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Author Topic: Osteochondral Allograft Knee from Cadaver  (Read 32447 times)

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Offline paulofea

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Osteochondral Allograft Knee from Cadaver
« on: March 22, 2009, 09:16:55 PM »
Hi, My name is Paulo and went recently under a Osteochondral Allograft of my Left Knee. I red many times this board so I thought it would be good to contribute to it with my experiences. I will do it like bullet points, with my former main concerns. Also, I am not a doctor, so my advices are really only my point of view.

1/ Allograft from Cadaver - it looks weird .- It  sounds weird, but this technique is quite old (more than 20 years being done) and results have been good. Around 70-90% success rates.

2/ Is that safe in terms of diseases transmission?- You have to make sure your surgeon works with accredited tissue banks. Generally they are very strict in terms of safety rules. Some told me that I have more chances of dying from a car accident on the way to the surgery than from a disease from the graft itself!

3/ What kind of allograft do I need?- Please avoid frozen allograft. Many studies have shown frozen allograft have lower adherence to old bone. Make that very clear to the surgeon. ask him which kind of allograft he uses. Better yet, ask him the advantages of fresh over frozen. He needs to have a very clear answer for that. If don't, beware he may not have much experience on the field.

How long it takes to find a Donor?- For me was 3 months. But it depends on your size and weight.

Assurance approve it?- Yes it did. But I know some insurance have restrictions. Some doctors will help you getting it approved. I know that if the procedure is done by an specialist that does these procedures a lot, it is easier to get it approved from Insurance. Basically the doctor knows how to ask it and the insurance knows the doctor competences.

How to chose your doctor?- I did the surgery with doctor William Bugbee, from San Diego. And I live in Miami. After reading a lot on the internet I could figure out that MD Bugbee, MD Tom Minas and MB Brian Cole are the best for these kind of procedure. I visit Bugbee in November last year and had my surgery with him on March 16th.
- It was worth all the wait and to fly from Miami. He is an awesome doctor, very confident. He also gives you confidence about the surgery. His nurse and staff are also very professional -The kind of people that call you when they say they will (basic thing that few people do) and that are very helpfull.
- I visited many surgeons prior to Bugbee and even if they told me they could do the surgery, I was not so confident. I got very specific questions like - Which kind of drill you will use,or, how many days the allograft can wait for me,or, which are the success rates for this procedure, or, how many procedures like this one did you do in the past, or, when was the last one?. I was amazed that in some occasions, I knew more than doctors I visited.
- When the anesthesia guy put the gas mask on you, on the day of the surgery, you don't wanna have second thoughts about the doctor you choose. It will be too late. This is a little dramatic, but when they put me to sleep, I was very confident and happy with my doctor.
- The hospital you will have surgery is also very important. The hospital have to have all the right equipments for your kind of surgery. In my case, I was operated at Scripps. Very nice hospital. Everyone so helpful and nice. When you are in Pain, you dont want any arrogant and helpless people around. Scripps staff was great.

How did you manage post operative and to fly back?- I stayed one week in San Diego after the surgery, so I would have a better fly back. I also flew business class. Forget flying economy for more than 1 hour, it would have been very painful.
- You have to move around the plan with crutches and to do heel pumps a lot.

I will give some updates later on, to say how things go.

2 weeks after surgery
So, today I am 2 weeks after surgery. From day one I was "toes down only" weight bearing and full range of motion. No braces and no CPM. That for me was weird because everyone I talked to had the CPM machine, but well.

Amazingly, I had no pain and still don't have much pain. The femoral block last like 3 days, and the pain meds every three hours realy killed the pain. Right now I am taking every 12 hours and sometimes theres is some pain, but I ice it and it is gone.
Last week I went to the office (work) 2 days. Found an empty conference room to work from and put my leg over another chair. It wasn't so bad. But I think this week I will work from home, as my boss will not be in town. The most you keep your leg up, the better.

I also started physiotherapy. I got 90 degrees of ROM and started doing some new exercises, as straight leg raising. Before surgery, for 3 months, I used to train straight leg raising at least 3 times a day, I think it is paying off, as the muscle is reacting now faster, but I really lost a lot of muscle - in just 2 weeks, amazing.

Other than that, I ve been constipated, but the laxative is working fine.

Next wednesday I have appointment with a doctor in Miami for the follow up. Lets see what he tells me,

4 Weeks after surgery


Today I am 4 weeks after surgery. I went to the miami doctor for follow up  a week ago. Pretty standard - 30 seconds with him, and said to keep doing what I am doing.

No Pain, swelling went down a bit. Still 25% weight bearing. 115’ ROM Flexion  and -8’ extension.

I can’t feel much of the skin around the scar, what gives me a weird sensation when I touch it. I red about it and some theories say that when they cut through the skin and flesh, they also cut some small nerves/receptors on the skin, and this is what causes the “numbness” around the scar. It makes sense.

I have appointment with OS in ten days, so lets see what he says.

My back and hands were really hurting from the crutches. So I decided to get new crutches (millenium with shockers). I really recommend it. I cost me 80 USD at amazon.com.

I am also very bored. Haha.

By the way, one very important piece of information. While in pain killers (Vicodin or Oxycodine) don’t worry if your sexual functions are dead! Nobody told me that and then I was a bit worried. But after about 1 week from the last pain killer pill everything went back to normal.

I also just got the bill from the surgery. Everything together neared the 6 figures. Hopefully the insured paid for it. I would suggest you check and recheck with your insurance and health provider that everything is ok before the surgery. You don’t want to have this kind of financial liability because things were not set properly.

Bye.



6 Weeks after surgery

Went to the doctor in Miami, but no big revelations – just the “ everything fine, keep doing what you are doping” thing….

The knee is improving a lot, the swelling went down and the flexion and extension is very good. No pain at all.

I started doing stationary bicycle today, it was good. Did it for 5 minutes without resistance.

I also had to travel to Brazil on a business trip. I thought it would be terrible, but it was not. Everything went fine. Actually, the assistance service many airline companies have helps a lot. They take you on the check in counter and bring you to your sit inside the plane. No hassle. I also was on business class, as economy is not an option right now. I think that helped as well.

I am also doing some walking inside my condo pool. Because of water resistance, I can walk normally without compromising my 30% weight bearing restriction.

I am starting to be tired of crutches. They are really annoying.

In two weeks I have an appointment with doctor Bugbee in San Diego, I am anxious to see what he says. I think if the xray looks fine, he will tell me to go down to one crutche.


10 Weeks after surgery

The knee is doing great, swelling is down (almost normal), no pain at all, flexion and extension are great.

I had, though, a tense last two weeks, because when I sent the XRays to Dr. Bugbee (I am in Miami, he is is Sand Diego) I notice a white spot that looked like a loose body. I was really afraid, as if it was a loose body I would need to operate again to remove it and if it was a loose body coming from the implant it would mean it had failed and I would need to do another cartilage transplant.

Well, Dr. Bugbee call me back and told me it was not a loose body, it was a calcified piece of tissue. Nothing to worry about...what a relief.

Then some days after that, his assistant call me and say he will be in Miami and if I would like, I could see him here and avoid a trip to San Diego. Can you imagine that? I don’t remember the last time this kind of thing happened to me: Without asking, someone proposes something that will help you out! To tell the truth, I had a general disbelief in all doctors, as my past experiences were sooo bad, but I can tell you that I started believing again when I became a patient of Dr. Bugbee. I know it looks cheesy, but it is the true, he and his assistant where so nice to me, and so competent.

Ok, so, I meet him in Miami and he told me the xrays looked fine. The knee had no fluid and the graft should be healing ok. He advise me to start walking with just one crutch for 1 week and then without crutches. He also told me to keep doing static bicycle and the PT exercises – quads, hip, etc.

It was a bit strange for me to start walking with just one crutch, but after one/two days I could manage without any problem. In 5 days I will start walking without crutches.

So, I think my next post will be at 24 weeks after surgery, when I will go to San Diego for a follow up. Bye, bye.






« Last Edit: May 25, 2009, 10:44:43 PM by paulofea »

Offline juieb

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #1 on: March 29, 2009, 05:36:58 PM »
Thank you so much for the information on your OATS surgery.  At this time, I am waiting for tissue availability from a cadaver.  I was told 3 days to 3 months and have passed about half of that time. Please keep us updated on your progress.  How long do you expect to be off work?  How long NWB?  Thanks!!
LK scope May 2008
LK OATS May 2009
LK scope Sept 2010
RK scope Dec 2011
LK Uni scheduled Dec 2012

Offline paulofea

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #2 on: March 30, 2009, 03:05:40 AM »
Hey, good for you, hope you all the best. I put a update on the main post. see you.

Offline aturpin

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #3 on: April 17, 2009, 09:56:41 PM »
Hi paulofea,

Thank you for posting your exeriences.  I am particularly interested in your recovery and post-op protocol becuase Dr. Bugbee is my doctor too.  Back in December, he performed a distal femoral osteotomy on my left leg to correct my alignment.  The next procedure in store for me is OATS (we just wanted to make sure that I had good alignment so the cartilage would last as long as possible).  I am curious on how you are doing with pain, how long you have to be NWB, if you ultimately get relief from the new cartilage, if it takes and the procedure is successful, and how long until you started feeling like yourself again. I know these are a lot of things so I will continue to follow your blog.  I also have a blog on the "Changing Forces Through the Joint" board.  Thank you again for the info and continued luck and success to you in your recovery.

Offline JosieS

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #4 on: April 20, 2009, 06:22:11 PM »
I had OATS done in Oct 07 LK.  I was on crutches still in Jan/Feb 08.  Off of crutches in the Spring with many limitations as far as walking, bending, normal everyday things were limited.  I began bike riding and by the end of the summer/fall I was doing pretty well.  I began doing more weights (light weights) and yoga/pilaties in the winter.  I also had surgery on RK, all the knee bends and probably other exercise moves really stressed both knees out very bad.  Both knees burn & hurt to stand & walk.  Unbareable pain, it's been 7-8 weeks now.  Anyway, went to OS Feb 09 and he told me to come back if the pain is unbareable for more surgery.  He did not tell me a diagnosis or take xray's.  I went to another OS who took X-rays & MRI on both knees.  Unfortunatly for me the OATS procedure failed and also the area of the donor site is greatly compromised causing pain as well.  The OS who did the surgery used a donor site on the same site as where the plug went (from the most supra part where non weight bearing). I'm in PT now hoping to not have more surgery.  The thought now is if this pain does not go away I may be facing TKR.  I'll say prayer for you that you have a better out come than I.  I've heard that the OATS procedure does not have good results.  If it works your saved from further surgery. 
Arthroscopy RK 01/2007
Chondroplasty & Mircrofrac MDC RK 01/2007
Chondroplasty Medial Facet Pat 1/07
Partial lateral menisectomy RK 01/2007
Resection of MP RK 01/2007
Partial synovectomy RK 01/2007
Arthroscopy LK 10/2007
Partial lateral meniscectomy LK 10/2007
biopsy & OATS-(failed) LK 10/07

Offline lis1

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #5 on: April 20, 2009, 06:48:44 PM »
i had 12 plugs done from NWB section of the same knee in  June last year......... was on crutches for 10 weeks and now at 10 1/2 months post op am having no formal pt but my physio is still keeping an eye on me and restricting how much i do until the one yesr mark, which is when the acl may have to be revised so it will start kinda all over again.

At times it feels as though this knee saga will never end, but i have to remember that in the grand scheme of things i am so much better than many others and that there is a lot i can do even though it is not at the level i was before, or at the same intensity.

I am in the uk and i am also a kinda guinea pig in that my OS has never done as many plugs on one person as he has done on me, my defect was large, and ultimately larger than he thought prior to going in.

I do still even now get some donor site pain, and the non working acl is starting big time to be symptomatic, but the oa pain has seemingly gone, so i would say at this early stage that indictaions are that it has worked.

Lisa
remidial meniscemtomy 1994
scope and tidy up july 2006
acl reconstruction and microfractures oct 2006 (failed on both counts)
oats june 2008 - very successful
acl revision patella tendon - oct 09

Offline juieb

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #6 on: May 03, 2009, 03:01:56 AM »
It is so good to hear your updates and that you are doing good so far. Tissue has become available for me and my surgery is scheduled for May 5.  I am excited and nervous and can't wait to get over with.  My biggest concern right now is the 6 weeks NWB after surgery. I have also been told that I will not have a brace or CPM after surgery.  I will try to get an update out in a couple weeks.
LK scope May 2008
LK OATS May 2009
LK scope Sept 2010
RK scope Dec 2011
LK Uni scheduled Dec 2012

Offline paulofea

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #7 on: May 03, 2009, 04:54:41 AM »
Good luck juieb, I am sure you will be fine.

The first two weeks are a bit tough, you have to adapt to the crutches and to the non weight bearing. But I would say after that, things get easier, and time just flies. Before you know, it will be 6 weeks pos op,

bye,

Offline paulofea

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #8 on: May 25, 2009, 10:45:23 PM »
Put a new update, bye

Offline juieb

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #9 on: May 31, 2009, 10:39:52 PM »
Thanks for the update, Paulo.  It sounds like you are doing well at this point.  I was glad to hear that you did not have a loose body that would require another surgery.  Did you stay on two crutches for the ten weeks then? 

My update:It has been 3 1/2 weeks since my surgery.  My OS only had to repair one sight instead of the two that he had thought he was going to repair.  Since he already had the cadaver tissue available, he used it for the entire plug.  I think that I got lucky that they didn't have to use any plugs from me.  The scar is looking good but I do still have some swelling in my knee and foot. The pain is manageable for the most part.  Sleep is very restless and I have to be very careful moving around.  I go back for my six week visit and expect to be released to partial weight bearing at that time.  We shall see. I am off of work until after my six week appointment. 

Update 6/24/09
:  It has been seven weeks since surgery and one week off of crutches. My OS took x-rays a week ago and said that everything looks good so far. It is very nice to be off of the crutches and back on my own two feet.  He did say that I can get back to everything except for jogging, which I can do in two weeks if I want.  I have had quite a bit of pain around the knee but it seems to be subsiding. Learning to walk again seems strange also.  I wore an unloader brace for 11 months before surgery and now I don't need it.  I have to retrain my muscles and regain the muscle that I lost.  It does seem to be going well, just a little slower at this point   
 
« Last Edit: June 26, 2009, 02:03:27 AM by juieb »
LK scope May 2008
LK OATS May 2009
LK scope Sept 2010
RK scope Dec 2011
LK Uni scheduled Dec 2012

Offline jc2545

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #10 on: June 20, 2009, 03:36:17 PM »
Hi folks -

My first post here.  I injured my RK on 12/26/08 while at work.  Injury diagnosed as osteochandral defect on lateral femoral chondyle of right knee.  Also had small fracture of patella and very small tear of medial meniscus.  Had arthroscopic surgery on 3/2/09 to remove loose body (bone chip from femur), debridement of meniscus, and had small holes poked in patella around fracture.  After that surgery went well, was put on waiting list for cadaver bone/cartilage.  Finally got donor graft and had Osteochondral Allograft Transplant on 6/12/09.  Had good advice from physio about 'loading up' on pain meds prior to the nerve block wearing off, and after reading comments on this site, am sooo glad I did.  Pain is manageable now, hardest part is crutches and no weight on knee.  According to OS I will be NWB for about 6 weeks.  I already have the CPM but he wants to wait 2 or 3 weeks to let the bone graft set before I start it.  Also have a machine called 'gameready' for cooling the knee.  I've seen it called many names, but its basically a sleeve that wraps around the knee and then has ice water circulated via a pump through the sleeve.  Also has a compression option.  The combo of the cold and compression has made a huge difference in the pain and swelling of the knee.  I'll keep updating on my progress and any setbacks, and would love to read other posts as well.

Take care,  jc

Update 7/8/09:  Still NWB on knee, really getting tired of crutches!  8 hours a day on CPM machine, up to 96 flexion and -06 extension.  Doc still wants me NWB for at least four more weeks and continued use of CPM. 
« Last Edit: July 08, 2009, 01:55:11 PM by jc2545 »

Offline razmataz

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #11 on: September 03, 2009, 09:01:12 AM »
Hello Paulofea.  I am scheduled for an osteochondral/meniscal allograft on Friday, 9/11 (I know, the date is scary) by Dr. Bugbee.  What I find especially strange and coincidental is that I had an arthroscopic surgery on my left knee by Dr. Bugbee on March 16, 2009!  Before my surgery he told me someone from Miami had flown out to get an osteochondral allograft and that was the moment I knew I was in good hands.  Any regrets about the surgery/Bugbee?  I got very lucky because I live in San Diego and Bugbee is within my HMO... this surgery (already approved by insurance co.) is going to cost me nada.  Well, just thought I would note how small of a world it is; happy healing.

Offline paulofea

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #12 on: September 04, 2009, 05:56:32 AM »
Hi Ramataz,

Wow, what a coincidence...this world is sure such a small world,

No regrets at all about Dr. Bugbee, he is just the best. No surgery is exempt of risks, but only 2 or 3 doctors in the world have the same experience as dr. bugbee when it comes to osteochondral allograft surgery. So, you are in good hands. By teh way I am 6 months after surgery and my knee fells great.

In addition to that he has a very professional nurse, Ms. Thara Robbinson, she is also great, will help you with all operational stuff.

One tip for you: Maybe you can benefit of homecare (for physiotherapy) for the first 1 or 2 weeks. it means that someone comes to your home to give you PT. I couldnt because here in Miami is different. It sure would help, as after surgery it is difficult to move around. Ask Thara.

Good luck

Offline swalk

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #13 on: September 28, 2009, 07:27:20 PM »
Hi Ramataz,

Wow, what a coincidence...this world is sure such a small world,

No regrets at all about Dr. Bugbee, he is just the best. No surgery is exempt of risks, but only 2 or 3 doctors in the world have the same experience as dr. bugbee when it comes to osteochondral allograft surgery. So, you are in good hands. By teh way I am 6 months after surgery and my knee fells great.

In addition to that he has a very professional nurse, Ms. Thara Robbinson, she is also great, will help you with all operational stuff.

One tip for you: Maybe you can benefit of homecare (for physiotherapy) for the first 1 or 2 weeks. it means that someone comes to your home to give you PT. I couldnt because here in Miami is different. It sure would help, as after surgery it is difficult to move around. Ask Thara.

Good luck

Offline keithap

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #14 on: October 21, 2009, 03:07:57 AM »
So how are things feeling six months out?  I've been on the list for sometime at the Hospital for Special Surgery in NYC.  I've had 5 prior operations, with 2 ACL-R's and a meniscus transplant as well.  This S++t has been hurting for sometime, and I work as a physical therapist so the job is tough.  Haven't met too many others with this procedure done, I have grade IV problems in the medial trochlea groove and the medial compartment.  ANy tips would be great, hopefully this happens sooner than later,

Thanks,

Keith Pacific
Keith Pacific PT, ATC, CSCS

Offline juieb

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #15 on: October 24, 2009, 02:31:23 AM »
Hi, Keith.  I had my surgery May 5, 09.  I started PT before I was off of crutches and was going 2X week until insurance coverage stopped at the beginning of October.  I was getting a lot better after surgery.  Then my knee started hurting again.  I had another MRI at the end of September.  The best news that came of that is that everything is intact from the surgery.  My OATS was a success! Now my TCL is inflamed. Probably from me pushing myself too much. I have been working out six times a week, so I will be taking it easy the next couple weeks. 
My tips include listening to your doctor, question anything you don't understand or if it doesn't sound right, and most importantly - don't push yourself too much.

Take care,
Julie
LK scope May 2008
LK OATS May 2009
LK scope Sept 2010
RK scope Dec 2011
LK Uni scheduled Dec 2012

Offline joquijada

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #16 on: April 19, 2015, 01:15:14 AM »
Hello, I know this is an old thread, but I had my surgery yesterday Friday April 17th, 2015. I had osteochondral allograft on my left knee. This was my diagnosis:

- Chondromalacia of patella
- Disorder of bone and carilag

I am a 40 year male. Mind you this is my third surgery (my first surgery took place in Spring 1995, my second took surgery was in October 2004.). My first two surgeries, especially the second one, vastly improved my knee condition. I believe this 3rd one will be the last as my doctor rassured me that allograft is a much more definitive solution. My Dr by the way is Robert Meislin from NYU Hospital for Joint Diseases. He's very good, and he performed my second surgery as well. I was 100% happy and extremely confident in this doctor's competence. He was quite pleased with how surgery went, and so am I.


In additional to light general anesthesia, I also had a nerve block which I don't think has worn off  completely yet. I'm taking Oxycodone every 6 hours for pain, 2 aspirins every for hours to fend off blood clotting, and one antibiotic every 6 hours to avert any potential infection.

I have a fully extended and locked knee brace. I'm to start CPM machine today bending at 25 degrees 4 times a day, one hour at a time, for a total of 4 hours per day. Each day I have to increment 5 degrees of bending. Despite pain killers I am in moderate pain right now. I've been icing using a frozen bag of peas, and I find it works better than ice cubes. Maybe this is because the shape and size of the frozen peas helps distribute ice coverage more evenly, who knows. Also I've bee keeping the leg elevated. I feel numbness in the inside of my calf as well.

My doctor said I'll be on crutches for 6 weeks. I have appt in 8 days, at which time I'll learn when physiotherapy will start.

I'll update on my progress later.
« Last Edit: April 19, 2015, 01:17:19 AM by joquijada »

Offline paulofea

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #17 on: December 09, 2015, 06:53:57 PM »
Hello, an update after 6 years Allograft:

I am now living in Swtizerland, and start felling a weird sensation in my knee. It start from nowhere and in a couple of days I had a clicking sound and an unstable knee.

Went to local doctor, got MRI/X Rays and two loose bodies were identified.

Had an Arthroscopy to remove the loose bodies and the doctor identified a piece of the allograft felt, and was the origin of the loose bodies. Also had a meniscus tear.

He said the rest of the allograft looks ok, and did some drilling on the damaged part, hoping to create some scaring tissue to protect the bone.

It is quite disappointing, as I was so good for so long. I think I may had pushed a little bit too much...was playing football these last 6 months....and this may have stressed the joint.

Well, back in the fight now.


Offline razuzin

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #18 on: December 10, 2015, 08:06:52 PM »
Hello paolofea,

what part of the knee was your allograft in, weight-bearing or NWB?
What was approximately the size of the allograft?

Has the doctor considered using an autograph?

Thank you.

Offline msiniscal

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #19 on: March 29, 2016, 10:14:01 PM »
Hi Paolo,

I'm getting an Allograft within next month at HSS in NYC. How old were you during surgery? Did the doctor attribute soccer as cause of joint break down?

Offline razuzin

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Re: Osteochondral Allograft Knee from Cadaver
« Reply #20 on: March 31, 2016, 01:06:38 AM »
Hi Paolo,

I'm getting an Allograft within next month at HSS in NYC. How old were you during surgery? Did the doctor attribute soccer as cause of joint break down?
hi msiniscal,
I'm curious who your surgeon is. I'm seeing Dr. Williams at HSS and contemplating a similar surgery.
By the way, he just published some results of allograft surgery for 40+ year olds.

Have they found a donor for you?