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Author Topic: Looks Like I am Having OATS Procedure, Are The Alternatives Any Better?  (Read 6174 times)

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Offline wokeye

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I had a high tibial knee osteotomy 2 years ago and also had TruFit CB plugs fitted to repair a large hole where a piece of cartilage had come away from my medial condyle. The surgeon told me that the plugs were the preferred option as the hole was to large to be repaired with a bone graft (autograft). My knee has never felt right although I have rarely been in pain, have just felt uncomfortable and have never seemed to be able to build up my quad muscle no matter how hard I tried.  4 months ago I was fed up of the constant stiffness and walking with a limp and went to see the surgeon again.  He suggested removing the metal retaining plate that was used on my tibia for the open wedge osteotomy.  He also said that he would carry out an arthroscopy at the same time to see if there were any other problems with my knee.  I asked about an MRI scan prior to the operation but the surgeon said that this would not be necessary as the x-rays showed things to be fine.

After the operation the surgeon told me that the Trufit plugs had not taken and were a mess.  He told me that as the osteotomy operation was designed to put the weight bearing onto the outer side of the joint it may not matter.  He also said that he had removed some dead cartilage and scraped something to cause it to bleed in a hope to stimulate the cartilage to grow around the plugs that were still in place.

I have just been back to see the surgeon as I am now 6 weeks post operation.  He said to give it another 6 weeks to see if my knee gets any better and that the discomfort that I feel is probably due to the plugs not taking.  If it is not getting better after the 6 weeks an MRI scan would be done with a view to carrying out the OATS procedure with donor bone coming from my hip.  This bothers me as in the first place I was told that the plugs were used as the defect in my medial condyle was too large for an autograft.  Other concerns that I have is that I have read about donor site morbidity and I have also read quite a lot on here of the procedure failing and being extremely painful.  Although I find it hard to believe that it could be any worse than the osteotomy operation that I had as that was totally awful and the pain was unbearable for quite some time.  But then again it was my first knee op so now I have a better idea of what to expect.

I am just wondering about alternative procedures such as an allograft or an autologous chondrocyte implantation. 

Any advice would be greatly appreciated as I am not totally clued up with all of these procedures and I am also not looking forward to the possibility of being laid up again for several months as the operation in questions appears to be a bigger procedure than I was expecting.   

Offline Sam451

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I have had an autograft which failed. After much research I have found that allografts have a greater success. That is what I just had done. I hope that it worked. I am nearly 14 weeks post op but not sure if it worked. My surgeon seems confident. Good luck to you. If it wasn't for my job I would want a knee replacement instead. Four surgeries has taken it's toll on me and my knee.  That being said I would make the same decision to have the surgeries because I want to stay in law enforcement and would go through it all again if it meant I could keep my job.

Jenni
Nov 09 Torn MCL, Articular Cartilage & Lateral Meniscus
April 10 Microfracture Failed/menisectomy
Dec 10 Autograft
Sept 11 Chondroplasty
Nov 11 Allograft MCL Recon
Jan 13 Chondroplasty, Lat Release
May 13 TTO/Lat Release
Dec 14 lat retinaculum repair
Nov 15 screw removal tighten lat retinaculum

Offline mccartjt

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Wokeye

Far be it from me to pour cold water on any surgeons work  but if all you have as a tool is a knife then it looks like someone is going to get cut. I personally don't like someone elses tissue inside me be it that they were already dead. Within the next 12 months there's going to be a new procedure out there for people with knee problems and a viable alternative for regrowing cartiliage.

We patients have waited long enough. Check out this website http://www.klsmc.com/in-the-news/insights/85-articular-cartilage-regeneration-with-stem-cells.html for ideas of what is coming down the surgical turnpike..

Offline wokeye

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Thanks very much for taking the time to reply it is certainly food for thought.  It is interesting what Jenni stated about allografts possibly being more successful. I would of thought that your body is more likely to reject a transplant from somebody else's body than your own.  But again I am pretty inexperienced with all this and wish that I had researched things further prior to my first operation.  It just annoys me that surgeons do not seem to want to do MRI scans, probably down to cost.  Then again I have private insurance through work, but then again nobody wants to spend money anymore in the current climate.  That is some interested reading there mcartjt, thanks for taking the time to post it, it is certainly very interesting and also a bit of hope for people with knee issues.

One thing I am not sure about again and I really need to research it more, is that so far what I have read on here and with talks with my surgeon is that the last course of action usually seems to be a TKR.  I work with a guy whom had a partial knee replacement 10 years ago.  He is overweight and also works as a mechanical fitter and is often on his knees.  He seems to have done very well from this procedure, but I guess everybody is different.  There must be some reason why replacing all the knee is preferable to just replacing the damaged part.  I need to research it more.
« Last Edit: March 07, 2012, 08:37:35 AM by wokeye »

Offline izzysmama

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Hi there,
I too am scheduled to have an autograft OATs procedure on April 17th and am stuggling with this decision.  My defect is large and I was told by my first surgeon that I would need an allograft procedure.  This surgeon believes that he can so an autograft procedure instead and basically said that he doesn't do allograft procedures unless he has no other choice because of the low success rate.  My struggle is that I am in virtually no pain and function relatively normally.  I am very active and work out at least 3 times a week.  I don't run but can use the eliptical just fine.  There is no pain going up or down stairs or walking.  I can even jump up and down without pain :) My knee does occasionally lock up but is easy to unlock.  The 2 drs I have seen say that I am extremely lucky but that they expect the defect to grow larger and start causing problems within the next few years.  At this point I'm almost wondering if I should just wait until I need a PKR or a TKR as the recovery from both seems easier than the recovery from the OATS procedure.  I am seeing the ortho that treats the Patriots and the Red Sox so I know he is good but I am still worried.  Looking for opinions on what I should do. I am so scared that I am going to end up worse off and that the procedure won't work and I'll have to have knee replacement immediately. Thanks to all! 

Offline NickCat11

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Hi there,
I too am scheduled to have an autograft OATs procedure on April 17th and am stuggling with this decision.  My defect is large and I was told by my first surgeon that I would need an allograft procedure.  This surgeon believes that he can so an autograft procedure instead and basically said that he doesn't do allograft procedures unless he has no other choice because of the low success rate.  My struggle is that I am in virtually no pain and function relatively normally.  I am very active and work out at least 3 times a week.  I don't run but can use the eliptical just fine.  There is no pain going up or down stairs or walking.  I can even jump up and down without pain :) My knee does occasionally lock up but is easy to unlock.  The 2 drs I have seen say that I am extremely lucky but that they expect the defect to grow larger and start causing problems within the next few years.  At this point I'm almost wondering if I should just wait until I need a PKR or a TKR as the recovery from both seems easier than the recovery from the OATS procedure.  I am seeing the ortho that treats the Patriots and the Red Sox so I know he is good but I am still worried.  Looking for opinions on what I should do. I am so scared that I am going to end up worse off and that the procedure won't work and I'll have to have knee replacement immediately. Thanks to all! 

I'd wait till the defect becomes symptomatic. I've read studies where, depending on the location, the defect remained asymptomatic for 12 years or more. There's no reason to jump into surgery at your current state. You'll kick yourself for it if you come out worse.

Offline izzysmama

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Thanks NickCat, that's exactly where I'm leaning at this point.  I'm going to talk to my dr. one more time and make a final decision soon. :)