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OATS Second time around with OATS

Deige

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In November 2018 I had a meniscus root repair and OATS procedure. Prior to that surgery I had 3 ACL revisions the most recent was 16 years ago.

The November surgery failed because of an incompetent surgeon.
I had Dr. LaPrade do a revision in August of 2019. He did a meniscus root repair, OATS procedure and ACL revision using the patellar tendon from my other knee.
It was a tough and painful recovery.

I finally had no pain for a couple of months and now the pain is back and is severe. I can’t think of an acute injury and I have only been doing PT and stationary biking.

I am 48 years old and an in excellent shape. I have three kids and like to be active. It’s painful to stand and watch them play a soccer game.

I am going to LaPrade tomorrow to have him take a look. I have a feeling he is going to say it looks okay structural. But it’s swollen and hurts.

I am thinking it’s time for a TKR but this is devastating to me and not sure I could go through another surgery. I’ve had 9 on this knee. Has anyone tried the Radiation Ablation therapy for knee pain? Or long term use of Percocet?
 

Celle

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Hello @Deige - and :welome:

What a time you've had with your poor knee!

Please will you tell us the full dates of all your knee surgeries, if you can, and which knee it is, so we can make a signature for you? Thank you.:flwrysmile:

I can understand how the thought of another operation is horrible for you, but I don't understand why the thought of having a TKR is so devastating for you. IT's one more surgery, that's true, but it's a surgery that could fix your knee once and for all.

Frankly, I think you should have had a TKR some time ago, instead of this series of surgeries that have all been just a temporary "fix" before yet another surgery.

When the first OATS failed, then was the time to move to a more permanent solution. OATS procedures only work when there is minimal damage to the cartilage and a second OATS is doomed to failure if the first one hasn't worked.

Try not to think of a TKR as being surgery "for old people". We've had people here in their forties, thirties and even in their twenties who have had successful TKRs.
Nowadays, a TKR can last for 30+ years, so there's no longer any need to fear multiple revisions. One done now could well outlive you.

Just in case you think that having a TKR would mean an end to an active lifestyle for you, have a look at some of these stories: Stories of amazing knee recoveries

I know that I waited for nine long and painful years because I was told I was too young for a knee replacement. When I finally had the TKR, it gave me back the active life I had missed for so long. I traveled the world with that new knee.

Don't have any more temporary fixes. Get the TKR. Do it once, do it right.
 
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Deige

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I know you are probably right and I am expecting that LaPrade will say the same. I was an avid runner Anf was hoping to get back to that. That’s what’s devastating but I am processing that. My last surgery was 8/7/19 the one before that 11/28/18
 

Celle

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I'm sorry, Deige, but those dates don't seem to make sense. Please can you have another think?

I'm talking frankly here - with all the knee surgeries you've had, running is never really going to be an option for you, no matter what you do.

But that doesn't mean the end of your active days.
Some keen runners take up cycling instead. @Roy Gardiner , one of our Forum Advisers, had bilateral TKRs and he is now participating in competitive cycling.
 

rosieNZ

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Hi.
Your story is wracked with pain and limitation. To think of how captured your life has become by the continual interventions and recovery is so distressing.
A TKR is not terrible. It has set me free to live an active life with less limitations. I feel so grateful for this op. Best wishes for a speedy end to your knee problems
 
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Deige

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Sorry the dates were 11/17 and 8/19 Acl was original done in 1992, 1993 and 2002 all my right knee
 

Celle

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So these are the dates? All on the right knee.
ACL Repair - 1992, 1993, 2002
OATS - November 28, 2018 - or was is 2017?
OATS - August 7, what year? It can't be 2019, as that hasn't happened yet.
 

Rockgirl4

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@Deige If it was me, I'd go straight to the knee replacement. I'm 46, getting both replaced this year. I waited too long and am paying for it.

In total, I've had 7 surgeries on the right and 3 on the left. Always the athlete, I'd had 4 knee surgeries by age 31. I then found a famous sports surgeon that was all the rage and a cartilage defect expert. He performed another 5 procedures on the right knee (2 OATS procedures in 2010,2013, followed by ACI in 2015 due to OATS failing again). He did a Microfracture on the left last May. It failed too.

Last summer/fall, I finally sought the opinion of a Orthopedic Reconstruction/Revision specialist at the advice of another medical professional. I went from being able to do 3 good leg workouts a week to one. Walking 3X a week went down to just once (only a mile around the block became impossible). Activities of daily life went out the window, and standing came to a stand still-----no pun intended. Life became very boring with lots of couch time. :( My core workouts are even suffering because the knee makes it tough to do certain things. Cardio is limited biking as even THAT causes issues after 8-10 minutes.

I've since learned cartilage repair procedures have the best chance of success for those <35 yrs old and caught very, VERY early!! My 2 OATS procedures were at ages 38, 41. When those failed, I had ACI at age 43. It was a last-ditch effort to avoid knee replacement but failed after 3 yrs. I'm now bone-on-bone in that knee, with the lateral femur collapsed onto the lateral tibia. The ACI was done on the medial femur, but it has zero cartilage left too. The "collapse" on the lateral side is much worse though (not sure of the specifics, as I was too shocked to ask the new surgeon more questions!!). He dispelled all of the lies my famous surgeon told me about implants loosening in 5 yrs, among others. It was the sawning of a new day and gave me hope back.

I apologize for the novel, but I'm just saying I feel your frustration and your efforts to prolong the knee replacements, but keep in mind things can go from bad to VERY BAD in just months. Lefty was fine in Feb '18 and by September both knees put me on my bottom most days. My knees rule my life 100% now, and my husband and 12 yr old son are paying the price for it.

All I can say is don't fall into the trap of believing the experts can continue cutting you open and fixing things. I wish I could go back and tell my younger self to get more opinions. My TKR surgeon-to-be said he will never disparage another Dr, but he WOULD say "You were misled for many years and nothing but a knee replacement can offer you any comfort or return to an active lifestyle at this point. Studies are slanted on new, cutting-edge procedures, otherwise surgeons wouldn't be able to get insurance to pay for them."

From what he has seen in his 25 + yrs of knee/hip replacements (he's actually a reconstruction and revision specialist, so he's seen it ALL!), he said most cartilage repair techniques have about a 10-15% percent chance of success in anyone >35. This is also why he takes anyone 45 yrs old or above, especially with an extensive surgical record such as ours, and even younger patients if necessary. He said my right knee should have been replaced at age 43, and insurance would have approved it in a heartbeat. :(

Best of luck in whatever decision you make.
 
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Deige

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ACL Repair - 1992, 1993, 2002
Meniscus Repair 5/2016
OATS - November 18, 2017
OATS - August 7, 2018
 
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Deige

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I appreciate your story. Honestly, I don't know if I can trust another surgeon. LaPrade is supposedly one of the best - he doesn't do knee replacements but others in his practice do. How do I find and know that someone is good?
 

Rockgirl4

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@Deige I have a Rheumatologist I see twice a year, thinking my early OA might not be just OA, but possibly inflammatory. Mr. Famous Sports Surgeon sent me to her years ago when he couldn't explain some other strange things. Plus, I've had other joints swell randomly a couple of times, so I like the simple checkup to insure we catch anything early in case something inflammatory is going on. She is the one who told me anyone with numerous prior knee surgeries shouldn't seek out just any Orthopedist who does knee replacements. We should seek out a Reconstruction/Revision specialist who has seen it all, does mostly knees/hips, and does >300-350 replacements a year. She referred me to either of 2 guys from a wonderful research/university hospital in my area (major metropolitan area in the central US), and she deals with their Orthopedics group a lot due to her patients needing early replacements from Rheumatoid Arthritis,Lupus, Psoriatic Arthritis, etc. I'm lucky she's dealt with these particular 2 main guys for YEARS, and her patients have wonderful stories to tell. She said if it was her daughter, this is who she would send her to.

I understand your lack of trust. I learned last summer/fall my famous sports surgeon actually lied to me on numerous occasions. Then I learned he did it to an acquaintance's sister. Same story basically except it's her shoulder and my knee. I felt like an idiot for not seeking other opinions sooner and listening to him go on and on about more fancy procedures being my only option, as I was too young for knee replacement. It took me months to let go of the anger and bitterness. Then I moved on, scheduling my TKR, after meeting with this new guy, asking 19 questions (I wrote them all down!!), and finally feeling validated. The more I learn about him, the more I like---I even had a good friend's husband just go through a TKR with him and it was a great experience. Anyway, I'll be wishing you the best with whatever direction you go in.

--Lisa
 

Roy Gardiner

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How do I find and know that someone is good?
You could try asking the nurses, they know who’s the best. I went to my local hospital where the surgery was scheduled and walked around the orthopaedic ward looking lost; it went something like:

‘Can I help you?’ a nurse asked/challenged me.

‘Oh yes, I’m here for my knee soon, I just wanted to see what it’s like,’ I replied ‘Dr Jekyll is doing my surgery.’ Rising tone at the end, to prompt a reply, and trying to turn the nurse into a friend (worked at once, nurses are nice).

‘You’ll like him,’ she replied, but adding quickly ‘of course Mr Hyde and the other doctors are very good, but Dr Jekyll is our best.’

That last is the response I got (luck works in life, a very fine surgeon living less than a mile from my house and working in a hospital 200 yards away) but you might get something like 'Yes Dr Jekyll is very good.' in which case you prompt 'But what about Mr Hyde, I've heard fine reports about him too.'

You get the idea. I found nurses and other staff only too keen to help; and they are like the NCOs in the army, the backbone that holds it all up.
 

Momma-me

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I too have been "sports medicined" to death.
I learned of this phrase most recently and my new surgeon uses that term as well.
Just because someone "CAN" do it... doesn't mean that it is the best practice. Every surgery your knee endures, will continue to break down the joint and the risks def outweigh the benefits.
I understand completely how you are scared. You don't want to give up your active lifestyle. I feel the exact same way. I've cried and asked "why ME??" But at the end of the day... it is what it is.
And just MAYBE, just maybe.... the very thing that you are most afraid of, is the thing that will finally set you free!!

If I were you... I would 100% go for the TKR!!

Best wishes!
 

Celle

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LaPrade is supposedly one of the best - he doesn't do knee replacements but others in his practice do
LaPrade may well be a good sports surgeon, but I think he has subjected your knee to too many surgeries, when he should have referred you to someone who would do a knee replacement.
 

Rockgirl4

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I too have been "sports medicined" to death.
I just learned of this phrase most recently and my new surgeon uses that term as well.
Just because someone "CAN" do it... doesn't mean that it is the best practice. Every surgery your knee endures, will continue to break down the joint and the risks def outweigh the benefits.
I understand completely how you are scared. You don't want to give up your active lifestyle. I feel the exact same way. I've cried and asked "why ME??" But at the end of the day... it is what it is.
And just MAYBE, just maybe.... the very thing that you are most afraid of, is the thing that will finally set you free!!

If I were you... I would 100% go for the TKR!!

Best wishes!
@Momma-me I just wanted to tell you how perfectly you explained this. It was VERY well-said. :)
 

Irish471

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Hi @Diege, I am the same age and never thought I would need a tkr before I turned 50, yet here I am. I knew I would need it sooner or later. I have always seen sports medicine orthopedic surgeons and they can do wonderful things, no doubt. The OS who did my microfracture 9 years ago said he needed to buy me time and he said he hoped that would be 10 years. He was right and that surgery served me well. When my other knee started getting bad, I went back to see him and he suggested that I see his partner to talk about partial replacement because what he could do for me would maybe give me only a 50% reduction in pain. I so appreciated his honesty! I was scared of the idea of a replacement. But when I met with his partner, I decided to go for it. You heal better when you're younger . I ended up going in for a partial and ended up needing a full replacement.

I am just 3 weeks into recovery so it's very early. But I do know I made the right decision. Recovery from any kind of knee surgery is no picnic, and I am so hoping this will be the last time I have to go through this, although, I know the other knee will need to be done eventually. I say fix it and fix it right this time. You would be wasting your time trying to put more band-aid procedures on your poor knee! I would ask the doc, don't you think this is the end of the road and it's time for a knee replacement? Because I can't keep doing this. Let him know you are tired of being a guinea pig and a research statistic. Stop the suffering.

I was never very athletic, so I can't say that I would ever be upset about not being able to run again, but I do like to hike and walk for exercise. Both of those things have not been possible for the past couple of years and I can't wait to do them again. Maybe later this summer :egypdance:
 

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