelling either. I think that is one of the reasons the other surgeon wouldn't explore the idea of of it having failed. However, I have always had pain when I walk and it gives away. I will keep posted on the ordeal.
Title: Re: Fresh Allograft
Post by: redlotus on September 22, 2011, 09:11:14 PM
Hi Jenni

Just wanted to say hello as I'm in a similar position to yours.  I've had 9 surgeries in the last 6 years, ranging from debridements and meniscal trims to ACI and TTT.  I had three ACI grafts done, two on my patella and a huge one on my MFC (pretty much the whole weight-bearing surface).  About 60% of the MFC graft and one of the patellar grafts have failed for some unknown reason (no trauma).  Started with that same old aching pain and effusion, and I just KNEW something was wrong.  It felt like it did before I had my grafts, so I had a scope/MRI/x-rays to confirm, and sure enough - failed.  So I've been waiting for about 3 months now for my donor match.  No news yet, and I was told anywhere between 2 weeks to a YEAR, so I've got my finger crossed it won't take that long.  I was also told by my surgeon's assistant that "these things happen more around holidays" because of travel accidents and (sad but true) suicides.  That's so sad to think about, but I try to tell myself that I have no control over someone else's fate and that I need to be grateful to whoever my donor is but not dwell on it too much or it'll just depress me.  So if it hasn't happened in the next month or so, you might have a better chance when the holidays start rolling around. 

Can I ask how the pain was with the OATS procedure?  I experienced some bone pain with the TTT and it really sucked, but I've heard from others that the allograft/OATS is more painful than the ACI and that I should be prepared for a lot of discomfort. 

I totally hear you on being anxious to get it done - I work in behavioral health and it can be dangerous, so I'm out of work until I'm "fixed" and I have lost my job as a result.  I'm just sick of waiting and being stressed!  It's been hard to accept that I can't run anymore and that I'm most likely going to be very limited in my physical activity, especially since I'm still so young (29).  I have genetically crappy knees - my grandmother and aunt both tarted getting arthritis in their late 20s, and I started having knee problems at about 17.  My right is the "bad" knee because I was kicked by a client at work (see?  Dangerous! :), but my left is starting to feel just like my right when it was starting to get really bad.  My surgeon, Dr. Minas (he's great!  One of the best!) has already told me based on my x-rays that there is thinning in my left knee and he'll probably have t "address that" soon.  *SIGH*  It never seems to end!

Best of luck to you on your wait, surgery, and recovery.  I'm here to talk if you need support, since we're sort of in the same boat!  I plan on doing a post-op diary again with this surgery, so if I get my graft first I'll be sure to share with you how long it took, what it was like, etc.  :)
Title: Re: Fresh Allograft
Post by: etrusc0 on September 23, 2011, 04:35:21 PM
RedLotus - good luck, my graft came though in the spring - motorcycle season is donor season.  Very sad, especially since I ride.

Pain wise the Allograft was nothing compared to the ACI, again had I not had the Osteotomy at the same time it would have been easy compared to the ACI. 

I sit at work and am a programmer, I had the surgery on Tuesday and returned to work the following monday and got my flexion back incredibly fast - 3 weeks I was at 125 degrees.  Compare that with the ACI which I treated much more delicately, 3 weeks to return to sitting at work, months to get the full range back, and even longer until you can walk, I remember 16 weeks on crutches and 5 months before I ditched the cane.

Similar situation to you with Patella, Troch, and MFC on the ACI.  With the Allograft he replaced two parts of the MFC with plugs and one problem he saw on the lateral side.  The  images taken while doing the Allograft really show improvement from prior to the ACI, patella and troch are much much better.  Only the MFC bothers me.  I am still hoping the allograft plugs fix it, but a little pain here and there and I'm already thinking it did not work.  Most frustrating part is the MFC graft was done because he saw a problem, so fix everything while in there ... it never hurt pre-surgery.

I remain active - mostly biking, going to start doing elliptical now, while cross training.  No more running though - with the miracles of modern science - one day.

Jenni - thanks for confirming my suspicion.  I think something is likely going on, but want to increase my activity a bit to confirm.  This may sound dumb, but if I can convince myself that there is definitely an issue - I want it checked out this calendar year while I still have maxed out my insurance contribution for this year.  Plus insurance covers less each year, I'm sure they can't wait till I'm old enough for a replacement.

Title: Re: Fresh Allograft
Post by: Sam451 on September 26, 2011, 04:39:59 AM
etrusc0 - not dumb at all. Use the fact that your deductible is paid off :)  I know everyone always asks me why I don't just get a TKR. They don't understand the limits that puts on a person. I know I will have one some day but I want to hold off as long as I can. I work in law enticement and a TKR would mean no more job due to restrictions so crossing my fingers for this last resort. Go with your gut on your issues. I began doubting myself when Dr dismissed my pain but turns out I know my body pretty well :)  Keep me posted.

Redlotus - I can't imagine 9 surgeries by 29. WOW!!  Your perspective on the donor made me feel so much better. It really is so strange wanting to have your surgery but then not wanting someone to pass away so you can have it. Thanks for the words of wisdom.

The oats procedure was not too bad. I took my oxycodone for about two weeks.  I was on it round the clock for about three days and then started backing off and going longer between until the two week mark. I hate taking anything but this kept the pain away and by two weeks it was bearable. Keep in mind my pain never ended as the surgery failed.  I would really like to communicate with you while you recover as I am curious about what goes on start to finish.

I can't believe you have already waited 3 months. My OS said a similar timeline as yours but said the average wait was 2-3 months. Everyday I hope I get the call.
Title: Re: Fresh Allograft
Post by: exwhaley on September 28, 2011, 11:03:57 PM
Just happened to check in at this site and had to answer your question about wait time for allograft tissue.  If was the one question I had when I was waiting.  I was listed on or around Febuary 15, 2005 and got the call that they it for me on June 4, 2005 (just short of 4 months).  The call came on a Monday afternoon and I had surgery Wedneday morning.  I had a large isolated lesion on my MFC which occured when I tore my ACL and menicus jumping from a boat to a stationary dock.  I had failed microfracture and was having a lot of pain.  It was the very best thing I have ever done!! I really have had limited issues post allograft.

My one word of advice is be ready.  I thought I was mentally prepared but when the tissue was finally available it really freaked me out.  I had less than 48 hours to get ready to be non weight bearing for 4 we+ weeks post op.

Hope this helps.
Title: Re: Fresh Allograft
Post by: Sam451 on September 29, 2011, 07:03:39 AM
Exwhaley - Thanks for your answer. I saw my OS today and he is guessing the surgery should happen within the next four weeks. Of course he doesn't know for sure but his average is two months so fingers crossed. As far as the preparation goes I have had an autograft already so I kind of know what to expect. The biggest difference is going to be that I am having my MCL repaired at the same time so more pain and extra scars lol.  I was on crutches for 16 weeks after my micro fracture and 12 after the autograft. This new OS wants me NWB for 3 weeks and partial for 1-4 weeks. We will see.  :). It is so nice to hear someone say they are having success with their allograft. I am such a skeptic after 3 surgeries that anything is going to work. You helped me to feel more confident in the potential for success. Thanks!!

Title: Re: Fresh Allograft
Post by: redlotus on September 29, 2011, 10:20:39 AM
Hi Jenni - still waiting for my donor match, so no news there, but I'm more than happy to keep you posted about the process once it happens (unless you get yours first!).  People always ask me why I don't get a replacement, too - I have to explain to them that a replacement isn't permanent and all the risks that go with it, especially in young patients. I feel like I should just print up brochures about all my knee issues and carry them in my purse: "TKR - Why It's Not For Me" "Allografts: What YOU Need to Know!" "Osteoarthritis: When Good Cartilage Goes bad!"   ;D  It'd be easier than explaining it all over and over again! 

Glad my perspective on donors was helpful - I've given it quite a lot of thought.  The other thing that I find helpful is the fact that I am an organ donor (in addition to being on the national bone marrow registry) and I know that personally, as an organ donor, I would really WANT some good to come out of my passing (if the worst were to happen).  The idea of someone's life being saved or improved because of me is one that I find comforting and positive, so I just have to assume that anyone who checked off that donor box on their forms would feel the same way and would be glad that some positive was coming out of tragedy.  I hope that helps, too. 

etrusc0 - Thanks for the info on the pain - I seem to get such conflicting reports from different people - some say it was easy compared to the ACI and I've heard from others that it was worse.  I imagine some of it is personal tolerance and reactions, graft size, etc.  I suppose I'll just have to wait and see!

I'll keep you posted, and here's hoping we both have timely and successful surgeries. :)
Title: Re: Fresh Allograft
Post by: etrusc0 on September 30, 2011, 05:31:47 PM
ExWhaley - I echo Jenni statement it is good to hear from someone who has had success with thier graft.  Most people that come here tend to not post once things start going well.  What is your activity level and age, if you don't mind me asking.  Can you run?

RedLotus - I agree that everyone has different pain tolerences.  I think I had just as much done both times.  After the ACI I didn't think I could ever go though that again.  Maybe with the new Matrix version but it was very difficult and a long road to recovery.  In 6 months I feel like I am to the same place it took almost 2 years to get to with my ACI.  Again skipping the osteotomy next time and I think pain would be very bearable.

Title: Re: Fresh Allograft
Post by: dm on October 03, 2011, 04:40:59 AM
Hi guys, I feel like I fit right in with y'all. I had a microfracture done Oct 2010 that was determined to have failed May 2011. I've a 1.2cm hole in my MFC at this point. I just started a new job about 4 months ago, so I can't take 3-4 months off for an OATS that my OS wants to do to try and fill in the defect. I don't have the FMLA job protections either, which don't kick in until you've been in a job for a year (US law).

Since the microfracture failed, my question I've yet to get an answer to is what is the likelihood of an OATS autograft - my OS's intended plan to fix the defect - failing as well? If OATS were to fail as well.... then as far as I know, then there's nothing left to do but a TKR, as I've heavy damage patellofemorally as well as medially - and I just started in on my lateral compartment this latest injury July 2010, and I'm gonna be 40 in 2 months.

By the time I get the FMLA protections and pass the probationary period for my job, there's also a chance the defect will have passed the point where they can even do OATS, given it's size now, and that it's in the middle of the weightbearing zone of the MFC. So, not much I can do meanwhile but live in my unloader brace and live on painkillers and other pain control methods, and wait. I changed jobs 4 months ago for a number of reasons, one of which was that it was killing my knee, I was on permanent work restrictions and was taking 3 times the painkillers I take now with my current job, and my knee condition has been the same since my last surgery a year ago this wednesday.

If y'all can think of any options... lets hear them, but I think I'm out of them... seems to me I've reached the point that it's about TKR time, as all I wanna do is walk without eating painkillers, and they're supposed to have some implants that are supposed to last 30 yrs now... lets get an implant to last the next 15... and I'll deal with replacing it then... the way tech advances maybe they can grow me a new knee by then!
Title: Re: Fresh Allograft
Post by: KSTL on October 05, 2011, 10:57:15 PM
I fit in as well.  I had my first microfracture April 2010 which failed.  Had synthetic plug in Sept. 2010 but it also failed.  Had fresh allograft put in at the end of Aug of about a nickel.  I had to wait for 3 weeks for a match.  I had a day notice.  I will not do this again.  The surgeon said it went well but still having a lot of pain.

I know you need to wait for FMLA job protection.  I know how you feel.  I lost my job because of all of this.  I went to the surgeon yesterday and still have 2 more weeks no weight even though it has been 6 weeks.  He thinks it will be a month to relearn how to walk.  My OATS is in the middle of the weightbearing zone so I know you pain.  I held out a year so I know you can make it before surgery.  I would then get it done.  I did not understand why they did not replace the knee because I will be 40 next May.  They said I was to young.  I feel your pain.
Title: Re: Fresh Allograft
Post by: dm on October 06, 2011, 12:32:11 AM
My OS plans to use autografting, but would probably end up needing multiple plugs, and if the hole's too big, obviously can't do that if he needs too big a plug.

My thought is this... if I'm bound for a TKR anyhow, and I've already had one failed attempt to get my body to mend the hole - whats the REVISED chances of a graft healing after one failed procedure already, and why go through months of hassle just to be disappointed and be told it failed too... then be told they want to try something else, and more months of misery.... when I could be back on my feet in 8 weeks after a TKR and be done with optimal outcome?

How much agony and repeated failed surgeries is one supposed to put up with?
Title: Re: Fresh Allograft
Post by: Sam451 on October 06, 2011, 01:11:18 AM
My husband and I have asked my new surgeon numerous times about TKR. I will be 40 next month and he wants to try this one last option before that. If I have a TKR I will lose my job as the restrictions would prohibit my return so I am praying this one works.

I feel your pain. Our timelines are very close. Microfracture April 2010 failed. OATS Autograft Dec 2010 failed. Just waiting on fresh allograft. Why do you say you would not do this again?

Good luck to both of you.

Title: Re: Fresh Allograft
Post by: redlotus on October 06, 2011, 04:52:48 PM
Got the call this morning - I've got a match!  Surgery the 18th (which is a lot more warning than I thought I'd get!).  I'll keep everyone posted on the process and outcome.  So nervous I puked after I hung up the phone LOL - you'd think after 9 other surgeries this would be nothing, but I guess pre-surgery jitters are normal.  I have to go from AZ to MA for the surgery, so lots to get ready before I go. 

DM - I know how you feel - I've asked Dr. Minas about TKR many times before, but at 29 he simply won't do it.  I know rationally that TKRs in younger more active patients tend to fail quicker and have more complications, but it's hard not to want to just do it anyway when you're staring down the barrel of surgery # 10. :(  All I can saw is hang in there - I know it sucks, but a TKR can't be undone once it's done and once you go down that road you're committed for better or worse. 
Title: Re: Fresh Allograft
Post by: dm on October 06, 2011, 05:14:14 PM
I'll be 40 in 2 months.... all I want is to not have to deal with every step in pain, or to face surgery after surgery with months long recoveries, feeling like I'm just a hostage to my knee, and them being reluctant to take the approach most likely to give me an outcome that gives me the ability to earn an income and take care of myself and not be a cripple. They don't seem to take into account that employers don't care that you can't work for months after some of these surgeries, and how are you supposed to pay your bills? Most of us live paycheck to paycheck these days, and are lucky to have health insurance, and if we can get insurance to pay for the surgery, still end up with hefty bills. Repeat surgeries are a job killer...
Title: Re: Fresh Allograft
Post by: etrusc0 on October 07, 2011, 05:48:12 AM
RedLotus - the 18th, that is a lot of time. I had one week.  Months of mental preparation knowing the moment is right around the corner and I still found myself less prepared than for a scheduled surgery.  Good Luck.  I know I've said this before but the Allograft is easier than ACI to go through.  And if Dr. M skips the Osteotomy then you just have to wait to the bone heals - 12 weeks max.  My ROM came back super fast, I think at week 2 I had 110 deg and started on the bike with no resistance. 

DM - there has got to be better options for you then a TKR, that is my last resort.  They can only do a knee replacement so many times and if it felt good - I'm pretty sure I would kill it fast.  I am fortunate to do most of my work from a sitting position so having multiple surgeries has not put me out much.   What else have you explored for pain - synvisc maybe - some people say it helps a lot.  I'm surprised by so many mfx failures - were you on a CPM right after your mfx surgery - Dr. Steadman (world renown for working on athletes) mostly does mfx with lots of success.  Lots of motion afterwards and a committed rehab program.  My mfx helped for a little while, but I did not get a lot of post op instructions and no CPM.  I was just told to move it a lot.  I do agree with your sentiment many of us here have had multiple surgeries still searching for relief and why not just fast forward to the TKR that is coming some day.  I hope you find something that works for you.
Title: Re: Fresh Allograft
Post by: dm on October 07, 2011, 09:24:43 AM
all the time in the world spent in a cpm wont matter a bit if the bone wont fill in and heal, which happened to me. I had school,etc, so even though I was nwb, i still moved it all the time. Plus it stiffened up if I didn't.
Title: Re: Fresh Allograft
Post by: KSTL on October 08, 2011, 03:18:55 PM
Jenni:  I would not do this again because of the pain and the mental that goes along with it.  For the last 16 months I have been on crutches for almost 12 months.  I lost my job because of the time.  The rehab alone is intensive and after the third surgery I feel I am right back to where I began.  I'm still in pain, popping all of the time and I am not walking yet.  Our family life has basically stopped.  I have 3 children and a husband so I feel I have missed so much during this time.  I feel they also have missed out. 
Title: Re: Fresh Allograft
Post by: etrusc0 on October 08, 2011, 05:40:57 PM
RedLotus - You have one of the best Doc's in the world for Cartilage Repair.  Since going to Dr. M I have continually felt like I have a good chance at remaining very active.  I have 2 kids as well and for a few weeks it is more straining on my wife.  I am very active 6 months post op - just can't run.  I look forward to hearing how you make out.  One cool thing was seeing the growth of cartilage on my patella and troch groove from the ACI - pre to post is from 0 coverage to almost normal.  After Tim gives you your pics let me know how they look.  Again good luck with the recovery.

There are only 6 or 7 docs in the US we people with serious cartilage problems should be going to.  A normal orthopedic surgeon just won't do.  I ended up at Dr. M by asking my orthopedic surgeon how many ACI's has he done - I never got a straight answer, so I asked for a second opinion and I said send me to someone good - even if they are not close.

Title: Re: Fresh Allograft
Post by: Sam451 on October 11, 2011, 03:22:43 PM
Redlotus - congrats on getting a date. I am still waiting. Keep us posted on how everything goes.

Title: Re: Fresh Allograft?
Post by: etrusc0 on October 28, 2011, 06:47:45 AM
Redlotus - how did the first few days go?
Title: Re: Fresh Allograft
Post by: beansmom on October 29, 2011, 09:12:21 PM
I had two OATS grafts done in Nov 2010.  Around Apr 2011 (when my doctor had to perform an additional microfracture on my kneecap), it was discovered that one of the two (which was the smaller) grafts had failed.  In July, I had a partial knee replacement to replace the failed graft.

I continued to complain to my doc about pain, which I've been doing since my original problem developed in Aug 2010.  He kept telling me to "give it time".  Finally, I went to another orthopedist, who immediately diagnosed that the other bigger graft had *never* taken, and now I have avascular necrosis (osteonecrosis = bone death) that has spread even further than the original injury and the pain is far worse than it was originally, too. He surmises that I was originally given unviable donor material.  Unfortunately for me, this means that I have to get a revision = total knee replacement in a couple of weeks.

Give the intense pain and very long recovery from the OATS done last Nov, I NEVER would have gotten this done and would have gone to a straight knee replacement.  My life has been a living hell for over two years, and after the next surgery and recovery, I'll be looking at 1.5 years of constant knee pain.  This will be my 6th surgery in 16 months.

My advice - don't bother with OATS - go straight to replacement.  It's not worth the "risk" of hoping the grafts will take. 

Best of luck.
Title: Re: Fresh Allograft
Post by: Sam451 on November 16, 2011, 05:20:41 PM
I got the call this morning and I and happy to announce I have a date for my surgery. Nov 28th. I am very happy to finally be moving forward in this whole process. It took three months to get the call. Not too bad.

Title: Re: Fresh Allograft
Post by: etrusc0 on November 16, 2011, 07:56:34 PM
Congratulations and Good Luck.

I remember being excited for about 10 minutes before getting nervous because I felt unprepared.

Happy Thanksgiving.
Title: Re: Fresh Allograft
Post by: Sam451 on November 16, 2011, 09:00:23 PM
Etrusc0-how true that is lol. I have had an autograft so I am not as nervous but yes, as the excitement is wearing off the mind is busy figuring out what needs to be done in preperation. Thankfully because of the holiday they gave me a week and a half notice because they just couldn't get me in sooner. More timen to get things done lol.

Title: Re: Fresh Allograft
Post by: GSB on December 02, 2011, 10:36:20 PM
Does anyone know good surgeons in LA, other than Mandelbaum, for OATS procedure?
Title: Re: Fresh Allograft
Post by: etrusc0 on December 03, 2011, 04:39:41 PM
No doubt Bugbee for an allograft. I think it's called the bugbee method.  Good luck.
I looked up his published success rates before having the surgery because that's what my doc suggested.