Osteochondral Allograft Transplant (OCA)
How is an OCA Performed?
An osteochondral allograft transplant (OCA) is a surgical procedure used to restore areas of damaged cartilage and underlying bone in the knee by transplanting a donor (allograft) graft. This is typically performed when cartilage damage is too extensive for small grafting procedures but is still localized enough not to warrant a joint replacement.
The donor graft is carefully matched in size and contour using preoperative imaging. During surgery, the damaged area of cartilage and bone is removed, and a precisely shaped plug of healthy bone and cartilage from the donor is implanted into the defect. The graft is press-fit into place.
The goal of OCA is to restore the joint’s smooth cartilage surface, reduce pain, and preserve the native joint for as long as possible. Surgery is performed under general or spinal anaesthesia and typically takes 1–2 hours. This procedure is often performed with other surgeries such as an osteotomy.
What Is the Recovery in the Immediate Postoperative Period?
Hospital stay: Most patients stay 1-2 days in hospital, working with physiotherapy.
Weight bearing: This will depend on the nature of the surgery and location of the lesion.
Brace: Most of these procedures do not require a brace
Range of motion: Early motion starts right away.
Ice and elevation: Used frequently to control pain and swelling. You should ice for 20 minutes, 3–4 times per day right after surgery. An ice/compression machine can be hired from a third party.
How Is the Wound Managed?
Bulky dressings will be removed 1–2 days after surgery.
A waterproof underlay dressing should be left on for 1-2 weeks.
Incisions typically heal within 2 weeks.
Showers are permitted while wounds are covered with waterproof dressings during the first 2 weeks.
Do not submerge incisions in water (baths, pools, or ocean) for 6 weeks.
A wound check with your GP, allied health provider, or our clinic is recommended at 2 weeks.
Absorbable sutures are usually used and do not require removal, though small remnants may surface naturally during healing.
How Do I Prevent Blood Clots (DVT/PE)?
Blood clots (deep vein thrombosis or pulmonary embolism) can occur after surgery.
You can reduce the risk by:
Moving your foot and ankle regularly while resting.
Walking early with assistance.
Avoiding long periods of sitting or immobility.
You will likely take aspirin for 2–6 weeks to prevent DVT/PE. If you have a history of blood clots or risk factors, a stronger blood thinner may be prescribed.
If you plan any long-distance travel within 6 weeks of surgery, please inform our clinic for preventative medication.
Seek immediate medical attention if you develop calf pain, swelling, chest pain, or shortness of breath.
How Do I Manage My Pain After an OCA Procedure?
Your anaesthetist will discuss possible spinal or regional nerve blocks to help control pain immediately after surgery.
Local anaesthetic will be injected into the knee during surgery.
Use ice regularly (20 minutes, 3–4 times per day). An ice machine may be hired from a third party.
Take prescribed pain medication as directed. Opioids may be used short-term but have known side effects (nausea, constipation, dependence). Non-opioid medications are preferred when tolerated.
Use a compression dressing on the knee for 6–12 weeks to manage swelling.
Begin gentle range-of-motion and muscle activation exercises as soon as recommended.
Use walking aids for stability while recovering your gait.
What Issues Should I Call the Clinic Regarding?
You should contact your surgeon or clinic immediately if you notice:
Increasing redness, swelling, or drainage from the wound.
Persistent or worsening pain not controlled by medication.
Fever, chills, or night sweats.
Calf pain or swelling (possible blood clot).
Any acute injury to your operative knee.
Prompt review allows early management of potential complications.
When Can I Return to Normal Activities After OCA?
Return to activities depends on the nature and intensity of the activity and the total number of procedures being performed on the knee. In general, OCAs take 3-6 months to heal. Thus, it can take 6-12 months to return to high level activites such as sport.
When Can I Drive?
You can usually drive once you can safely control the vehicle and perform an emergency stop comfortably.
This is typically 8–10 weeks after right knee surgery, and 2–3 weeks for the left knee.
You must not drive while taking strong pain medication (e.g., opioids).
When Can I Return to Work?
Return to work depends on your occupation:
Office or sedentary work: 1–2 weeks (once you can commute safely).
Light manual work: 4–6 weeks.
Heavy manual labour: 4–6 months or longer, depending on recovery.
Should I See a Physiotherapist?
Yes. Physiotherapy is recommended for optimal recovery after any cartilage procedure.
Your physiotherapist will:
Guide you through a structured rehabilitation program.
Focus on restoring range of motion, strength, balance, and gait mechanics.
Progress exercises gradually from early mobility to functional activity and low-impact sport.
What Are the Complications After an OCA Procedure?
While OCA is an effective cartilage restoration technique, possible complications include:
Infection (superficial or deep)
Blood clots (DVT/PE)
Knee stiffness or reduced range of motion
Graft failure or lack of integration
Persistent pain or swelling
Fracture of surrounding bone during graft placement (rare)
Cartilage delamination or wear over time
Nerve irritation or numbness around the incision
Degeneration of adjacent cartilage
