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Author Topic: What Next... Failed OATS  (Read 16462 times)

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Offline Shelbylw

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What Next... Failed OATS
« on: March 08, 2009, 04:30:09 AM »
Hello, I am hoping that someone might be able to help me.  I am a 30 year old female with 4 young boys and a husband and am getting quite frustrated with recovering from surgery... what is my next option?  Here is my  story...

I had OATS surgery in June '08 ~ 1 cm full thickness femoral medial condyle. 6 weeks NWB, 3 week PWB, 4 weeks with a cane, 3 months of PT... Recovery was smooth.  Had xrays at 8 weeks post op, the graft was undetectable... perfect! :) That was the last time I saw my OS... At 6 months post op, my knee started to swell and get more and more painful.  Occasionally it would give out on me and finally got to the point that I had to use my cane again to keep me from falling because my knee would lock sometimes... Not good...  I went to see my family doctor who made me an appointment with my OS again (He is only in our area once every month or two so its hard to get in to see him.)
I saw the OS two weeks ago and he sent me for xrays but figured that everything was still fine and that I needed to lose weight and things were just still  healing ( I have lost 20lbs since my surgery). The radiology department was closed at the time of my appointment so I had to go back the next day and the OS was already gone so I had to wait to see my doctor again, but as soon as I saw the pics come up on the screen I could see the defect in the femur.  And once I saw my doc and he read the radiology report, it confirmed that the graft didn't work.

My OS is not back in my area until April now and I don't know what to do, should I try to get in to see him before then?  I read somewhere that you can only have OATS done once, is that true, if so, what next? The doctor also suggested getting injections of synvisc or durolane to help with pain, has anyone had this done?  I don't have arthritis.

My family doc is trying to get me into a study similar to ACI with a different OS, its a new procedure with a better success rate than OATS, but it means that I can't have the injections if the injections would even be worth while... (I don't know, everything I have read seems to say that they are for arthritis and I don't have arthritis so I don't know what to think about the injections???)

Any thoughts would be helpful

Thanks

Offline michelel

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Re: What Next... Failed OATS
« Reply #1 on: March 09, 2009, 01:17:22 AM »
Hi I am so sorry for your problems with the OATS. Yes I believe that OATS is a one shot deal, due to the fact that they remove so much of your nonweight bearing articular cartilage.  You could still have OATS allograph if the lesion is large enough greater than 2cm. You could also have the ACI procedure.  Maybe you should change your OS to a defferent one even if its in another city, theres a place on Knee geeks that list recommended surgeons.  As far as the injections wait until you decide on what to do especially if they affect the surgery.  Good luck to you and pleasae keep us posted.
Peace
Michele
Right Knee:  1983 meniscal tear scope debridment &lateral release. 1991, 1997, 2001
2003 scope meniscal tears. 
8-08 MFX MFC lesion FAILED.
 4-09 Went in for OATS-not a canidate.
 6-09 Uni Right MFC.

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #2 on: March 09, 2009, 01:47:21 AM »
I am going to call my OS tomorrow and see if I can get an appointment before April just to discuss options, also call my family doc to see if he has heard from the other OS about the new study and if I am a candidate or not... everything seems to be a waiting game, its driving me crazy.
I will check out the list of OS's for sure, it could be worth looking into...

Thanks,

Shelby

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #3 on: March 09, 2009, 08:48:39 PM »
I saw my family doctor today and talked on the phone with my OS. The family doctor spoke with the Specialist doing the study and it was shut down due to lack of funding... (gotta love research)  I have to travel to see my OS at the end of the month but it sounds like I am going to have a scope done to remove the last graft and we will talk about options for another OATS procedure but I think its unlikely he will do it, I will probably be sent to another surgeon.  The other option was a Tibial osteotomy... I think this is also an unlikely option for me.  In the meantime, my hip is so badly out of place I can hardly walk from limping.. Its awful...

Are there any other new and improved procedures out there to help out knees... I still have the synvisc sitting in my closet waiting to be injected... I just don't know if it would actually help or not? Comments?

Shelby

Offline digginit

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Re: What Next... Failed OATS
« Reply #4 on: March 10, 2009, 03:51:38 AM »
The hyaluronic acid injections may not help, but they *might*, and they won't hurt too much...lol.  My bone doctor doesn't advocate for the cartilage restoring/replacing procedures because the failure rate is so high, and the recovery is so difficult for such a low yield.  Despite this, he did send me for other opinions before my total knee.  At 42 I was the youngest person he's done a TKA on. 

For the most part, surgeons let people your age and mine suffer...either with nothing or through difficult surgeries that don't often amount to much.    Six of one, half dozen of the other as far as I can tell.

There is that fella in CO and his regenexx, and a fella in Miami with something similar.  Wish I could help more with actual direction.

~dig

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #5 on: March 10, 2009, 02:19:41 PM »
Thanks for being honest dig,

You are the first person who has given me a somewhat straight forward answer and I have read lots of other posts besides just mine...  I saw the doctor yesterday and have my appointments now and honestly would really like to just get this graft out of my knee.  Its catching and locking and making me fall so that will be nice.  I might try OATS again but even if I do, it will be a long way down the road,  18-24months just because of wait times with the new OS. I'm told he's really good though and if this one fails (if he can even redo it) then I will give up and wait for a TKR and suffer through.  The injections... I am going to try them in the wait time after the old graft is removed if I still have lots of pain which Im sure I will... the problem isn't going away... Its at least worth a try. The other problem with the injections is the cost... they are really expensive! :o

I will let you know what the OS says after I see him on the 1st of April...

If anyone else has any great words of wisdom for me, I would greatly appreciate them... I am relatively new to this knee injury thing... and I have to say, not liking it much either!!! Any comments are appreciated.

Thanks,

Shelby
« Last Edit: March 10, 2009, 02:23:12 PM by Shelbylw »

Offline coco45inark

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Re: What Next... Failed OATS
« Reply #6 on: March 14, 2009, 03:29:56 PM »
Hello,

I was just told yesterday that I may be having the OATs procedure myself. I tore my (L) ACL and lateral & medial meniscus with chondral defect 3 yrs ago.
4 wks ago today I reinjured/tore the same ACL & meniscus without falling or twisting. An MRI two wks ago revealed (L) ACL tear with a few strands remaining but I was told meniscus was intact. Then after one trip to Walmart to buy groceries left knee gave out on me. Called Orthopedic for him to call back a day later saying maybe meniscus wasnt intact after all. I am 45 and it seems like I fall in between the success rate years.
After finding another orthopedic for 2nd opinion. I am now scheduled for surgery again. This time with OATs procedure on April 13, 2009.......This surgeon said the op notes said my knee was weak following the 1st surgery and that the wear and tear gradually took out the hamstring ACL reconstruction from "06". I have had continuous swelling since "06" but thought it was just something I had to live with. I am hoping this new doc can back up what he says.
He is doing my procedure over 6 months; with 1st one OATS, 2nd for ACL reconstruction once grafts are secure...........and advise out there??? My 1st injury in "06" was due to basketball. ???
Coco45inark
ACL tear Jan 06; lateral & medial meniscus tear jan 06;
ACL reconstruction May 06 with meniscus repair.
MRI 2/09 reveals Failed ACL and Meniscus repair
Scheduled Surgery for OATs April 09??

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #7 on: March 15, 2009, 09:08:15 PM »
Well, I can't say OATS is a fun surgery nor that the success rate is really high... but its high enough that the OS's feel it worth doing or else they wouldn't do it, right? I think I read somewhere that the success rate is around 80%, which is not bad, not great but not bad either.  I mean if it were birth control I think we would probably consider other options but there are lots of options out there for birth control... unfortunately, we are talking about joints... and worse cartilage which grows very slowly and heals even slower.  There are not a whole lot of options out there for knees yet at least not for young people.  I am only 30, they won't even consider me for a knee replacement until I'm over 50.  That is my last option when everything else fails. Which isn't  a long list of options. 

Back to OATS... So, if you have had ACL surgery then you can remember the recovery somewhat.  You will be put on a CPM (Continuous Passive Motion) machine the same day of your surgery probably, that is up to your OS.  I was NWB (Non Weight Bearing), not even toes down for 6 weeks (some OS's require longer some shorter, longer seems to be the consensus) then PWB (Partial Weight Bearing With Crutches) for 3-4 weeks, then down to a cane for it seemed like forever but I think it was a month. All the while I was in PT (Physical Therapy).  The sooner you can get ROM ( Range of Motion) back the better.  Its a long recovery, but I'm sure the ACL was too.  I don't know if your OS is doing your surgery open knee or Arthroscopic but mine was open knee and I had 16 staples that came out 10 days later. I developed cellulitis in my incision and ended up on IV antibiotics for 14 days post op... lots of fun, but that's pretty rare I hear... and I am very prone to it, I have had it on more than one occasion... 
If you listen to your OS and PT people and set up a really good support system you should be fine.  Take it slow, let your body guide you, and use the pain meds for as short a time as possible, pain is good, it tells you when you are doing too much too fast.  Overall once I got past the initial pain of the incision and surgery pain, I was fine, pain-free, until I had to start walking.   Then I just took it slow and let my body be my guide.  Unfortunately  it still didn't work and lucky me, I fell into the 20% category, its a chance I took, and I will probably try it again  for a better quality of life.  I have 4 sons who love sports and being active and its hard to sit on the sidelines instead of being in the thick of it with them so I hope that one of these days I can be back out there with them again.  I have 15 years until I can have a TKR (Total Knee Replacement) so until then I want to do what I can to improve my quality of life for myself, husband and kids.  My doctor did tell me that it is inevitable that one day I will have a knee replacement and just do whatever I can to get myself through until then and put it off as long as I can.

There aren't alot of options out there for knee surgeries and if your OS thinks this is what is best, and you have faith that you have a good OS, then you need to trust him/her.  Do some homework,  check up on your OS, ask for references.  Remember, you hire them, not the other way around.

The Xray department from the hospital just called to confirm my appointment while I was typing... kinda funny how things work.  I have my appointment coming up soon too to see what they are going to do about my knee.

Best of luck, I really hope you fall into the 80 % category!! :)

Offline coco45inark

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Re: What Next... Failed OATS
« Reply #8 on: March 16, 2009, 12:31:40 AM »
Thanks so much for replying to me.

My OS actually said he may have to do open surgery on me, but he also said he's not sure until he gets in there when doing the arthroscopy.
I am actually a Nurse  but it seems as though you never know enough and things are not like the books say they are supposed to be. I too have children, three sons all that are very outdoor oriented and a husband. None of us like to stay inside too much, so this is disheartening to me to say the least.

I would very much like to hear from you again as its nice to have a friend going through similar situation.


Thanks,

Colette
Coco45inark
ACL tear Jan 06; lateral & medial meniscus tear jan 06;
ACL reconstruction May 06 with meniscus repair.
MRI 2/09 reveals Failed ACL and Meniscus repair
Scheduled Surgery for OATs April 09??

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #9 on: March 16, 2009, 11:08:42 PM »
Hi Collette,

I bet you got a giggle out of all the expanded abbreviations.... lol... ya, its really hard to think that you have to recover for so long.  The surgery is a piece of cake, its the recovery that takes forever...  I remember just wanting to get up and run because i felt so good about 4 weeks after my surgery, I had very little pain, my knee was bending pretty well, but I wasn't even allowed to put my toes on the floor yet.  It takes lots of time and lots of the other posts will say that it is worth it and hopefully it will be for me next time too, if the OS can even do another OATS...  It was suggested that I might consider a Tibial Osteotomy(sp?), it sounds awful, but if the OATS is a no go then I don't know what other options there are.  My biggest problem is losing weight.. that is a continuous battle, I can't do any aerobic exercise with my legs but I'm supposed to lose weight... there are only so many calories I can deprive myself of without starving myself, lol... I guess thats what I get for having 4 kids, I was thin before that. How old are your kids? Are they big enough to help alot with your recovery?  Mine were a huge blessing.  My older two boys were 11 and 9 and were able to look after my 7 and 2 year olds while my husband was at work.  Then my mom and sister would come and help with cleaning on their days off, so it was a big group effort.  I had church ladies bring in meals and my neighbors brought cookies for the kids.  We were well taken care of. Some friends of ours took the boys camping for a weekend to give me a break.  If you can get some people in place like that ahead of time, it makes all the difference in the world!!!  Even to have someone come and sit with you for an afternoon so that you can have help with snacks and getting to the bathroom :-[  for the first few days... embarrassing but necessary until you get stable enough.
I am really looking forward to having my next surgery, not the pain or recovery but just not having my knee lock so often.  I know that it will come back as the damage progresses but until I can have another OATS or whatever the OS decides to try next, it will be good to have some balance and stability back.
Write me anytime, its good to have somebody to talk to about this stuff, I am the only one in my city with this injury, so I have NOBODY else locally to talk to about it. The nurses didn't even know what to do with me after I got out of surgery because I was the first patient they had ever dealt with, with an injury like this.. bizarre, I figured it would have been more common, fairly small hospital though.
Keep me posted!!

Shelby


Offline Peg Leg

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Re: What Next... Failed OATS
« Reply #10 on: March 18, 2009, 02:41:35 AM »
Shelby,

I'm so sorry to hear about your knee trouble.  I am 46 and a Mom of 3 kids.  I hurt my knee 3 years ago playing softball.  I used to be very active and always kept up with my kids. I went in for a scope and clean-up and woke up to a Microfracture to the MFC with 6 weeks NWB and crutches for 9 weeks.  After 5 months of pain and struggling with PT, I changed Dr.s, had another scope and cell retrieval for ACI.  That surgery was 8 months after my 1st and I was 8 weeks NWB and more months of PT. Struggled a lot with patella pain, finally had it scoped 6 months later and that defect (which had been small and a grade 3) had grown bigger with all the exercises I was doing to build my quads. Long story short, my Dr. decided on an Osteotomy to unload the patella defect.  Guess what? You got it, 6 weeks NWB, followed by 8 months of PT. Have I mentioned how much I love my Physical Therapist?!!!  I have continued to struggle, went to Indianapolis to see a top knee OS who specializes in Cartilage repair and he tells me my Carticel graph is failing and I now have BOTH defects to deal with.  He tells me that since the ACI didn't work well the first time, I am not a candidate to have it done again. So he recommends an Osteochondral Allograft, which freaked me out totally, not to mention it involves 8 weeks NWB followed by a 12 month rehab!!! I am ready to get off this merry-go-round and my OS is suggesting a Bi-Compartmental Replacement, which he says is a better bet for me.  I don't tell you this to scare you, because most people don't have the sorry luck I've had, but you do need to educate yourself as much as possible.  Where are you located that your Dr. is only there occasionally?  The one thing I have learned from being around this board is that you need a Dr. who is very skilled in Cartilage repair.  The more experience they have, the better your chances for a good outcome.

Well, I've unloaded a lot on you!  I didn't mean to go on so, but I have a lot of experience in this knee stuff and sometimes I just get carried away!! Take care of that knee and I hope you can get it all worked out sooner than later. Also remember that there are positive outcomes, but those people aren't sitting at home blogging about their awesome knees!!

Peg Leg
10/06  Miicrofracture Rt knee on mfc
defect was 1.3x2, small defect under patella
04/07 Arthroscopy/Cell harvest for Carticel
06/28/07 Carticel surgery ,Rt. Knee
12/27/07  Scope to debride Patella lesion,Rt. Knee
4/17/08  Fulkerson AMZ, Rt. Knee
6/25/09 ConforMis BiCompartmental Knee Replacement

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #11 on: March 18, 2009, 07:14:26 PM »
THANK YOU PEG LEG!!!

 I love getting stories like that, I really do.  I am in Canada, Northern Ontario. I live in a relatively small city but close enough to a large one that I can commute to get my needs met and get really good medical care, but I have tried so far to stay close to home.  My next step is to go to the "big city" doctors. The OS that I have now had been operating in a large hospital and found a need in the smaller hospitals so decided to give up his practice in his hometown and travel to all of these "remote" places to serve the needs of our communities and we love him for it.  He is really quite good but unfortunately our hospitals just can't keep up with his wealth of knowledge and expertise so I'm sure it must get frustrating for him.  On the other hand it has improved our hospitals drastically because we have this caliber of surgeon on staff we have received funding tor more equipment...anyway... long story short... he can't do what I need so I have to go to the Winnipeg next.  I am interested in hearing more about this other procedure you were talking about, the bi-compartmental replacement... is that like a partial knee replacement??  I'm sure I would have to go through all the other hoops before I got to that point but, the long and the short of it is, I JUST WANT TO BE FIXED WITHOUT ALL THE RECOVERY TIME!!!! PERIOD! lol.................   I'm sure you understand, I feel for all of you mom's and dad's out there who are going through the same thing, our kids want us back, I know, mine have told me time and time again...
Yes I too love my PT, we chat at the grocery store checkout on occasion, and our kids play sports together... its very weird, small town.... I shouldn't know them that well....lol


Keep the comments coming guys, this is more information that I have received from any of my doctor visits combined, they are always so rushed and intimidating... Its good to have knowledge to go into my visits with.  Thanks!   ;D

Shelby

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #12 on: March 20, 2009, 01:50:04 AM »
Okay, another quick question for all you knee geeks out there.... is there anything I can do differently to avoid having my knee lock up on me or buckle?. It happened again today and I fell, its very embarrassing.  I didn't have my cane, I was just walking from the kitchen to my bedroom, I wouldn't have cared but my Mom was here and.... well... she's a worrier... so now she is afraid to have me stay alone, what if I fall when I'm alone with my youngest son?.... etc.. etc...etc...... ::) I know she means well but I can't stand using my cane in the house it just gets in my way and well, ahh... I'm just frustrated... any suggestions???



Shelby

2 weeks till I see the OS..

Offline michelel

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Re: What Next... Failed OATS
« Reply #13 on: March 20, 2009, 09:53:09 PM »
Hey Shelby, I was looking up some things about knees (seems like thats all I do), and came across an article that suggested that when your knee is giving away it could be related to quadrecep (spelling?) weakness. And that it occurs often after knee surgery.  The other page I looked at said it could be from patella instability, ACL tear, meniscus tear, or MCL tear. So theres you something to chew on a while :P.  As far as what to do to prevent it...I think 1. if it is the quads then ofcorse you'll have to do strengthening exercises,2. if its something else well you know what will have to happen then yea op. But the quad thing seems more likely to me.Even though its a hinder go ahead and use that cane even if its around the house.  Good luck sweetie.
PEACE & LOVE
Michele
Right Knee:  1983 meniscal tear scope debridment &lateral release. 1991, 1997, 2001
2003 scope meniscal tears. 
8-08 MFX MFC lesion FAILED.
 4-09 Went in for OATS-not a canidate.
 6-09 Uni Right MFC.

Offline FormerlyActive

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Re: What Next... Failed OATS
« Reply #14 on: March 20, 2009, 10:08:40 PM »
Hi Shelby - just catching up on your post. Sorry to hear of your troubles. Also Peg Leg you poor thing. Really sympathize.
Shelby I didn't understand, how did you get the defect if you don't have arthritis? maybe dumb question but didn't understand that part. Best of luck to you in finding some answers, as we all know it can be a long road, but gotta drive it. Best healing wishes.
3/82 - Medial Synovial Plica removal both knees
9/89 - Lateral Release both knees
3/08 - Reinjury left knee hiking Asia Pac
5/08 - Miserable Malalignment diagnosis
4/08 - 9/08 Five doctors diff. opinions
7/08 - 02/09 - In PT, no chg.
4/09 - Dr. 6 opinion femur & tibia derotation together















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