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Author Topic: TruFit OBI recovery...please help  (Read 36472 times)

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Offline steve439

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TruFit OBI recovery...please help
« on: August 27, 2006, 01:49:02 AM »
I had the TruFit OBI procedure to address a chondral defect 8 days ago.  I am a 38 yo male that is(was) reasonably athletic.  This was the second procedure to attempt to address a grade-IV chondral defect on my femoral condyle.  20 months ago, the OS performed a microfracture.  At that time the defect was 2mm across.  I was on crutches PWB for 6 weeks.  The area would continually become sore if I biked too much on it.  I had a series of Synvisc injections and then a series of Orthovisc injections.  For some reason, the microfracture was not successful.  I am wondering whether I put too much weight on the leg too soon or pushed the rehab too hard too fast. 

We decided to address the site of the defect using the OBI plug.  The same defect was now 7mm across.  The OS commented that there was minimal regrowth of new cartilage around the site of the original microfracture.  The OS removed the damaged cartilage and used a TruFit OBI plug to fit the hole.   I am currently on crutches PWB (toe touch) for 6 weeks and my OS wants me to begin rehab on the exercise bike (with no resistance) for 10 minutes on this Monday, which will be 11 days after the procedure.  His thinking is to gradually increase the time and then steadily add resistance over the next 8 weeks.  We will also do a series of 3 Othrovisc injections starting 6 weeks after the procedure (one per week).  I am taking 2000 mg of Cosamin DS daily (2 capsules in the morning and 2 at night).   

I have read in other postings that there is a variety of approaches to recovery from this procedure.  I am hoping that I can get some input on whether it is better to do PWB or NBW on the crutches during the 6 week healing period and whether it is better to start on the exercise bike so soon after the procedure.  Any other tips or advice on raising the probability of a successful recovery would be very much appreciated.

Thanks in advance,

Steve

Offline brattkids

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Re: TruFit OBI recovery...please help
« Reply #1 on: August 27, 2006, 01:39:40 PM »
It seems as though all OS have different rehab proceedures.
But as far as weight bearing it really depends on if the plug was put in a weight bearing area of the femoral chondyle. It is just common sense that if it was in a weight bearing area to put weight on it immediately might compromise the plug.

Let me know how you do with the OBI and where your defect is.  I had the OBI plugs two years ago(I was in the experimantal group before they were approved by the FDA) and didnt have any luck with them. My defects were much larger than yours and I had three defects in heavy weight bearing areas. I was NWB for 6 weeks and partial weight bearing for another two. I am having issues again after a traditional OATS and would like to try the OBI again to avoid a TKR

Paulette
4/04 microfracture
5/04 debris removal
8/04 OATS with synthetic plugs
11/04 OATS traditional autograft medial femoral chondyle
05/05 debris removal and OATS assessment
6/05 Cadaver Allograft OATS lateral femoral chondyle
9/05 OATS redone could not save allograft plug
12/2006 2007 and 2008 scop

Offline shade

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Re: TruFit OBI recovery...please help
« Reply #2 on: August 27, 2006, 03:03:55 PM »
Steve,

Hi there, like Paulette says protocols differ & it's also the location, depth of damage, width of damage & any other procedures done at the same time.   My protocol was no therapy during the first 6 weeks, but I had a combined TTT/OBI procedure.  I've also managed my own rehab without problems using a recumbent bike & walking on a soft surface to strengthen my leg.  I've used no tension or any weights whatsoever due to the area of damage.  My other leg has problems so it's slowed  progress a little, but I've still managed to regain strength without many problems.  I'm approx 5 months post-op and my right leg feels great......
Hope you have a great rehab Steve.  Take your time and if you are having difficulties talk to your OS and PT instructor.  I've found following your bodies warning system helps - if it hurts - STOP. 
I've had agressive physio in the past and it's only hindered progress, so I've been happy taking things slow and easy and gradually progressing.  It's boring, but it has worked.....
You need to chat with DJK - he's just had an allograft w/OBI TruFit and he's been PWBing and just beginning his home therapy program also.....  Here's his post.......

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=28925.0

Let us know how everything goes.  ~shade
« Last Edit: August 31, 2006, 10:34:51 AM by shade »
July '05†(RK) - LR/debridement
Mar '06†(RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07†(LK) - LR + Fulkerson TTT

Offline steve439

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Re: TruFit OBI recovery...please help
« Reply #3 on: August 27, 2006, 07:09:42 PM »
Paulette and Shade....Thank you for the responses.  The location of my defect is certainly WB and given the trouble that I had with the microfracture, I would surmise that the defect/plug is in a heavy WB location.  Just for complete info....I am 6'1" and about 190 lbs.  The plug needed to placed (drilled) 10mm deep (it was a grade IV defect) and width of the defect was 7mm.  This was the only procedure done during the operation. 

My OSís rehab plan is solely an upright exercise bike, using cyclical progression to gradually increase time and resistance over a 6 week period.  My OS wants me to start at 10 min on the exercise bike with no resistance and add 2 - 3 min per day.  After about a week, then I add a bit of resistance and decrease the time on the bike, building back up by adding 2 - 3 min per day....and over and over so that by the end of 6 weeks of rehab on the exercise bike, I'll be at 60 min with moderate resistance.  I will certainly listen to my body and not push the envelope of function and stop if I am feeling pain.

It's been 9 days since the operation.  I still am waking up a few times each night when the knee gets into a painful position, sometimes surgical pain, sometimes bone pain...but it seems to be feeling a bit better with each passing day. 

I am most concerned about creating the best environment in my knee for the regrowth of tissue into the OBI plug....as one OS puts it...so that there will be lots of seed and it will fill-in optimally. 

Offline steve439

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Re: TruFit OBI recovery...please help
« Reply #4 on: August 30, 2006, 07:24:31 PM »
Brief Update....  Had another post-op appt this past Monday and got the stitches removed.  OS said that everything looked good and I began PT on Monday.  All bone pain has subsided from the operation, but strangely I have numbness on the skin on top of the knee cap.  Random.  Anyone else have this issue?  I am still PWB on crutches for another 4.5 weeks.  The area throbbed after the first 10 min session on the bike w/o resistance, but has felt OK the past 2 days after the PT riding. 


Offline brattkids

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Re: TruFit OBI recovery...please help
« Reply #5 on: August 31, 2006, 02:12:44 AM »
I have numbness on top of my kneecap also and it has been almost a year since my operation. I believe that is probably one of the normal side effects of having surgery. Ask your OS if it really concerns you.

Its great that you are doing well at PT and your bone pain has subsided!!!! Keep up the great work!!

Paulette
4/04 microfracture
5/04 debris removal
8/04 OATS with synthetic plugs
11/04 OATS traditional autograft medial femoral chondyle
05/05 debris removal and OATS assessment
6/05 Cadaver Allograft OATS lateral femoral chondyle
9/05 OATS redone could not save allograft plug
12/2006 2007 and 2008 scop

Offline Natalie.D

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Re: TruFit OBI recovery...please help
« Reply #6 on: August 31, 2006, 12:53:08 PM »
Steve,

Its fairly common to have numbness, the OS has to cut through nerves and this sometimes causes numbness which can be temporary or permanent.  Both my knees have numb patches of about 4 inches in length and 2 inches across which have never regained feeling.  Its not really a problem for me although it does still feel really weird.

Natalie.
Dislocations since age 12
Trochlear Dysplasia
Maltracking
Hypermobile
LR/MR-failed
TTT, LR, MR L knee 95-Success
TTT, LR, MR R 02-Success
Screws out
Partial tear ACL
Severe end stage OA
4 Debridements
Partial Meniscectomy
Failed Microfracture
11mm Defect LFC
Bone Spurs, Kissing Lesions

Offline steve439

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Re: TruFit OBI recovery...please help
« Reply #7 on: September 16, 2006, 06:45:55 AM »
4 week post-op update....most of the surgical pain is gone, but the area of the plug remains quite tender.  When I have twisted the knee the wrong direction or put too much weight on the leg (like tonight), I get a sharp pain from the area.  Also, the area gets sore during rehab riding on the exercise bike even though there is light resistance.  Is this normal?  I would have thought that the area would have started to feel stronger by now.  I am getting a bit concerned.

Offline shade

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Re: TruFit OBI recovery...please help
« Reply #8 on: September 16, 2006, 12:24:18 PM »
Steve,

Very normal if you are overstressing the area.....†
This surgery takes a long time to heal, remember you've had bone removed.† Are you using a stationary bike or a recumbent bike??† (think recumbent's are easier on the knee joint)† If you are getting the area irritated, go back a few steps & find a comfort level that doesn't irritate your leg.† I'm 5 1/2 months out & just recently started using therabands.  Talked to a physio who told me to never use weights on my PF joint once it's been damaged, but could use therabands for resisted exercising.† Maybe that's something you could try also.†
Hope you're feeling better soon.† ~shade
« Last Edit: September 16, 2006, 12:57:22 PM by shade »
July '05†(RK) - LR/debridement
Mar '06†(RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07†(LK) - LR + Fulkerson TTT

Offline stgiles16

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Re: TruFit OBI recovery...please help
« Reply #9 on: September 16, 2006, 02:15:38 PM »
STeve, I have not had the same op as you but I have had 2 microfractures and am in a clinical trial for the arthrosurface hemicap ( a big screw put into the chondral defect). I am currently 7 mnths post op from the hemicap. After EVERY one of these surgeries and even today, if I twist my knee at all, i get severe shooting pains up my femur from the defects. They are also tender to the touch (two different defects). My last micro is over 2 yrs old and still tender to the touch. I dont know if it will ever feel "normal" again. Just thought that I would put that in to let you know that it does seem to be normal for it to be tender , long after the op.
good luck
missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline DJK

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Re: TruFit OBI recovery...please help
« Reply #10 on: September 16, 2006, 08:03:54 PM »
Steve, I am in the same boat as you...same problem too...along with twisting, any lateral movements will also trigger extreme sharp pain from the plug sites...as Shade stated it is going to take awhile for the bone to heal...being that shade and I share the same OS I am not yet released to any weights or resistance yet...just weightbearing and doing quad sets and slr's along with some heel slides/drags...the majority of my surgical pain is gone though I still have the deep bone pain at the lesion site.
L knee
scoped/debridement 10/02
Fulkerson 12/03
got unscrewed 9/04
scoped/debridement/LR 8/05
Allograft w/OBI plugs 8/10/06

Offline steve439

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Re: TruFit OBI recovery...please help
« Reply #11 on: September 16, 2006, 09:21:15 PM »
Shade/Stgiles16/DJK - Thank you for the recent posts.  I really appreciate the thoughts. 

Now I know that this may sound strange, but when I sleep at night and the knee is under the blanket and gets hot, the surgical area throbs and is much more uncomfortable when it is warmer (using more covers).  Last night, I probably woke up 20 times from the throbbing.  I choked down 4 Advil as soon as I got out of bed this morning.  Wonderful little suckers.  I am also icing the area 4x per day. 

In regards to some of the other questions...I am using an upright stationary bike for the rehab riding.  Still using light/moderate resistance.  Yesterday, I did 46 minutes with light resistance.  I guess that I overdid it and I'll take the minutes and resistance down. 

I am supposed to be off of the crutches in 2 weeks.  I was supposed to be PWB (toe touch) for a total of 6 weeks.  Honestly, I have no idea how I will be able to put full weight on the area in just another 2 weeks.  Did anyone have to be on crutches longer than 6-7 weeks after getting an OBI plug?

OS wants to start a series of Euflexxa injections (1 per week for 3 weeks) at the 6 week post-op point.  OS says that the Euflexxa will act as a fertilizer to help regrowth the cartilage for the plug.  Anyone have any experience with Euflexxa?

Shade - I totally take your point about having bone removed and it taking time.  OS said that it would be 6 months until I could run again.  My passion is mt. biking and it has been hellish not being to ride without pain for the last 2 years. 

All - thank you for the support.  This has been a scary and frustrating experience. 

Offline Athlete Mom

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Re: TruFit OBI recovery...please help
« Reply #12 on: September 17, 2006, 04:47:44 AM »
Hi -- my son (13) had the OBI plugs 3 months ago (a larger lesion on the lateral femoral condyle 1.5 cm in diameter).† The doc placed two 5mm plugs and microfractured around them.† He had my son no weight bearing (toe touch only) for 6 weeks -- no P/T during that time.† †Once he started P/T at 6 weeks, it took a couple of weeks to let go of the crutches completely - and he is a top level athlete.† We were a little surprised by that!† After 2 weeks, he went down to 1 crutch and uses it when we go to crowded places (pro ball games).† He has no real P/T restrictions, other than NO RUNNING, pounding, twisting, or pivoting.† He is doing some weights (leg presses, etc.).† Doc says can't return to sports and start running for 6 months (from the date of surgery) -- January.† He experienced some numbness at first, but has had no pain in his knee whatsover.† He does however, get pain in the top of his foot, his shin and calf.† I know his age helps him, but still, the doctor is VERY OPTIMISTIC about these plugs -- he expects him to make a full recovery.† Hope your recovery goes as well!

Offline DJK

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Re: TruFit OBI recovery...please help
« Reply #13 on: September 17, 2006, 05:24:03 PM »
Steve, I understand the throbbing when it gets hot...I usually sleep with my knee uncovered or just with a sheet on it...no blamkets...also ever since my TTT I have not been able to go into a hot tub for anymore than say 5 minutes...the heat from the water makes my knee throb and it swells up instantly...makes it very painful...guess its just the nature of the knee beast...DJK
L knee
scoped/debridement 10/02
Fulkerson 12/03
got unscrewed 9/04
scoped/debridement/LR 8/05
Allograft w/OBI plugs 8/10/06

Offline guamanian

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Re: TruFit OBI recovery...please help
« Reply #14 on: September 20, 2006, 10:55:04 PM »
what is a TruFit OBI plug?  I have heard of autografts (from somewhere else in own body), allografts (from a cadaver), and the system of harvesting  a small amount of one's own living tissue then culturing in a lab and t reimplanting at a later date, but this sounds like something else altogether.  Please advise!  Thanks, G
L knee trauma, proximal realignment, LR, TTT, mosaicplasty X 2, scar revision and debridement x2















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