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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

Offline Robin M.

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Re: What Next... Failed OATS
« Reply #15 on: March 21, 2009, 01:43:56 AM »
Hi Shelby,

Wanted to let you know that you are not alone. Not very long ago I was in a similar situation to yours. I had mosaicplasty(OATS) 11/05. in 3/06 diagnosed with arthrofibrosis (scar tissue formation). OS did a scope to remove scar tissue and manipulation. Got great results ROM 125, graft was healing and rest of the knee didn't have any problems. In 2007 had problems with the knee while recovering from a HTO on the right leg. MRI found degeneration in other parts of the knee. The graft was intact but the rest of the knee was arthritic. I was devestated.At that point I didn't have many options. Wanted OS to do an HTO but that wasn't possible since I had deterioration of cartilage on the lateral side and under the knee cap. This past May I had a TKR with great results.

I had the surgery at 41 yrs. old and would do anything to avoid an early knee replacement. I knew going into the surgery that there was only an 80% success rate but was willing to try anything. The recovery and rehab. was tough. I was a former gymnast and had always been active-going to the gym,playing tennis,etc. I am married and have 5 children. I'm also a rehab/longterm care nurse(currently not working due to having a hip replacement this Monday).

We place so much faith in these surgeries helping us until of an age for knee replacements. I live in an area where orthopaedics is some what conservative. I traveled an hour to see my cartilage specialist and the same distance in other direction to see my joint replacement Dr. My OS sees quality of life more important than age when doing replacements. Where I live they prefer to wait until 50yrs. old to do replacements.

What part of your knee do you have the defect?Will the OS do an MRI? I would suggest doing some research and getting as much knowledge as possible before another appointment. After surgery I always have very weak quads and alot of problems with the knee buckling and severe weakness in the leg. Once I gained quad strength the buckling stopped. On the other hand the knee giving way could be caused by the graft failing. I experienced alot of giving way, grinding, and crackling before the defect was repaired.

You're seeing a doctor in Winnipeg. My husband's employers corporate office is located in Winnipeg, New Flyer of America. It's a bus making company. My husband works in engineering sales here in the US on the East coast.

Sorry for rambling. Good luck with your appointment.

Robin
Lt. knee- 6/04 scope and chondroplasty of MFC,11/04 Synvisc injections, 11/05 mosaicplasty, 3/06 scope,LOA and MUA, 1/08 degeneration entire knee, 5/12/08 TKA, 7/21/08 MUA
Rt.knee- 10/06 scope,,plica removal-OA, 3/07 HTO, 9/09 hardware removal  12/7/09 TKA 1/10,3/10 MUA, 11/10 LOA,partial revision

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #16 on: March 21, 2009, 05:00:58 AM »
Oh, to answer the question of how I injured my knee, its the stupidest thing... I was at the pool with my then 2 year old and being the protective mama... I wanted to be in the pool before him and he jumped in so I jumped to catch him, the water was ALOT shallower than I had anticipated and I jarred my knee, I was twisting to catch him at the same time... you can kind of see how it would happen... I tore a chunk of bone and cartilage out of my right side femoral medial condyle.  My knee hurt initially, but I didn't think it was that bad and continued to swim.. and didn't actually see the doctor for another week.  Then when I went to the OS, ( he happened to be in town the day I went to see the doctor) he had me in for a scope the next day because he thought I had torn the meniscus.  Nope, no such luck...

I guess I could work on the quad strengthening but its been a while, does anyone have any suggestions that won't make my knee to angry with me... I am not allowed to do ANY aerobic exercise with my legs at all right now, which really sucks... I live in a beautiful part of the world and I get to see it looking out the window of a car, I would love to be walking or biking again, but the terrain is too much for me to do either. I bought an eliptical traiiner and was told not to use it until further notice... so basically I have the exercise bike which is soooo uncomfortable.  ( I broke my tailbone Cross country skiing last March just before my knee injury, when I told my OS he asked me if I should be paying  him salary.. as a joke of course... lol) so you can tell, I love to be out with my kids, but my body... well, not so much....

If I can find a doctor that will do a knee replacement for me younger than 50, I'm sure I will go for it, but Im sure it would be hard to find, and the waiting list would be long.  Free health care doesn't mean fast health care... I think its amazing that they did your replacement before 50 and GREAT for you, I hope it works for you.  I hope to be part bionic woman by the time I'm 55, because I will need a new knee, probably another knee from favoring this one and a new hip because I broke my right one as a baby and it is already arthritic and not very nice. lol Until then I just hope  I can find all the info I can from all you lovely people to chat with my doctors about.

Cool about your husband's company being out of Winnipeg. Small world we live in. I go there at least once a month.

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #17 on: April 02, 2009, 03:29:08 AM »
Hi Knee Geeks!

I saw the OS today... it was an interesting visit.  I had comparison xrays.  I brought some from my hospital and had some taken at the hospital I was at.  There were only minor differences but enough that it was warranted.   This time he finally believed me when I said that my pain was from the graft site and not the donor site when he saw the xray.  He will NOT do any more surgery and has referred me to the surgeon in Winnipeg.  I have done some research through some PT friends of mine and they say he is the best in the city.  I am going to look into a few more names before I go ahead with anything but really it will come down to whomever I can get in to see. The OS said that he thinks I have osteonecrosis but that the cartilage looks like it is still intact.  The defect is bigger, he figures about 1.5- 2 cms, up from 1 cm,  but hard to determine on an xray. Osteonecrosis, I looked it up, means the bone died, he figures I have a cyst  of dead bone under the cartilage graft. I didn't ask enough questions when I was there, like, will this spread? If so, How quickly?  Is that even possible for a bone to die but the cartilage to be fine?  The donor site looks perfect!!! All healed and no pain from there at all. I do know that the dead bone is soft and brittle if that makes sense, so easily damaged.  I have to use my cane  ::) and the only exercise he wants me doing is still the bike and pool.  Anyone else have any suggestions or experince with this.  Oh yeah, I have officially joined the osteoarthritis club.... yay me...very sarcastic btw... RT Hip, big toe, and knee. :(


Help!!

Shelby

Offline Robin M.

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Re: What Next... Failed OATS
« Reply #18 on: April 02, 2009, 03:48:33 PM »
Hi Shelby,

Glad to hear that you got a referral. Hopefully this OS in Winnipeg has some answers and a treatment plan. There's nothing worse than waiting for answers. How long must you wait until you get an appointment?

I was concerned that I had osteonecrosis after the MRI revealed problems with the mosaicplasty. If I remember correctly from the internet research I did on osteonecrosis, you can have different levels or degrees of bone death. I think it went from 1-4 and the treatment varied depending on what level you were at. Google it and I'm sure you'll find alot of different websites to look at.

I didn't have any problems with the donor site but had a cyst under the graft. At the time of the replacement, my OS said that the mosaicplasty was healed but the rest of the knee had areas of bone on bone.

My PT has always told me that the best form of exercise is the bike or getting into the pool. Sorry to hear that you've joined the OA club. We're way to young to be dealing with all this crap!

Have a good day.

Robin
Lt. knee- 6/04 scope and chondroplasty of MFC,11/04 Synvisc injections, 11/05 mosaicplasty, 3/06 scope,LOA and MUA, 1/08 degeneration entire knee, 5/12/08 TKA, 7/21/08 MUA
Rt.knee- 10/06 scope,,plica removal-OA, 3/07 HTO, 9/09 hardware removal  12/7/09 TKA 1/10,3/10 MUA, 11/10 LOA,partial revision

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #19 on: April 02, 2009, 04:07:52 PM »
Thanks Robin,

I will google it, I also made an appointment with my regular doc to talk to him about it to see if he can answer some questions, at least I know that this is actually possible and my OS is NOT full of crap, the way he was talking it made me wonder... it just didn't sound right but I guess it really can happen, thanks for putting my mind at ease that he didn't screw up, my body did.  I don't know that that is much more comforting but better myself than someone else I guess. 

Keep the comments coming, I need all the feedback I can get, its gonna be a long wait.. 12-18 months it says on the answering machine at the new OS's office.  Research is good.  My only concern is, do I have that long with a necrotic cyst in my knee? Is an MRI what I need to determine the degree of bone death?

Shelby

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #20 on: April 02, 2009, 04:12:01 PM »
I added a new thread for Osteonecrosis, so you can respond to either.  Thanks guys and gals!!

Shelby

Offline Robin M.

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Re: What Next... Failed OATS
« Reply #21 on: April 02, 2009, 04:51:56 PM »
Hi Shelby,
It's a good idea to talk with the family doc. I did the same. An MRI will give a more indepth look at your knee- soft tissue, cartilage,ligaments,etc. An x-ray is more bone related. My x-ray showed that something was wrong but the MRI gave more detailed imaging. As far as how long you have with a necrotic cyst, I don't know much about that. In my case, I had a scope to clean out scar tissue and a MUA in March 2006 the knee was in great condition, no degeneration, by November 2007 I had cysts and cartilage degeneration. In my case it happened quickly. But during that time I had the osteotomy on the right knee and spent 10 wks. non-wt. bearing which may have been a factor in the quick deterioration of the left knee. But who knows why this occured. As my OS said I was a perfect candidate for the surgery but there is still a 25-30% failure rate. :(Can you call back your other OS and ask him this question? I think that is what I would do. Bummer about such a long wait to see the new OS. Post me if you have any more questions or just need to vent.

I have to go and get ready for PT. Just had a total hip replacement last Monday. When does it end?   :(

take care.

Robin
Lt. knee- 6/04 scope and chondroplasty of MFC,11/04 Synvisc injections, 11/05 mosaicplasty, 3/06 scope,LOA and MUA, 1/08 degeneration entire knee, 5/12/08 TKA, 7/21/08 MUA
Rt.knee- 10/06 scope,,plica removal-OA, 3/07 HTO, 9/09 hardware removal  12/7/09 TKA 1/10,3/10 MUA, 11/10 LOA,partial revision

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #22 on: April 24, 2009, 07:50:09 PM »
Hi everyone,

I haven't posted in awhile. Not to much has changed, my knee still hurts and I'm still waiting for an appointment with the new surgeon in Winnipeg.  I did see my old surgeon one more time for what I thought was going to be a question answer appointment and he proceded to contradict everything that he has told me about my knee to this point and discounted everybit of pain that I have and said that he would be surprised if the new doctor does any surgery on my knee at all.  I asked if he would do an MRI to have a look at the joint surface and he said it wasn't necessary and then I asked about a CT and he said no to that as well. I have completely lost faith in this doctor and have decided to NEVER see him again.  I think I will go see my family doc and ask about those tests because to date I have never had an MRI or a CT of my knee and I have not had a scope since my OATS surguery last June.  Other than Xray, we have no diagnostics on my knee at all and I am at the end of my rope.  Can someone please tell me, is this normal protocol for post OATS?  I kinda figured that they would want to know what was going on with the joint surface and with the bone since they think a section of it has died, more than just an xray??? I thought I would have had a scope by now especially now that I am having problems with the graft site.  So now I am even doubting myself because I am working with a doctor who does not appear to be on my side.  Does this seem right to any of you Post OATS people? I'm starting to lose my mind!!

Any comments are welcome.

Shelby

Offline matty

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Re: What Next... Failed OATS
« Reply #23 on: April 24, 2009, 09:06:45 PM »
Hi all, hope you dont mind me jumpin in on your page, although I have read all of your posts and you all seem like you know what your talking about.

Maybe someone could answer my query?

I am 23 and a year ago I had Micro Fracture carried out on the Medial Femural Crondoyle as I was told that the OATs procedure was not suitable due to the size of my defect.  Defect size is 2.2cm x 1.5cm.

Since I have been weight bearing I have been having problems with my knee, quite similar to that what you all talk about, with my knee clicking and cracking, it locks and hurts more than it did before my op.

I had a follow up appointment Wednesday just past and have been told that I will be needing more work doing.  My OS says that although I have cartilage damage I also have done damage in the same area (weight bearing area) and the OATs is not suitable due to the bone being damaged.

My OS has told me some different procedures and I was wondering what your views are? I appologise if i am rambling on.

He mentioned about obtained doner cartilage and bone and doing somethig with that?? I'm not sure what that is about! He also said he is concidering plating my knee either on the side of the defect or on the opposite side and then re-alligning my leg, so that weight bearing would be on the outer side of my leg and not inner.

He said he wont do knee replacement as I am too young? Apparently it wont last my life time?

Maybe someone couldhelp me understand what is being proposed to be done.

Thank you taking time to read through this.

Any comment would be greatly appreciated.

Mat

Offline FormerlyActive

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Re: What Next... Failed OATS
« Reply #24 on: May 06, 2009, 05:40:54 AM »
Hi Mat
Thats a shame. Do they know why you have so much wear for such a young age? That seems important to find out, otherwise you might have some donor cartilage but just wear on it again.
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

Offline michelel

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Re: What Next... Failed OATS
« Reply #25 on: May 06, 2009, 09:41:39 PM »
Hey Matty, Seems to me your OS is talking about OATS but allograft instead of autogtaft.  Allograft means from another source.  What happens is they get donor cartilage and bone from a cadaver, youll be put on a waiting list until they find a match for you.  Then they go in and core out the defect and replace it with the donor cartilage and bone.  I believe it is an open procedure.  You were talking about the alignment issue, thats probably a TTT they take a wedge out of your tibia and thats suppose to shift the weight so that its not wearing on your defect site.  Thats probably the reason for your defect in the first place.The reason he doesnt want to do autograft OATS, is probably because it would entail taking too much cartilage and bone from your knee, that could cause its own probs.   How old are you, and did you have an injuryto cause this defect in your knee?  Well dont hesitate to email me or PM me (if you have enough post 20) if you have any questions.  Good Luck buddy.
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 Peg Leg

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Re: What Next... Failed OATS
« Reply #26 on: May 07, 2009, 02:00:52 AM »
Shelby,

I'm sorry for all the frustration you are having, but unfortunately that seems to go along with knee problems.  Though I totally understand your anger and confusion with your Dr. and his fickleness.  Hang in there and keep bugging the other Dr's office and maybe the squeaky wheel will get the grease.

Matty, I am also sorry for what you have endured.  I, also had microfracture to the MFC area, defect was 1.3x 2cm and mine failed as well.  After mine failed, the defect got bigger and  I had Carticel 8 months later.  Because I also had a small patella defect that continued to grow and become much more problematic, I had a TTT to change the way the patella tracked to unload the defect.  Long story short, continued problems led me to a specialist who told me that my Carticel graft was failing from the bone up and I needed an Osteochondral Allograft, which is where they take bone and cartilage from a donor and implant it like Michele said. The other proceedure he mentioned is resurfacing the MFC or in other words a uni-compartmental replacement and a TTT osteotomy to change the load to the lateral side. There is a lot of information on these proceedures under the arthritis section.  Learning as much as possible is the best way to make an informed decision.  Too often, people go through a surgery only to have complications and THEN they start the research (this was me before microfracture!).  Good luck to you and please keep us posted.

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 #27 on: June 16, 2009, 10:28:22 PM »
Hello all,

So I finally got my appointment with the surgeon in Winnipeg, its September 22, 2009, and I am having an MRI July 29, 2009.  Everything in this part of the country moves soooo slowly. Shortage of doctors, what can I do.

 My knee is the same, I use my cane less and less, mostly because I have gotten used to my limitations and know what I can and can't do. Now I just use it to walk any great distance. It has taken 7.5 months to get an appointment with this surgeon in Winnipeg, now I just hope that there is really something that he can do. I'm not taking pain meds anymore because of my stomach, what does everyone do for that.  Do you have to take some other kind of drug for you stomach to keep taking the drugs that keep the pain under control.

Its been a slow spring doing alot of nothing physically. I need to find a way to get rid of a few pounds before I see this surgeon so that I can do everything I can to make sure I am a prime candidate for surgery.  Any suggestions, Exercise is limited and eating is under control. I do think I am getting a bit down, the process is so long and I have had to wait so long, I just want to be fixed already!!

Thanks for sticking with me guys!!

Shelbylw

Offline embillma

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Re: What Next... Failed OATS
« Reply #28 on: June 16, 2009, 11:15:15 PM »
You can have a  defect before arthritis starts in... Sometimes it's due to a injury.  I tore my acl in college soccer and then went back to playing/running after recovery...apparently it was too soon.  It wore away my meniscus causing a rather large defect (I was told my knee hurt because of scar tissue and that I wasn't causing any damage running through the pain...actually I was wearing more cartilage away)  The defect is the beginning of arthritis but you can catch it before it's full blown!

I had ACI surgery to repair my defect (it has worked as you can see the implant in the mri scans now and it is not bone on bone) but I am still having a lot of knee pain.  The doc doesn't know what it is and wants to scope me out, and/or have me do nothing except bike for the next month and wear my unloader brace (it is a pretty sweet arthritis don joy brace that you tighten with a little allen wrench to take the pressure off one side of your knee)   and see if taking time off helps.  He also mentioned the synvisc injections but said although that might help with pain, it won't solve the root of the problem...since my pain will be reduced I probably wouldn't stop being active .
1998 ACL reconstruction
2005 Microfracturing
2006 ACI
2007 Overgrowth of ACI -trimmed down excess cartilage

Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #29 on: June 18, 2009, 03:29:55 AM »
I had an xray of my knees and hips just recently, a year follow up from my injury to see what a year of limping had done to my body, it was amazing the difference. I had an xray to compare to from my hips only because,like a stated in a previous post, I broke my tailbone in March a year ago, so they had one on file and my knees well, I have lots and lots of knee xrays... My hips have shifted and I now show OA in both hips, more in my right (the one I broke when I was a baby) and OA in both knees, more in the right knee, the damaged one, but almost the same amount in the left because of favoring it.  There is also a decrease in joint space on the right side.  I don't know that I would have been able to prevent it, and it was utterly amazing to me how quickly it was THERE!!

I'm with you. I still have the synvisc in my closet but have not had any of the injections.  I think it could help but not fix the underlying cause of the problem and I have heard that they can be very painful to. I also think that if I create an atmosphere of no pain then I will use it and just cause more damage.

I'm still holding out that my new OS is going to be able to do something to be able to fix me... There is always wishful thinking.

Shelby


Offline Shelbylw

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Re: What Next... Failed OATS
« Reply #30 on: August 22, 2009, 02:51:00 AM »
News!!! I finally got the report from my MRI... All I have to do is ask and I can get whatever I want from my family doc..love him, he's the best!!  Well, its says in the report that there are cystic changes within the medial femoral condyle at the surgical site. The overlying cartilage is thin and irregular. There are cystic bony changes at the site of the previous surgical repair. That's really all it say's, its open to your translation...

I still have to wait until September to see the surgeon, but at least I have the results of this now.  I do have cystic stuff going on in there... Now I guess I just have to wait and see to what extent this all is.  But at least I know I'm not crazy like my last OS was starting to make me feel.  When I left his office last he made me feel like it was all in my head!!  Now I have the proof that it really is in my knee and not in my head...  Hopefully they can fix this.  I don't really know what they are going to do to fix it, maybe another graft, maybe the necrosis treatment? I don't know, just getting frustrated with the long wait, but at least this is a step in the right direction.

Open to interpretation and opinion, realisitially positive please... ;)

Shelby