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OATS recovery to play sports again

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LAman

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Hi folks - 43yr old man, just found out I need to have have knee surgery, and should go under the knife in the next two weeks. Surgery on my right knee (i'm right footed) - they have a donor, and will cut out a piece of bone with cartilage from the donor, and plug it into me where I have damage (my femur, behind the knee cap), then pop a metal plate in below the knee to correct a minor alignment issue, so i don't put extra pressure on the area.

I'm told 2hr out-patient surgery under general, 6 weeks on crutches, 6 months and I'm playing soccer again.

Wondering if there's anyone out there of a similar age who's been through this, and has advice for speedy recovery? Also, if anyone of a similar age has gone back into playing rec. sports afterwards, and was recovery full - could you play as hard as before etc? I'll be devastated if I can't play again. Anyhow, its less than a week since I found out. I've never had surgery before. The dust is still settling. I'm pretty down. I welcome any advice, tips, threads to read, folks experiences etc.
thanks in advance,
Tim
 
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Helizabug

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I’m older by a bit, and my husband is older by an even bigger bit. AND I don’t know about the surgery your facing, exactly.

Still, I can tell you that a surgery and rehab that goes well can very likely return you to the activity you love. If it was me, I’d shy away from non-contact-that-is-really-contact sports, but my husband, who tore his quad clean across returned to basketball, three times a week after six months of rehab.

Speedy recovery is tricky because sometimes trying to hurry your recovery can make things worse. Your doctor should have some good stats about all of this.
 

Pumpkln

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@LAman
Welcome to BoneSmart, glad you joined us. :welome:
You'll notice that I have moved your thread to the Pre Op forum, where you will receive support from others facing surgery.

So please post any updates, questions or concerns about your upcoming here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.
 

Pumpkln

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Please confirm you are having both an OATS and a high tibia osteotomy (HTO).

Please post your surgery date, a moderator will add it to your signature for you. Having the exact date will help us properly advise you. Thanks!

Here is a link to threads of other members facing OATS.
 
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LAman

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hi - thanks - I had posted in the post surgery as I was hoping to hear from folks who'd been through the procedure and could comment on the extent of their recovery as it pertained to playing sports.

For my procedure itself...I'm not to sure of the correct category - as I understand it their are two parts:
1. A piece of bone with cartilage taken from the lower femur of a donor, and placed into my lower femur, at the knee.
2. A metal plate added below my knee to adjust my alignment so my body does not put too much pressure on the repaired area.

Date of surgery is being finalized - but likely 1/31/2020
 

Celle

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Hello @LAman - and :welome:

Please will you tell us the full date of your knee surgery, so we can make a signature for you? Thank you.:flwrysmile:

It sounds as if your surgeon is planning an OsteoArticular Transfer System (OATS) for you, together with possibly a High Tibial Osteotomy (HTO) .

These links may explain a bit more:
https://www.verywellhealth.com/oats-procedure-2548496
High Tibial Osteotomy (HTO)

As a rule, recovery from an HTO is prolonged and rather painful, and I think your surgeon's estimate of you playing soccer by 6 months is rather over-optimistic.

Here are some people who have had an HTO:
https://bonesmart.org/forum/view/knee-surgery-recovery-area.9/?prefix_id=136

and some who had the OATS transfer:
https://bonesmart.org/forum/view/knee-surgery-recovery-area.9/?prefix_id=139
 
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LAman

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thanks for the info - i will gratefully check it all out. I did talk to my surgeon specifically about the plate, as I was surprised at first, as it was below the knee - he said my body aligns in ever so slightly, whereas most people align outwards. The damaged area of the bone is on the inside - so my body alignment would put extra pressure on the area. He says his plan is to make a very minor alignment adjustment of just a couple of degrees, to take the pressure off. I'm not sure what a typical HTO involves - but perhaps as mine is just a minor adjustment, he is more optimistic on the recovery time?
 

winedunce

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thanks for the info - i will gratefully check it all out. I did talk to my surgeon specifically about the plate, as I was surprised at first, as it was below the knee - he said my body aligns in ever so slightly, whereas most people align outwards. The damaged area of the bone is on the inside - so my body alignment would put extra pressure on the area. He says his plan is to make a very minor alignment adjustment of just a couple of degrees, to take the pressure off. I'm not sure what a typical HTO involves - but perhaps as mine is just a minor adjustment, he is more optimistic on the recovery time?
I have a surgeon who is recommending an Osteotomy for me now rather than a TKR. I've had four knee surgeries on my right knee all related to cartilage. I know the Osteotomy isn't for me for a few reasons. Be sure your surgeon does a lot of these surgeries - because it is very complex. Ask the surgeon if you can talk to other people your age that have gone through it so you can see their results (my surgeon offered me that opportunity). The surgeon I was talking to about this surgery said he does about 40 a year and that is because he said "this surgery is a dying art because most people go to Total Knee Replacement instead" - He told me the Osteotomy wasn't going to prevent my TKR but he felt it could buy me some time. I know that it won't be the right surgery for me because he wants to put my weight onto the medial side of my knee which has a microfracture that pains me when it bears too much weight. I have heard the recovery from Osteotomy is really challenging. I think you are non-weight bearing for six to eight weeks (which is very different from just being on crutches). At 40 years old, I had a non-weight bearing six week recovery for my microfracture and was still on crutches for another 4 weeks after that because you have to build up strength in your leg muscles again to bear weight. I agree that six months after surgery sounds very optimistic to play soccer again. I do know my surgeon invited me to talk to one of his Osteotomy patients who is young and recovered and back to aggressive skiing now. Good luck. I hope you get to play again.
 
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LAman

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Hi folks - so the bone donor just passed cultures and my surgery has been brought forward to this Tuesday 1/28. I do want it quickly, but am in a bit of a panic as to trying to think of things i need to get done in prep. ahead of time. I just got a call about the medical equipment I need, and pricing (a couple of things I get a discount with my insurance) - my pre-op is on Monday, so i don't know anything about the equipment yet, and was hoping some of you could share your experiences over what is truly valuable, and if there are good more affordable alternatives, before i commit to purchases/rentals. I'm having OATS and HTO on my right knee, here's the list:

Knee brace purchase $101 (insurance discounted)
Range of motion machine rent $225 for 1 week, $25 p/d after that
Ice machine purchase $350
Crutches purchase $7 (insurance discounted)
OR, alternative to regular - Spring assisted crutches purchase $150

Would welcome any advice,
thanks!
 

Jockette

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As I don’t know much about the recovery of this particular procedure, I don’t know what recovery aids you will need.

I would like to request that you document your recovery here on Bonesmart so we can all learn from your experience. We don’t have any members who had this procedure that stayed and posted the details of their recovery as they went through it.
 

Celle

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my pre-op is on Monday, so i don't know anything about the equipment yet, and was hoping some of you could share your experiences over what is truly valuable, and if there are good more affordable alternatives, before i commit to purchases/rentals. I'm having OATS and HTO on my right knee, here's the list:

Knee brace purchase $101 (insurance discounted)
Range of motion machine rent $225 for 1 week, $25 p/d after that
Ice machine purchase $350
Crutches purchase $7 (insurance discounted)
OR, alternative to regular - Spring assisted crutches purchase $150
I think that most of the equipment you'll need will be similar to what you need after a knee replacement,so these articles may help:
Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery

Unless your surgeon specifically requires you to use them, you may not need a brace or the Range of Motion (ROM) machine - which is called a CPM (Continuous Passive Motion). THey're not is general use now and studies have shown that whether you use them or not makes no difference to your eventual ROM.

Many people find an icing machine very useful, but you can use other ways to chill your knee:
Ice to control pain and swelling

You will need some means of elevating your leg:
Elevation: the do's and dont's

Crutches or a walker will be necessary. I wouldn't bother paying extra for spring-assisted ones.
You'll probably need a walking cane as well, for when you come off crutches.
 
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LAman

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super helpful - thank you so much!!!
 

tejubeha

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Hi @LAman, I had OATS almost a year ago along with a Patello Femoral Replacement. I did not use a Passive Motion machine nor did I need the cooling system. Gel Ice Packs that you can get at the pharmacy worked best for me. Ice will be your best friend for quite a while. Also, you may need to remind your Physical Therapist that you had an OATS procedure. Mine got a little too aggressive and I had to tell him. If you have any other questions, please let me know.
 
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LAman

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Thanks so much for the responses. Its a great help and source of comfort hearing from others. Just adding on as I move along should this be helpful to others with regards to equipment - again, not sure if this is specific to OATS and HTO:

We quizzed the doc hard at the Pre-op:

Crutches - regular are fine for me, so getting those for $7 ($35 pre-insurance)

Ice Machine - he views having ready and constant access to ice cooling as essential for pain and swelling management, but getting large gel packs that cover the entire area, and having backups constantly in the freezer is a suitable alternative. I ordered (3) 23"x13" gel packs from Amazon that go all the way around my leg at the knee, and a couple of smaller ones for more localized pain. Ice machine was $350, vs $80 for the gel packs, and the gel packs are easier to transport should i need to take some with me.

-Knee brace - absolutely essential to have a quality brace, so getting that for $101 ($505 pre-insurance)

-CPM machine - I've read differing opinions on this, lots say no need. But my surgeon, who is mid-40s and is part of the medical staff for a professional football team, and use to rehab'ing athletes, deems this as essential for my procedure. He wants me using it starting the day after surgery, and using it regularly throughout the day. He says it is to prevent the build up of scar tissue around the joints, which will lead to later stiffness, pain, and slow recovery. One of the most common follow-up procedures required is apparently them going in to remove scar tissue at a later date - and he feels early and regular use of the CPM will prevent that. I trust his opinion and am getting it. $225 per week, $25 per day after that - but expecting use period to be 1-2 weeks total.

Additionally, as I will be on the crutches for at least 6 weeks, I read more advice from others using crutches long term, and purchased crutch pads and a crutch pouch (a little bag that attached to the side of the crutches and you can pop a bottle of water, phone, that kind of thing in there) - about another $26 total from amazon.

Anyhow, an admin mess-up pushed my surgery out till Tuesday 2/4. I'll try and come back when I can and add more information on surgery/recovery.
 

Pumpkln

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Sorry to hear your surgery has been postponed until next week, keep us posted on how you are doing.
 
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LAman

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Hi - looking for pain/sleep management advice. I was warned in my pre-op that the combination of my two procedures will be extremely painful, and that managing my pain after surgery will be a top priority. I am getting a nerve blocker in my knee after surgery. I have been prescribed percocet for the pain, asprin to prevent blood clots, and ambien for sleep - as i'm told sleeping will be very challenging.

My issue is, i know i can't take the percocet and ambien together. So, if my pain is so extreme I need percocet, but the general post surgery setup, with brace and dressing etc. makes it hard to sleep, how do i navigate the two drugs? Would greatly appreciate any advice from folks who have dealt with this....

thanks!
 

Pumpkln

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LAman,
Recommend you talk to your pharmacist or MD about how to take both Percocet, and use the Ambien for sleep. The Percocet may be enough for sleep, be sure to set your alarm to wake up when the next dose is due rather than sleeping through and waking up in pain.
 

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Just something to consider once you start rehab. I ended up with adhesions in my quadriceps muscle, though I was using a CPM machine 6-8 hrs a day following a different type of big knee surgery (ACI). I ended up with an MUA anyway, but it busted up lots of quad adhesions instead of "knee" adhesions. I didn't know it can even happen, but my PT said he sees it occasionally in people who are non-weightbearing for 6-8 weeks. I was 100% non weightbearing for 8 weeks with not even a toe-touch allowed until week 7, so a perfect storm so to speak. :( I would ask your PT to specifically keep an eye on your quad function and maybe even add massage to keep that muscle happy and in use as much as possible while sedentary.
 

Celle

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It's not inevitable that you'll develop adhesions because you're immobilized for a while, so try not to worry about that.

I ended up with an MUA anyway, but it busted up lots of quad adhesions instead of "knee" adhesions. I
An MUA does usually break adhesions in the quads - that's what it's designed to do. This article explains:
MUA (Manipulation under Anaesthetic) and Adhesions

Adhesions form between the muscle fibres, like this, not actually inside the knee joint:
1580670395268.png


And they are most frequently found where the dotted lines show:
1580670461504.png
 
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