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OATS 9 months OATS post op...help please!

jbings4444

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I really need some help/support/advice.
I was a very active 37 yo/male up until I started getting some pretty serious inner right knee pain the past few years. A few of the doctors I saw recommended microfracture procedure, but most said the cartilage defect was much too large for this procedure.
In 2005, I had a loose body removed through arthroscopic surgery.

I decided to go through with the OATS procedure in August 2016. Here are the exact pre-op notes from the DR:
1. Chronic painful right knee, large medial femoral condyle osteochondritis dissecans lesion with cyst formation.
2. Chronic painful right knee loose body formation.
The exact lesion was measured at 23mm by 14mm

This brings to me to May of 2017.
I went through the PT and the pain of surgery and finally built my muscles back up.
My major concern is that I'm having equal to/greater pain in the exact spot the OATS procedure was performed. I called my doctor and he suggested having a new MRI on June 6th, 2017 to see what is going on.
I guess my question is, am I being too hasty to jump to the conclusion that the OATS procedure has failed?
My doctor previously said the next step is to use cadaver cartilage, if this OATS procedure didn't work. It is very disheartening and down right depressing to still be experiencing the same pain. I currently cannot run or play with my 2 kids and have another on the way in 2 weeks.
I'd just like to be normal again, although I know this may not be possible.
Any suggestions/support/advice/personal experiences which I can draw from to figure out the next step?
Thanks in advance for taking the time to read this.
 

Pumpkln

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jbings4444,
Sorry to hear you are doing no better after your OATS procedure. You had a very large defect.
I would advise a second opinion with a surgeon specializing in complex joint reconstruction, they have the education and back ground to determine why your OATs is still problematic, and suggest options. Your second opinion should have no relationship with your present surgeon, not even golf buddies.
You can use the find a surgeon button at the top of the page. You will also need to call the offices and ask about the OS experience and background.

Do not rule out any options including joint replacement because of your age.

I am going to tag @Josephine for you, she is our forum nurse with 50+ years experience in orthopedics. She presently is out recovering from complex shoulder joint surgery. It may be awhile before she responds. @Jamie or @Celle may also be able to advise.

Keep us posted on how you are doing,
 
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jbings4444

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I really appreciate your quick response.

I scheduled a 2nd opinion visit for tomorrow morning. I will keep you updated.
 

Celle

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Hello @jbings4444

I'm really sorry the OATS procedure doesn't appear to have given you the result you hoped for.

For the benefit of others reading this, OATS stands for “osteochondral autograft transfer system”. It is one of two types of cartilage transfer procedures. The other is called “Mosaicplasty”. Small plugs of healthy cartilage taken from a donor site are inserted into the area where existing cartilage has failed.

I agree entirely with Pumpkln's suggestion to seek a second opinion, even a third one, if necessary.

It sounds to me as if your current surgeon is prepared to do a series of operations, in an attempt to make cartilage grow again in your knee. Possibly, this is because of your age.

Quite honestly, If it were me, I would not put myself through that. Once the cartilage is gone, as your is, it is increasingly likely that more and more cartilage will also fail. I would look for a surgeon who is prepared to fix my knee once and for all, instead of attempting a series of "holding" operations.

I would ask to go directly to a total knee replacement (TKR). It may be that you have been told you are "too young" for a knee replacement, but that is no longer true. Done properly, a TKR can last for 30 years, or more, and it will give you back the life you want. We have had several people on BoneSmart who have had knee replacements in their thirties.

Don't be tempted to go for a partial replacement, on the grounds that you are young and only one compartment of your knee is affected. Partials have a limited life span, some of them even failing within the first year. I had one that lasted for eleven years, but mine appears to be the exception.

I'm suggesting that you ask for a TKR as a one-time solution, rather than muck around with a series of smaller, but no less painful operations. After a fairly long period of recovery, you should be able to return to a normal life. Have a look at some of these stories, to see what people with total knee replacements can do:
Stories of amazing knee recoveries

Do come back and let us know what you decide and how you are getting on, won't you?

PS: Please will you tell us the full date of your OATS procedure, so we can make a signature for you? Thank you.
 

Jamie

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Celle has given you the exact same advice I would. You need to have some frank discussions with an independent knee surgeon about the condition of your knee joint. Sadly, in most cases where the arthritis is at all advanced, cartilage replacement efforts are not successful. And, as you are seeing, the recovery from this type of procedure is every bit as long and painful as a knee replacement.

These days implants last a long times (20 years or more) in most people. You may find the best option for you is to just get the knee replaced now and move on.
 

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