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: Post Op feedback for OATS, Mosaicplasty for Osteonecrosis, AVN. Success so far.  ( 1190 )

AVNsufferer

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Here are my experiences on the above provided as feedback for other sufferers:

My profile:
Otherwise healthy male aged 52, 64kg (140 Pounds), non smoker etc, no serious knee problem history, but there had been occasional pains and 13 years previously a sharp knee pain which resolved itself. No sports or other strenuous activities, but plenty of walking (no car).

Problem/Injury:
Sharp knee pain caused by sudden (with no known cause) onset of osteonecrosis in medial femur condyle age 52. Pain occured during load bearing. Some swelling occured. Some pain at night during non load-bearing, but mostly load related. Walked with a limp.

Diagnosis:
First MRI after months of pain (too late), osteonecrosis had already spread to load bearing medial (inner) femur area. There were also some lesions on the cartilage behind the patella (knee cap).

Conservative Treatment:
After months of no treatment (due to bad advice and my lack of recognition of the seriousness) - 5 months of zero and limited load bearing using crutches. Had no effect on osteonecrosis, but did reduce bone lesions. The area of necrosis became a hollow cyst 12mm long with no bone material beneath the cartilage. No improvement overall and no regrowth of bone was visible. The necrosis area was considered large by the specialist.

Operative Treatment:
The clinic decided on the OATS procedure: This has similarities to the mosaicplasty procedure; in my case it involved transfer of 3 x 8mm cores of bone from behind the kneecap to the load bearing area. An autograft used my own bone/cartilage (rather than from a donor which is not allowed in my country). For a knee replacement I was considered too young. For cartilage repair, too old. The OATS procedure (I was told) is normally used for much younger patients e.g. sportsmen.

Post Operative report:
Load bearing 20kg immediately after operation. 2 weeks of pain killers. Very low range of motion for many weeks. No CPM machine used at all, just a knee brace. Twice weekly manipulation by therapist. Generally, not much therapy or other treatment was provided other than walking and slowly building up motion. Full load bearing after 6 weeks post op (first time for 10 months in total). No therapy at all after that. Improvement was continuous, though there were setbacks with recurring pain. Swelling gradually reduced over a year. Probably 18 months passed before there was a day where I was not reminded of my knee by some pain/stiffness.

Summary 18 Months after the operation:
Osteonecrosis has been stopped. Mobility is c. 95% of previous state for normal lifestyle; walking, cycling etc (but no strenuous sports or impact activity). Improvement is still ongoing. Brief, light running is possible with care. Still some imbalance of loading when trotting/running slowly. There is still some pain when lifting the leg whilst prostrate, but this does not cause a problem during normal activities.
My goal was to return to normal life (without sport or hard physical activities) - this has been fully achieved so far.

Future prognosis:
I have no treatment or therapy at all. Overall there was not much beyond a few checks and therapy sessions post operative. Today, I consider the operation a success. The knee is still improving 18 months post-op. Possible problems could occur in the future due to the large donor area behind the kneecap (patella). I was told of this at that clinic.

Overall summary:
I think osteonecrosis may have come from a previous injury. Once it spread it would not stop (it feeds on itself due to the load bearing). In my opinion if osteonecrosis (AVN) can be stopped by conservative treatment, then only if this is used right at the beginning. OATS autograft was successful for me (so far), but lifestyle, age, general health, bodyweight are important considerations. Another important factor was the skill and specialisation of the clinic here in Germany which performed the operation. Very little physiotherapy was applied other than in the 6 weeks after the operation.

Good luck.
« : June 06, 2014, 02:11:26 PM AVNsufferer »

brobb129

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Hey AVN,
Thanks for all of the info on your OATS procedure.  I had OATS done for an injury to my cartilage in my left patella.  I had a question for you...  what was the recovery like?  I know you stated that it was 18 months until you felt relatively normal, but did you have any set backs or increased pain during therapy?
I had my procedure on Dec 5, 2015 and everything was coming along very well until the 3 month mark.  After a day at PT I noticed a grinding sound with no pain.  I happened to see the surgeon later that day and he was not concerned at all.  A few days later I started getting pain where I hadn't had pain in about a month and a half.  2 weeks later I'm in more pain and icing my knee almost constantly and having trouble walking.  PTs have said it's everything from scar tissue to my muscles being weak, but I don't understand how I could be feeling worse at 16 weeks than i felt at 8 weeks.  Did you experience anything like this or was the recovery gradual and linear?
Any help/advice/feedback would be appreciated.

AVNsufferer

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Dear brobb129,

Apologies for the long delay. I hope you are feeling better.
I am writing this for other sufferers as an update at the end of 2017. Please bear in mind my disclaimer below.

In answer to your questions, after the operation and when I started walking unassisted, there were setbacks. These were periods of a few days of recurring pain and warming of the joint. I did not use icing nor any other treatment, I just observed and walked carefully. I think there was some grinding in the joint. There were times when I was limping again, but mostly it was not the same pain under load bearing as before the operation, though there were times when I could barely manage stairs. I remember it as a motion-induced pain, rather than sharp pain on load (as had been the case before the operation). Overall, though, the improvement was continuous, but with pain returning for up to a week. However, it never got so bad that I returned to the specialist for consultation.
Now, 5 years after the OATS grafts, I am still walking well and have not touched the crutches since 6 weeks post op.

Disclaimer: These are my personal experiences and are not to be considered general advice for sufferers. I am not a doctor. Each sufferer is an individual with their own unique health/treatment profile and hence my experiences cannot be considered a general set of expectations for OATS treatments nor prognosis for sufferers of similar ailments.

Good luck.