Banner - Hide this banner





Author Topic: What Next... Failed OATS  (Read 16463 times)

0 Members and 1 Guest are viewing this topic.

Offline Robin M.

  • Forum Faithful
  • ****
  • Posts: 496
  • Liked: 0
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
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.

  • Forum Faithful
  • ****
  • Posts: 496
  • Liked: 0
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
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.

  • Forum Faithful
  • ****
  • Posts: 496
  • Liked: 0
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
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

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
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

  • Forum Faithful
  • ****
  • Posts: 365
  • Liked: 0
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

  • Forum Faithful
  • ****
  • Posts: 295
  • Liked: 0
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

  • Forum Faithful
  • ****
  • Posts: 495
  • Liked: 0
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 25
  • Liked: 0
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
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
















support