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Author Topic: Was supposed to do ACI surgery tomorrow but the chondrocyte preparataion failed  (Read 9917 times)

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Offline sjunkerg

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So, I was supposed to do the whole ACI surgery with a Maquet tomorrow but was told two days before the surgery (i.e. yesterday) that the lab had not been able to expand the cells to the extent needed during the last phase of the grown procedure. Totally bummed out as I had everything arranged for doing the surgery and the rehab. I will now get another bonus surgery tomorrow just to do the biopsy again (I had the original biopsy done during a clean-up procedure in February when the lesion was discovered). The ACI procedure is now tentatively scheduled for November.

How often does the preparation of the chondrocytes fail? Has anyone else here gone through a similar issue and then been successful on the second time around? Apparently, the cells were just under the quality limit they had so it was close but not quite there.

Offline sjunkerg

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So I ended up just doing a cartilage biopsy last Friday. The procedure was quick and my OS also cleaned up some scare tissue from my original scope back in February. I am now a week out from the biopsy procedure and recovering well. I can walk pretty well without any pain and even up and down stairs without too much trouble.

The ACI procedure is now re-scheduled for 12/7. The main fear and concern now is that I will have the same bad news a couple of days in advance of the next procedure and the ACI will not happen (again). The OS is thinking about securing some Denovo material as a potential backup so the surgery can go ahead regardless of the outcome of the carticell growth success or not so I am spending quite a bit of time at the moment reading up on Denovo.

For now, it is back to PT for the next month to recover from the "bonus surgery" I just had and getting ready for December and once again reorganize my life for a couple of months of down time focused on rehab and telling everyone that it is for real this time (maybe).

Offline OCD in Portland

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Wow Sjunkerg, that really sucks.  I have never heard of that, but I had also never heard of ACI until last January when I was surprised with the need for it.  After my insurance approved it I was able to get my cells grown in two weeks with no issues, and I'm doing my other knee December 16th with left over cells from my orginal biopsy in January.  It seems really strange to me that they didn't know waaaay earlier that your cells weren't going to work, but I don't know exactly how it works.  If I were you I would call the Carticel rep and talk to them about it.  They can probably provide some details how often that happens, how likely it is to happen again, and provide status along the way.   And finally, I know it really sucks to prepare for the surgery and then have it pushed out, but the whole things sucks, and you get through it, and when it's over you won't remember details of why it sucked, or care that it took 4 weeks longer or 2 months longer, as long it works all will be good.   ;)

Offline sjunkerg

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Supposedly, it failed to reach specifications during the very last step of the lab process and I really hope they informed me as soon as they knew it was not going to happen. I have talked to the carticel rep directly about the process and whether to harvest new cells or try again with some of the leftover stuff. In this case, the surgeon thought it best to get some new cells and thus the second "bonus" surgery three weeks ago. I now have 5 1/2 weeks left until the next ACI attempt.

cdubb

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sjunkerg,
That actually recently happened to me also.  Not to the extent that it was cancelled right before surgery, but US bio got my cells out when we were starting the process for my right knee.  I had ACI with a TT to my left knee last November and am moving forward with my right knee now.  We were getting the insurance auth in place and my docs PA called to tell me that US Bio called them about my cells and it didn't look like they would be able to expand them.  They took them out on a Friday and said it didn't look good and tried to do something with them over the weekend, but that still didn't look good, so that is when my docs PA called me.  US Bio could still have tried, but there was a very high chance that surgery would be cancelled in the day or so prior to surgery...like what happened to you.   I was told that it was pretty unusual for that to happen.  Instead of getting a new biopsy, my Dr. opted to switch to DeNovo NT as my graft material.  I'm scheduled in December for that with the TT again.   My cells the first time around also took 30 days to proliferate, but I thought that was normal...but I see below that some people have had it done in 2 weeks.  I'm told that my initial ACI graft done last year isn't compromised...but it sure makes you wonder???

Offline cookstar100

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Hi sjunkerg, I had my MACI graft done in Feburary of this year however had a similar experience with the biopsy. My cells actually grew an infection whilst growing which meant they had to get rid of them and I had to reschedule for operation. A month after getting the original cells I had the cells taken out again and then in February had the impantation. I was extremely concerned that the cells might grow an infection again however everything worked out well. I am now 10 months post surgery and am now allow to perform small jumps (on a mini tramp) and also jog on a smongy ground. Jogging is still painful but am in the process of building up strength within the knee so hopefully things will continue to work out. Hope your operation works out for you.
2008 Left knee Lateral Release; 2009 Left knee cartiledge tear requring arthriscope & patella microfracture; 2010 2 x left knee athriscope; 2011 left knee patellofemoral MACI

Offline sjunkerg

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I am exactly half-way between the "bonus" surgery described above and the ACI surgery in early December. I have found out that carticel have changed their lab criteria this year and after doing that, they seem to reject more often than they did before. It is kind of an interesting situation where it does not benefit them financially to do this change but if it really makes a difference in surgery success rates, I am thankful that I am having my knee done after the change. Apparently, the failure rates are as high as 30% these days in growing the material. I have not yet found out how often it happens as close to the surgery date as it did for me.

My situation is a bit weird in that I really only have occasional pain in my knee right now and have few problems day-to-day but I am no longer able to do what I used to enjoy like running etc and every so often, I end up having bigger problems and have to do a couple of months of PT. I am thus about to change what is a fairly normal existence for the most part for a lot of recovery work for a long period of time. If I can go back to doing triathlons and skiing again and avoid a total knee replacement, it will all be worth it in the end.

cdubb

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Good luck on your surgery. I'll be about a week behind you with a Dec. 13th surgery date. Since we're both having TT's, we'll be essentially on the same recovery track.  We should compare notes as we go!

Offline sjunkerg

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Just got the word this morning that the production step worked for the next attempts and three vials are being flown in from Boston tonight. Given how much the cost to produce, I am assuming they are flying business class. Surgery is on Wednesday so less than 48 hours until they are installed.

cdubb

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I'm sure that the cells are overnighted!  They are ridiculously expensive to proliferate....my EOR last year came in at $61K...insurance negotiated rates was about $32K..but yes...crazy expensive! Good luck!

Offline sjunkerg

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Ok. Surgery now done and back home. We got a late start on Wednesday and I was not rolled in until 6 PM. I got a femoral nerve block and we were off to the races. ACI implantation, TTO and removal of old hardware in patella from 1996 surgery. They got done at about 9 PM and I remember pretty much nothing until I was in my room at 11. Got on the CPM machine around midnight and ran it pretty much continuously throughout the night at 50 degrees.

I was fairly nauseous on Thursday and had to stay until today, Friday, before getting discharged. I can't imagine doing this surgery outpatient. It would have been very rough.

cdubb

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Glad you're home.  Outpatient really wasn't bad...and I didn't even have a femoral nerve block.  I was discharged about an hour after I woke up last time...rolled into surgery at 2:30 pm, woke up about 5:30 pm and waiting for the valet at 6:30 pm.   I hope round 2 goes as well on Tuesday and I do just as well at home as I did the first time. 

Are you still at 50 on the CPM? I wasn' t allowed past 40 for 4 weeks, but that could be the patella vs. trochlea difference?

Offline sjunkerg

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I could not make it to the bathroom for almost 48 hours after surgery. Got really dizzy as soon as I got vertical.

I am at 85 deg right now after ~12 hrs / day. OS wants 90 deg after first week so I am ahead of schedule at this time.

Offline Rennschnecke

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I guess the difference is how we each respond to anesthesia sometimes people get very low blood pressure following surgery.  I know that I don't which makes me a good candidate for spinal (apparently!).

Now you're able to be a bit more upright it sounds like you'll be doing fine!
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope debridement, trochlear cartilage lesion (Gr4); 12/08 Scope chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope LOA, IPCS & patella infera; 9/10 Scope AIR & LR.

Offline OCD in Portland

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I just got my ACI with a bone graft on the 16th, went great.  Glad you hear you guys are doing well as well.   I definitely couldn't imagine leaving the hospital same day.  Both this time and with my other knee last February I went in Friday morning and left Sunday.  For both surgeries I had a 8-12 hour period of really bad pain in the first 48 hours and I would not have wanted to deal with that at home.  I'm home now, hanging out in my CPM.  My doc wants me at 90 before two weeks, but I haven't gone above 75 yet, I really need to get on that.  90 is my max based on location of my lesion.  It's interesting doing the same surgery twice, especially in the same year, as I have expectations don't really hold true.  This time there is almost no swelling, but the pain is taking longer to wear off.  Last time I was off pain meds no problem 5 days after surgery, I'm 9 days out now and need light meds to get around.   Definitely hope that goes away soon.  The combo of the pain meds, anti-biotics, and residual anesthetic I feel pretty crummy right about now.















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