Watch 2019 JRAD Videos

OATS The future after OATS

Olyoutside

new member
Joined
May 19, 2018
Messages
11
Age
41
Location
Washington
Gender
Female
Country
United States United States
I am a 40 y/o female. I had an active youth and adulthood, ski racing, soccer, mountain and road biking, running, etc- and injured my knee several times with a high mechanism of injury. So the injuries healed initially, but then 2 years ago, I ended up with bilateral swelling and pain and real difficulty with squatting and climbing stairs- and came to find out that I had chondracomalacia in all three compartments of both knees.

I did steroid and PRP injections, and had a scope meniscectomy and debridement of the left knee in Feb. I’ve also been doing PT religiously

The injections seem to be keeping the swelling in my right knee at bay somewhat and I have pretty good strength in that leg but my left knee is a bit of a mess. I just can’t seem to bear weight through that 45-90 degree range without pain and swelling

Where I used to be able to run 10 miles at the drop of a hat I now struggle through four once a week, and I pay dearly when I over-do or when I run hills.

I have constant swelling on my lt knee. The Dr can remove between 15 and 40mls of joint fluid on any given day. I also always have pain. Sleeping, stairs, using the toilet!!!! Getting out of bed is always painful and I have catching throughout the day

My Orthopedist and OS agree On an OATS for me of 3 or 4 3cm patches of cartilage plugs.

It’s a long backstory but here’s my question: I’m nervous I’m going to LOSE mobility, not gain through this surgery. Do you think my fears are warranted?

I am currently running. Not a lot, not fast, and not without repercussions, but I can do it, and I’m not going to cause any “catastrophic failure” by doing it. I can ride a bike but it hurts, and getting out of he saddle is very painful

I’m also worried that the location of my lesions isn’t totally normal. The surface is the articulating region at about 45-90 degrees. It isn’t where my leg is straight (this is why I can run). I worry about peeling away the edge of the graft because of the location

So my question I guess, is for those of you familiar with this procedure, what do you think my risk is for losing mobility post recovery considering my age (40) the large amount of graft (4*3cm and all compartments), and the location of graft (45-90 degree articulating surface)

I’m running now. I want to keep doing a little bit of that down the road someday and standing up on my bicycle pedals from time to time!!!! I live an active life. I have two small boys, I coach soccer, I am a media producer. Being active and outdoors is my life

I have also not tried Synvisk or stem cell. Worth a shot?
 

Josephine

NURSE DIRECTOR EMERITUS
Nurse Director
Joined
Jun 8, 2007
Messages
84,940
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
I’m nervous I’m going to LOSE mobility, not gain through this surgery. Do you think my fears are warranted?
my opinion is that you are more likely to lose mobility if you do nothing.

OATS (Osteoarticular Transfer System also known as mosaicplasty) can be a bit of a chancy thing. There are no guarantees about its outcome. The same with Synvisk and stem cell. No guarantees of outcome. Nearly all of these will also inevitably end up with a TKR.
 
OP
OP
Olyoutside

Olyoutside

new member
Joined
May 19, 2018
Messages
11
Age
41
Location
Washington
Gender
Female
Country
United States United States
Thanks for the reply Josephine

I am anticipating a knee replacement down the road- but, like most of this board’s participants, I’ve been told I’m too young, and Drs are trying to prolong for as long as possible.

I know my knee is degenerating, I have more bad days than good, but I was hoping with increased focus on strength training and stem cell or hylauronic acid injections might allow me to run for a while longer.

The difference between the injections and he surgery is, if the injections don’t work, I've still got arthritic, but working knees; if the surgery fails, I’m non-ambulatory, and will probably need a knee replacement immediately.
 

Josephine

NURSE DIRECTOR EMERITUS
Nurse Director
Joined
Jun 8, 2007
Messages
84,940
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
Well, whether you do all these delaying procedures and they don't work, or something like OATS and it doesn't work, what's the difference? I would also say that this comment is a bit contradictory.
I've still got arthritic, but working knees
It's unlikely you'll have arthritic and working knees forever! The TKR, however, will likely last you upwards of 35 years!

I also suggest you look for a surgeon who professes an interest in "Arthritis in the Young Adult".
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
37,717
Age
78
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
With knee replacements nowadays lasting 30+ years, there's no longer any need to wait for a knee replacement until you are "old enough". That's old-fashioned thinking.

There only a few ways in which you are too young:
  • You are too young to be living your life in constant pain.
  • You are too young to have your mobility so badly compromised.
  • You are too young to be giving up the lifestyle you enjoy.
  • You are too young feel so old.
Knee replacement has a very high success rate. There's no need to fear being non-ambulatory.
Have a look at these posts, to see what some people can do with their replaced knees:
Stories of amazing knee recoveries
 
OP
OP
Olyoutside

Olyoutside

new member
Joined
May 19, 2018
Messages
11
Age
41
Location
Washington
Gender
Female
Country
United States United States
Well, whether you do all these delaying procedures and they don't work, or something like OATS and it doesn't work, what's the difference?
You have a good point. The difference, I’d say is losing a year to a lengthy recovery process, and losing the few runs I have left.

I do have arthritic but working knees. Some days I can’t bear weight for several hours or eve or climb stairs without leaning a rail- but if I warm up thourally, I can run and bike without pain sometimes- I really don’t want to lose that
 
OP
OP
Olyoutside

Olyoutside

new member
Joined
May 19, 2018
Messages
11
Age
41
Location
Washington
Gender
Female
Country
United States United States
Well, whether you do all these delaying procedures and they don't work, or something like OATS and it doesn't work, what's the difference?
You have a good point. The difference, I’d say is losing a year to a lengthy recovery process, and losing the few runs I have left.

I do have arthritic but working knees. Some days I can’t bear weight for several hours or eve or climb stairs without leaning a rail- but if I warm up thourally, I can run and bike without pain sometimes- I really don’t want to lose that
You know- when I walked in to the (very well renowned, pro athlete) surgeon office, the first thing he said to me was “you, and running for fitness is over”. That sentence still rings in my head- and at 40, I’m just not ready for it to be true
 
OP
OP
Olyoutside

Olyoutside

new member
Joined
May 19, 2018
Messages
11
Age
41
Location
Washington
Gender
Female
Country
United States United States
Well, whether you do all these delaying procedures and they don't work, or something like OATS and it doesn't work, what's the difference?
You have a good point. The difference, I’d say is losing a year to a lengthy recovery process, and losing the few runs I have left.

I do have arthritic but working knees. Some days I can’t bear weight for several hours or eve or climb stairs without leaning a rail- but if I warm up thourally, I can run and bike without pain sometimes- I really don’t want to lose that
With knee replacements nowadays lasting 30+ years, there's no longer any need to wait for a knee replacement until you are "old enough". That's old-fashioned thinking.

There only a few ways in which you are too young:
  • You are too young to be living your life in constant pain.
  • You are too young to have your mobility so badly compromised.
  • You are too young to be giving up the lifestyle you enjoy.
  • You are too young feel so old.
Knee replacement has a very high success rate. There's no need to fear being non-ambulatory.
Have a look at these posts, to see what some people can do with their replaced knees:
Stories of amazing knee recoveries
Celle- thank you for the link and stories, they are very uplifting, though I am curious whether they are the rule or the exception, since I know few people with TKR. You are very right when you imply that “old enough” is a ridiculous gauge for TKR readiness. But, what happens after those 30 years? A 2nd replacement means what for people-walker? Cane? I would be 70 then- I know that’s a ways off, but I imagine, I’ll still have a lot of living left to do!!
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
37,717
Age
78
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
I know its hard when you love running, but it has probably contributed to you having bad knees now.

Quite frankly, I think that if you continue to run after an OATS, you will find it isn't a success.

You can go back to most sports after a TKR, but running isn't a good idea. @skigirl has bilateral TKRs and she was a ski instructor for a long time after those surgeries.

You will know when it's time to have knee replacements, but her is a chart you can fill in, to estimate how much your knees are affecting your quality of life:
Score chart: how bad is my arthritic hip/knee
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
37,717
Age
78
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
thank you for the link and stories, they are very uplifting, though I am curious whether they are the rule or the exception
They are probably the better examples of what is possible with replaced knees. However, almost everyone who has a knee replaced ends up more mobile than before their surgery, and goes back to leading a life uncompromised by knee pain. The first 3 months or so are hard, but after that, people's reactions are usually more like "Why did I wait so long to have this done?"
I know that my first knee replacement gave me back the active life style that my arthritic knee had taken away.
But, what happens after those 30 years? A 2nd replacement means what for people-walker? Cane? I would be 70 then- I know that’s a ways off, but I imagine, I’ll still have a lot of living left to do!!
Well, I've had a second knee replacement, when I was 70, by coincidence! I also had the other knee replaced when I was 73. My mother had her second knee replaced when she was 85 - and she ended up walking without even a cane - and in no pain.

My second replacement (revision) on my right knee was no big deal - the recovery was no worse than my original surgery - and the result was excellent. I'm 76 now, and I am still completely mobile, walking without a cane, driving my car, taking trains, planes and buses without help. I do all my own housework and some gardening. Every year, I travel from New Zealand to the UK and back. I visit other countries, I play with my grandchildren. I have a pretty active life with two replaced knees.

My replaced knees function so well that I usually forget I have them.
 

SusieShoes

FORUM ADVISOR
Forum Advisor
Joined
Oct 31, 2016
Messages
6,326
Age
66
Location
Philadelphia
Gender
Female
Country
United States United States
I have an athletic son who takes part in Iron Man competitions around the globe. He also runs marathons, swims, bikes, plays Ultimate Frisbee, and does yoga. I'm not sure how I ever gave birth to someone like him, but there you have it. He's in his 30s and we've talked. He's already had surgery on his knees and knows, from family history and his doctors, that he will be facing knee replacements down the road... especially given he is "running his knees into the ground." Those are his doctor's words. He's enjoying his original knees while he can.

He has some friends who have had TKRs and who continue to be very active, but none of them run marathons anymore. They do, however, bike competitively, swim, snowboard, ski, play softball, and do yoga. That's my son's plan. When he can no longer run, he will still have the biking, the swimming, the yoga and the rest of his life.

I'm not an athlete, but my bilateral knee replacements completely restored my ability to MOVE. Over the years as my knees deteriorated, I'd made thousand of minute, insidious concessions that led to me accepting pain and limitations as normal. One of the things that has astonished me most about getting my knees replaced is how active I've become. Again. I used to be very active. Not an athlete kind of active, but a get up and go kind of active. And I'm that person again. The only thing I don't do that I used to do is run just for fun.

I can run, though. :running: I tried, just to see, and I can run. If the zombie apocalypse should strike, I'm ready!
 
OP
OP
Olyoutside

Olyoutside

new member
Joined
May 19, 2018
Messages
11
Age
41
Location
Washington
Gender
Female
Country
United States United States
Update: my surgeon found me a donor, and I agreed to have surgery on Tuesday. I’m very nervous, and emotional about the changes that I will have to make, but I’m also looking forward to having less pain
A funny thing happened when I finally decided to have the surgery- my knee really gave out, and the rest of my joints started feeling better. I’ve been having a ton of pain in my lt knee, but my Rt knee, and hips and even shoulders feel looser. It’s sort of weird.
 
OP
OP
Olyoutside

Olyoutside

new member
Joined
May 19, 2018
Messages
11
Age
41
Location
Washington
Gender
Female
Country
United States United States
I have an athletic son who takes part in Iron Man competitions around the globe. He also runs marathons, swims, bikes, plays Ultimate Frisbee, and does yoga. I'm not sure how I ever gave birth to someone like him, but there you have it. He's in his 30s and we've talked. He's already had surgery on his knees and knows, from family history and his doctors, that he will be facing knee replacements down the road... especially given he is "running his knees into the ground." Those are his doctor's words. He's enjoying his original knees while he can.

He has some friends who have had TKRs and who continue to be very active, but none of them run marathons anymore. They do, however, bike competitively, swim, snowboard, ski, play softball, and do yoga. That's my son's plan. When he can no longer run, he will still have the biking, the swimming, the yoga and the rest of his life.

I'm not an athlete, but my bilateral knee replacements completely restored my ability to MOVE. Over the years as my knees deteriorated, I'd made thousand of minute, insidious concessions that led to me accepting pain and limitations as normal. One of the things that has astonished me most about getting my knees replaced is how active I've become. Again. I used to be very active. Not an athlete kind of active, but a get up and go kind of active. And I'm that person again. The only thing I don't do that I used to do is run just for fun.

I can run, though. :running: I tried, just to see, and I can run. If the zombie apocalypse should strike, I'm ready!
Your son is smart- I always thought that I somehow would sidestep all these problems, some people can- and maybe he will!! I agree with his philosophy though, that you have to enjoy what you’ve got, while you can :). I’m pretty excited to do yoga actually. Yoga is one of the first hints that I became unable to do, because it isolated the knee and you can’t compensate with other joints. I’m looking forward to that. It feels good to hear all of the things that I’ll still be able to do- running is only one thing among many- I’m going to try to look at this as an opportunity to explore things that I wouldn’t otherwise try. Thanks again for the encouragement.
 
OP
OP
Olyoutside

Olyoutside

new member
Joined
May 19, 2018
Messages
11
Age
41
Location
Washington
Gender
Female
Country
United States United States
OATS is a bit different than TKR or HTO, in that you stay non weight bearing for a long time. They’re replacing bits of bad articularccartilage with donor cartilage, and it needs the better part of a year to assimilate, so its crutches for up to 12 weeks, CPM for 6-10 hours a day at first, and a gradual return to regular activity over the period of a year. Anyone have experience with this?
 

nuttybrunette

senior
Joined
Apr 7, 2018
Messages
257
Age
52
Location
Ca
Gender
Female
Country
United States United States
Hi! I was 40 when I had my first TKR. I wasn't a runner, but was very active: water ski, snow ski, swim, bike, 2 kids:) I know what you mean about a working arthritic knee, that's what I had, even though it was very bad, bone wearing away bone. But I could still do lots of things, without too much pain. Replaced it because structurally it just really needed it. Best thing I did! That whole "without too much pain" thing is overrated. There were a lot of things I didn't realize I couldn't do anymore. I think we try to be tough and convince ourselves that we're not that much different from all the "normal" people. And we are, different. That new knee kept me going for 10 years, bought me some time on the other knee, but then this past year the second knee went downhill on a speedtrack. To the point of needing crutches and on disability. Now I've got a 3 week old new knee! I wish you luck on this surgery and hope it works. It sounds pretty cool and if it buys you time then that's fantastic. The recovery sounds tough tho. I just wanted to relay that being 40 and looking head on to possibly needing a TKR is traumatic and horrifying, but if it comes to that then you'll be amazed at what you can do with NO pain, instead of "without too much pain". Again, good luck, I wish you the best!!
 

SuperSnapper

post-grad
Joined
Oct 2, 2014
Messages
1,523
Age
69
Location
Yorkshire
Gender
Female
Country
United Kingdom United Kingdom
I did not have OATs but did have micro fractures on both knees many years ago. My left knee lasted a long time about 14 years but my right knee is still going after over 16 years. I was in my late 40s when I had the first done. I was told 5-7 years before I would need a TKR. I still only needed a PKR when the left one gave out.
The rehab was difficult 12 weeks non weight bearing and I stuck scrupulously to this. I also went to physio twice a week and did my exercises at home. It wasn’t painful just long and tedious but time well spent. A lot of micro fractures fail but a lot do because people forget the non weight bearing or get fed up with the regime.
However, I was able to swim, run after my kids, walk long hikes and keep active and still can.
Good luck with whatever you decide to do but you might be pleasantly surprised and be one of the lucky ones.
 

skigirl

FORUM ADVISOR
Forum Advisor
Joined
May 5, 2009
Messages
13,614
Age
75
Location
Minneapolis, MN
Gender
Female
Country
United States United States
i had an OATS. six weeks of crutches and then weeks of cpm, which I had to give up on since it was killing my back. When I woke up from TKR and saw the cpm on my bed, I just climbed over it and asked the nurse to remove it!!

The OATS took a chunk of my life and the results were so-so. Less pain at first, but it seemed to wear very quickly when i began skiing again.

after my tkr, I was really sorry that i spent so much time chasing rainbows. The TKR was the final surgery---no knee pain, no knee thoughts. The only thing that is difficult for me is kneeling.
 
Last edited:

KenUSA36

junior member
Joined
Feb 9, 2018
Messages
81
Age
37
Gender
Male
Country
United States United States
Hi! I was 40 when I had my first TKR. I wasn't a runner, but was very active: water ski, snow ski, swim, bike, 2 kids:) I know what you mean about a working arthritic knee, that's what I had, even though it was very bad, bone wearing away bone. But I could still do lots of things, without too much pain. Replaced it because structurally it just really needed it. Best thing I did! That whole "without too much pain" thing is overrated. There were a lot of things I didn't realize I couldn't do anymore. I think we try to be tough and convince ourselves that we're not that much different from all the "normal" people. And we are, different. That new knee kept me going for 10 years, bought me some time on the other knee, but then this past year the second knee went downhill on a speedtrack. To the point of needing crutches and on disability. Now I've got a 3 week old new knee! I wish you luck on this surgery and hope it works. It sounds pretty cool and if it buys you time then that's fantastic. The recovery sounds tough tho. I just wanted to relay that being 40 and looking head on to possibly needing a TKR is traumatic and horrifying, but if it comes to that then you'll be amazed at what you can do with NO pain, instead of "without too much pain". Again, good luck, I wish you the best!!
How's that knee holding up after 10 years? I'm on track to need a TKR by age 40. My left knee has taken so much damage and now bothers me daily. It is pretty scary to think I'll need a TKR by age 38-40. But, I'd rather get back to living.
 

nuttybrunette

senior
Joined
Apr 7, 2018
Messages
257
Age
52
Location
Ca
Gender
Female
Country
United States United States
My 10 year old knee is THE best part of me. Ive never regretted it. Well....during rehab, I did. LOL but most of us question it right after. Actually my only regret was waiting till 40. It was just garbage way before that. X-rays show no diminished space or wear or whatever they look for. They say it still looks great. And I’ve raised my kids and worked full time as a teacher on it. My advice is to not question it one bit. I think I, and maybe you too, thought of TKR as an “old” persons thing. That I had to ignore what was going on with my knee until I was”old”. I don’t really know what that “old” age was in my head but clearly after being here on BoneSmart I was very wrong. Age doesn’t matter, the condition of your knee does. Good luck in your decision and comfortableness with it. Let me know if I can answer any other questions.
 
OP
OP
Olyoutside

Olyoutside

new member
Joined
May 19, 2018
Messages
11
Age
41
Location
Washington
Gender
Female
Country
United States United States
I just got home after my OATS procedure. They put six plugs in, about 18mm a piece. Surgery went well, but I’m scared to use my CPM. I have been in this straight leg brace for about 24 hrs. My sons preschool graduation is tomorrow, so I want to get enough movement to at least crutch over to see that
 

BoneSmart #1 Best Blog

Staff online

Forum statistics

Threads
50,574
Messages
1,368,178
BoneSmarties
31,741
Latest member
HighCountry
Recent bookmarks
0

Top Bottom