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Offline jmcreynolds

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OATS Procedure Recovery
« on: March 10, 2005, 05:37:29 PM »
Hello All,
I am a 47 year-old female that started having knee pain on my left medial femur.  An arthroscopy showed that I was missing a 1.5CM by 1.5 cm piece of articular cartilage on the weight-bearing portion of my femur.  Three months later, I had a OATS procedure (actually called a COR procedure due to the instrument used) and filled up the defect with two plugs.
I was totally non-weight bearing for 3 weeks and then another 3 weeks of partial weight-bearing.  After the 1st 3 weeks, I went to a PT and achieved full range-of-motion in a couple of weeks as well as started the stationary bike for 30 minutes per day.  After the 1st 6 weeks, I was off crutches and started leg strengthening.

I have a lot of pain walking without the crutches.  For the first few days, it was OK...I just walked very slowly.  It felt like my knee was going to buckle any minute though.  The PT had me doing straight leg lifts with 2 lb weights.  After about 5 days, he increased it to 4 lb weights and my knee started hurting a lot.  Can someone tell me their experience a this stage of OATS recovery?  I am anxious about the knee pain.  I still can't walk up or down stairs at all.  What should I expect regarding pain in my knee during my recovery? 

Thanks!   Joy in Dallas :)
Scope 10/04 and debridement of chondral defect,  OATs on 1/05

Offline kathleenj

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Re: OATS Procedure Recovery
« Reply #1 on: March 10, 2005, 06:27:07 PM »
Hi Joy,

Sorry that you are still in so much pain.  I have had 2 OATS procedures and totally understand how frustrating it is to have gone thru the surgery and still have pain.  The first thing that I thought when I read your post was 'only 3 weeks non weight bearing?'  For both of mine I was 5 weeks almost 6 weeks before I was allowed to bear any weight.  And then it took another 2 weeks of partial before I could go without the crutches.  My defect was smaller than yours too...10 mm.  I dont mean to upset you or scare you but I wonder if your pain now has to do with the earlier weight bearing.  I had to have my first one redone because the plug shifted somehow.  I am certain now that it was because I pushed it and went without the crutches too quickly. 
However, you dont mention what type of pain you are having now.  Is is the deep bone pain?  Ice pick type stabbing? Or is it just pain from the muscles not working right?  I think it depends on what type of pain you are having.  Maybe you can elaborate and maybe someone will have a suggestion. 
I cant really say specifically what you should be experiencing because my surgeries were is no way typical.  After the first one I immediately started to have the ice pick pains once I started without the crutches and then after the 2nd one I was having problems with scar tissue and plica.  Even now, after my last surgery with was a chondroplasty/plica/scar tissue removal, I'm still having problems. 
Anyway, sorry if I am confusing you.  But basically if you are experiencing the same pain as before your surgery I would be concerned.  If it is different and more of a general achiness I would tend to think that it is more of a muscle weakness problem because you said your knee seems to give out on you. 
Oh, and about the not being able to walk up or down stairs...that is very typical.  I still have a hard time going down.  I think alot of people have stair problems after surgery and it takes alot of work in rehab to get that back.
Let me know if you have any other questions and good luck with the recovery.
Kathleen 
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline jmcreynolds

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Re: OATS Procedure Recovery
« Reply #2 on: March 11, 2005, 03:35:51 PM »
No stabbing pain, just the same soreness on the medial side of my knee.  I called the PA yesterday and he said it will take until about June or July for the pain to abate (and maybe a full year for any final traces of pain to go away).  He said I had a large defect (1.5 cm2) that will take awhile to be pain-free.  He also said that the doctor says only 3 weeks non-weight bearing and then 3 partial weight-bearing is that less scar tissue forms.  Not using it for 6 weeks has a tendency to create scar tissue.  It probably also has to do with the number of plugs you have transplanted.   I'm probably not going to visit this site for awhile.  Good luck on everyone's knees!
Scope 10/04 and debridement of chondral defect,  OATs on 1/05

Offline thkaa

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Re: OATS Procedure Recovery
« Reply #3 on: March 11, 2005, 03:48:53 PM »
Sorry to hear about that but I think pain is the progress to recovery. At least you've done the surgery. BTW, would you mind sharing about your experience?
You have a medium size of leison, did you feel painful before the surgery? How did you get that hurt so unluckily? I really want to find out if my pain comes actually from the leison of cartilage or the degeneration of the bone.
27 yrs old now
10/2000 hurt my knee
10/2003 found ACL broken in 2000
07/2004 ACL recon
01/2005 scope
04/2005 drilling

Offline jmcreynolds

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Re: OATS Procedure Recovery
« Reply #4 on: March 14, 2005, 09:00:55 PM »
Who is BTW?  I would like to read his posts if he had the OATS procedure also.  Has anyone out there had the OATS procedure done and then had pain in the same place after the surgery?  If so, how long was it before the pain abated (assuming it did).   I think if I found someone that has experienced what I am currently experiencing, that will help me cope better and not worry so much.
Scope 10/04 and debridement of chondral defect,  OATs on 1/05

Offline kathleenj

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Re: OATS Procedure Recovery
« Reply #5 on: March 14, 2005, 09:21:14 PM »
If you are looking for someone who had that exact pain as before the Oats...that would be me.  In my case it was because the plug shifted and needed to be redone.  I am now having similar pains and the reason now is because I have since developed significantly more defects in the same area which required a chondroplasty in Dec.  I still have issues with the cartilage which I am trying to deal with non-surgically because I have been thru 3 procedures in one year.  I need a break. 
Anyway, like I mentioned before...and again I dont mean to scare you or get you nervous but, if you are experiencing the same pain as before the surgery I might be concerned at this point.  I know your doctor or pt said that it can take a while to heal but I wouldnt think it would still be hurting the same as before.  My OS did an xray after the 1st and was able to tell that the plug wasnt right...maybe you can push for one if you hadnt had one yet after the Oats.  Just a thought. 
I'm really sorry I cant help and tell you that I had the same pains and everything turned out fine.  Believe me, I really wish it did.
Good luck to you!!!!!!
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline jmcreynolds

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Re: OATS Procedure Recovery
« Reply #6 on: March 21, 2005, 03:44:00 PM »
I'm 9 weeks post-op from OATS in my medial femur (weight-bearing, 15 cm2 defect filled with 2 plugs).  Ever since I went weight-bearing, I have experienced the same pain in the defect area as before the surgery.  It is a pain that comes with each step I take.  It is like pushing on a sore area.  Continued walking aggravates it.

I am seeing my OS next week to see what he thinks.  I think the graft has failed.  Will he be able to tell this by taking an X-Ray?  Also, if it did fail, what next step is there?  How long to they wait before a next step is taken?

Thanks fellow knee friends,
Joy in Dallas with her dog Sam
Scope 10/04 and debridement of chondral defect,  OATs on 1/05

Offline kathleenj

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Re: OATS Procedure Recovery
« Reply #7 on: March 21, 2005, 05:11:02 PM »
Joy,

I am so sorry to hear that you think the graft has failed.  I truly know exactly the way you are feeling right now.  It is still possible that the graft is fine so try not to give up total hope until you see the OS.  As far as the xray goes...my OS was able to see the graft had shifted as clear as day.  In my case the graft shifted and was not flush with the surface so it was easily seen.  Typically cartilage cant be seen on xray however the plug is bone and that was seen very easily.  It might be a place for you to start.  I'd definately ask for an xray first. 
As for how long he will wait if something else needs to be done...I'm not sure.  I think every OS is different.  I waited 6 months in between each but I think it was more of a schedule availability issue rather than a determined amount of time.
I'll keep my fingers crossed for you and continue hoping that things will be alright. 
Good luck!!!
Kathleen     
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline jmcreynolds

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Re: OATS Procedure Recovery
« Reply #8 on: March 21, 2005, 05:31:22 PM »
Kathleen,
Thanks for saying that it is still possible for the graft not to have failed because I was feeling hopeless.  It's much easier to wait for my appointment next week thinking it still might be OK.  My dog, Sam, thanks you too since I've been here all morning crying.  He just stares at me and doesn't know what's wrong.

If the graft has failed, what would be next?  ACI?  I don't think I have enough cartilage left to do another OATS.  They used two 6mm plugs in my last one and I am a small person (5'2").

Joy and Sam (the dog)
Scope 10/04 and debridement of chondral defect,  OATs on 1/05

Offline kathleenj

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Re: OATS Procedure Recovery
« Reply #9 on: March 21, 2005, 06:23:14 PM »
Joy,

I remember after my first Oats, my OS told me that chondral injuries do take a while to heal.  I suppose it is common to continue to have some pain at the site for some time afterward.  He told me to be patient with it.  Unfortunately for me, it turned out that the graft was not right but my point is...you still might be ok.  I think it is really wise to see him next week and see what he has to say.  If, and I do mean if, your procedure has failed, there are other options.  My first surgery was just one plug 10mm.  The second surgery was 6 mm.  At this point my OS said he wouldnt take any other plugs from my own knee so that leaves only the allograft (cadaver) or something he mentioned about a tibial graft. Sorry, I really cant find any information about the tibial graft. Those were the options he gave me in Dec after he found more defects and did the chondroplasty to buy me some time.  Eventually I'll need to do something but not yet, I'm not ready for more surgery.  Talk to your OS.  He will know best as to what will work for you.  I'm not sure about ACI...I'm not a candidate because I have kissing lesions, so I really dont know much about that. 
I am really hoping that this is premature, and that your grafts are ok.  Keep your head up and hang in there.   I'm sure everything will be ok.   
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline thkaa

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Re: OATS Procedure Recovery
« Reply #10 on: March 22, 2005, 02:16:52 PM »
If your surgery fails unluckily, you can have another surgery called HTO. If you only have medial side leison but the lateral side is fine, then this can be a choice other than ACI. If you are a candidate for ACI, it should be a better choice than HTO, I think.

Hopefully, you can get better by resting. Since you have a leison on your bone, it takes longer time to heal. Two month is a very optimistic healing period, actually it may take a long period according to different situation of different people. So remember not to hurry, give yourself one more month.

thkaa
27 yrs old now
10/2000 hurt my knee
10/2003 found ACL broken in 2000
07/2004 ACL recon
01/2005 scope
04/2005 drilling

brattkids2

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Re: OATS Procedure Recovery
« Reply #11 on: March 22, 2005, 08:54:09 PM »
I have had two OATS proceedures (first one with synthetic material) and had continued pain at the OATS site. I had the last proceedure in November of 2004. I am going back in for a scope in May to see whats going on but my OS believes that the head of the graft has broken loose as the MRI shows the site concave instead of smooth.

Because I have no cartilage left to take from another location (I had two large lesions on the lateral side and one large one on the medial side lateral side took great to the synthetic materal and is almost completely filled in but my medial side is being uncooperative) my next option is cadaver allograft. I have already had microfracture with no success.

So there are other options!! I am also a small person 5'1"

Hope things go well for you.
If you have any questions please feel free to contact me!!

Paulette

Offline jmcreynolds

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Re: OATS Procedure Recovery
« Reply #12 on: March 24, 2005, 02:10:43 PM »
Paulette,
What is the synthetic material they used that worked for your lateral grafts? 
Would this synthetic material be something that could be used on me if my OATs has failed? 
Why is the synthetic material not an option for you on the medial side now that your OATs on that side failed?
How did your doctor discover that your medial OATs graft had failed? 
Would I need a scope to verify that my graft has failed or not or would an x-ray be all that is needed?
If my x-ray on Monday shows that the graft 'looks' OK, should I push for a scope to identify why I still have pain? 

If you can't tell, I'm anxious about this.  I want to have all of my questions ready for the doctor on Monday.

Thanks,
Joy


Scope 10/04 and debridement of chondral defect,  OATs on 1/05

brattkids2

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Re: OATS Procedure Recovery
« Reply #13 on: March 24, 2005, 10:03:36 PM »
The synthetic material is from a company called OBI www.obi.com and it is still experimental so I am not sure how many OS are allowed to use it. It wuld surely be worth asking.

They did use it on my medial side and it failed.

As far as knowing the OATS failed. For the first time I had to have it diagnosed with a scope as all the xrays showed fine. I even had an MRI that only showed I had inflamation. This time they can see on the MRI that the site is concave and not flush.
I sure understand about being anxious!!! I am going back in in May to see the extent of how much the current graft has failed.
Please keep in touch and let me know how it goes!! If you still have lots of pain I aould not hesitate to push for the scope!!

Paulette

Offline JG

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Re: OATS Procedure Recovery
« Reply #14 on: March 24, 2005, 11:29:08 PM »
Joy,

I went through a very large mosaicplasty procedure about 2 years ago.  In total my medial joint took 5 10mmx12 mm grafts and trochlea took another 11 (same size grafts). The difference with mosaicplasty is the grafts interlock rather than just sit next to each other like a typical OATS procedures.  I've not seen anything like it...incredible.  I can understand your being anxious.  I finally feel like my knee is better.  I didn't begin weight bearing for 8 weeks, then another 4 weeks partial weight bearing.  I was convinced at 8 weeks the grafts had failed, then I was convinced at 12 weeks the grafts had failed, and then I was certain the grafts had failed at 6 months and positive they had failed at 12 months.  "Failed" means that the graft NEVER started to heal or incorporate.  Basically, it died and never started "living".  This will show immediately (within 4-6 weeks) on MRI or x-ray.  Relatively speaking grafts don't die.  They actually do well is they are "fresh" like in an autograft procedue (or fresh allograft).  I think the bigger problem is poor placement by the physician or having too much pressure put on the graft too early (to me weight bearing at 3 weeks is early...I wasn't allowed to even touch my little toe to the ground).  I believe both Kathleen and Paulette dealt with both these issues.  To me your three weeks NWB was far too short.  I believe 6 weeks minimum for any of the osteochondral procedures on a weight bearing portion of the knee (microfracture included).  There are reasons that the big cartilage docs get great results...they are conservative with the NWB stuff...from Steadman (microfracture) to Bugbee. 

In terms of PT, I really don't understand why PT's have patients use weight with SLR.  To make them harder, just hold longer.  Where are you in the rehab process?  I would say that I was not good at 6 months, but much better at 9 months. How often are you going, what is your protocol?  Again, I'm almost 24 months out and I still go to PT.  I tried to go to PT 1x per month for the first year.  I certainly got better, but not where I wanted.  Then I had a 12 month check up scope so was out for about 6-8 weeks.  To really get over the hump and feel better functionally, I started going 2x per week, very intensely.  I plan on doing this the remainder of the year (I pay out of pocket for this, about 1/3 what they normally charge).  My PT is 60 miles from my home, but I work half way between.

In terms of Paulette's procedure with synthetic material, personally, I would not touch it unless one of the really top top cartilage guys (Minas, Cole, Bugbee, Gross) was using it.  That's just me.  To me "experiment" is last hope, not first step.  There are decent surgical and non-surgical options, so experimental would not be my first, second, or third choice.

Also, it takes lots of time to heal.  I've stated this over and over again to Paulette and Kathleen (the most active posters).  My surgeon kept reassuing me that it would take 24 months.  I had a hard time believing him and POOF at about 20 month, my legs (muscle strength wise) felt awesome, my knee way more normal.  Like you I really didn't have stabbing pain, my was more diffuse. My medial joint had intermittent pain, but nothing really regular.  Most physicians who really focus just on this problem with the knee will tell you it takes a long long time to heal.

Given you are just a 2-3 months out of surgery, I was just starting to walk at 12 weeks.  You might want to suggest a follow up MRI and scope at 6 months.  That's standard for this procedure.  We waited for 12 months for mine primarily because my OS wanted to let everything heal up.

If you have any questions, let me know...Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions