Knee Infection Help! Potential Knee Infection 14 months after surgery

noura

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I am posting this on behalf of my mother who had a TKR in her left knee in July 2015. Everything went well and she recovered gradually from her surgery, until 2 months back which pain started abruptly in her knee. She lives outside the US and had her surgery in Germany but she is visiting me here and her pain started while she is visiting.

Xrays of the knee showed some kind of bone fracture. But also knee aspiration showed high WBC count (5000), although as I see from the results normal should be <200. Also something called SEG SYN (a test of the synovial fluid) had a value of 87 (normal <20). Although I took her here to one of the top hospitals in US, the OS shook his head and was very blunt about it. He indicated that she has infection but her surgery is very complicated that he does not recommend revision surgery. Her first surgery was complicated in the first place where a special "hinged" implant was used because she has RA and her ligaments were not strong to support the knee. We were told this kind of implant is only used in Europe. The implant is deeper in the bone that a regular implant. The OS indicated that it is a risky surgery that he does not recommend. He made it sound that she is doomed if she chose to undergo the surgery and doomed if she did not. And mentioned all kinds of horrible outcomes.

My mother does not have insurance here and most probably we will not be able to perform the surgery here, however, I want to act on this quickly if she truly has an infection and we want some advice. Isnt it strange that the OS would not recommend anything and just send her back home? I feel me and my mother very stuck in a situation where we do not know what to do next. Her physician in Germany indicated from looking at xrays that she needs revision surgery with bigger implant. We can travel to Germany to see him but I want to make sure that it is indeed infected so I have the following questions:

1- Shall I look for another OS or Infection disease specialist.

2- Based on the results above, I am not sure if she definitely has an infection or we need to redo the test or make different ones. Based on my research I found those additional tests:
- Alpha defensin test
- WBC tagged bone scan


3- The OS told her that it is a chronic infection. Other than pain that is very bearable for her right now, and some swelling, I do not see any other symptoms. How soon do we need to act on this? Also would taking oral antibiotics make it any better or slow down progress of infection?
 
norua,
Welcome to Bonesmart, glad you joined us.
I am going to tag @Josephine, she will be able to answer your questions, about what tests to ask for, etc.
I would look for another OS who specializes in revisions, and infections. If you are anywhere near Texas, Gerhard Maale MD is the OS to see. http://dfwsarcoma.com .

You can also use the find a clinic link at the top of the page, you will have to call the offices and ask if they specialize in revisions and possible infections.
@Jamie may be able to assist.

Here is some additional reading:
Infection: Acne pathogen implicated in peri-prosthetic infections
Infection: Peri-prosthetic infection - also known as late onset infection
Infection: Periprosthetic infection (Scientific Articles)

Good luck in your search to help your Mother,
 
Last edited by a moderator:
@Pumpkln
Thanks so much for your feedback. That's very helpful. Actually I did read in this forum about Gerhard Maale before I posted this message and I contacted his office two days ago. I live in Chicago. They refused to make any consultation on the phone. Could they have changed their policy? Not sure if there is any way I can convince them to give consultation over the phone. My mother is not in a position to travel and move very much.
 
Sorry for the outdated information, I will just provide contact information in the future. Thanks!
You should be able to find some one in the Chicago area. We have many members in that area.
@Lovestoread may be able to make some suggestions.
 
But also knee aspiration showed high WBC count
I assume they did not culture for bacteria? I would think that would be the next step, then decide if she needs antibiotics, and which one.
I am going to give you and infection banner, it will help bring members with infections to your thread.
 
@Pumpkln Thanks! I was wondering how to add that banner.

They did not do culture because they said sample was not enough to do culture. I will have mom repeat the knee aspiration again. Not sure though if I can go to a primary care provider and ask to help make an order or find another OS or infection specialist.
 
@noura
I'm sorry to hear of all your troubles. I will pray for you and your mum. It sounds like you might need an infection specialist. @KarriB might be able to offer advice.
Best wishes to you.
Tabby xxx
 
He indicated that she has infection but her surgery is very complicated that he does not recommend revision surgery. Her first surgery was complicated in the first place where a special "hinged" implant was used because she has RA. We were told this kind of implant is only used in Europe.
First I would suggest that this chap you saw has no experience of note in this kind of revision so I would certainly recommend you ignore all he has said. Hinged implants are not problematic, not uncommon and very cutting edge technology. Neither are they exclusively used in Europe. In fact, we have a number of US members on here who have had them for revisions and/or for shabby ligaments. So put that out of your mind right away!
I want to act on this quickly if she truly has an infection and we want some advice
IF she has an infection. But periprosthetic infections are quite different to the usual, run of the mill infections which need to be treated in haste. Assuming you have read the articles Pumpkln left you, you now understand more about the particular characteristics of a PPI, the primary one of which is that it's often better to leave the infection to mature before diving in with antibiotics and such as too early and they won't be effective.
I will have mom repeat the knee aspiration again.
I strenuously advise you not to do that. Because a) even if there is an infection present, the aspirate is unlikely to reveal anything new yet and b) repeated intrusions into the joint puts her at risk of an infection all on its own!
1- Shall I look for another OS or Infection disease specialist.
The kind of surgeon you need to be looking for is a revision specialist as they are the ones with the particular expertise in dealing with PPIs. In my experience, infection doctors don't.
I contacted Dr Maale's office two days ago. They refused to make any consultation on the phone
No he won't do a consultation on the phone but what he will do is to let you send all her notes, xrays and lab reports and will mail or email you his opinion. That's quite different. I suggest you try again.
But also knee aspiration showed high WBC count (5000), although as I see from the results normal should be <200.
That could be coming from almost anywhere - a UTI, for instance.
Xrays of the knee showed some kind of bone fracture.
Can you get copies of those xrays and the report for me to see? You can post them on here.
 
My infection was an early onset, just 4 weeks after TKR, so my revision specialist felt an antibiotic washout/spacer exchange was the way to go. During the surgery cultures were taken and grown over the days after surgery which is when an infectious disease dr became involved. Four days after surgery the ID knew which antibiotics to use to combat the infection.
As Josephine said, a revision specialist is a must and when/if there is specific information on the type of infection, then an ID would become involved.
 
You are right there in Chicago. Rush hospital has some famous knee surgeons. @Lovestoread had a wonderful surgeon, I am hoping she comes on soon and recommends him to you.
 
Sorry….been a bit under the weather for a few days and haven't logged on. Yes, I had Dr. Richard Berger at Rush. I'm not sure if he is considered a revision specialist, but Midwest Orthopedics at Rush has many excellent ortho doctors. I'm sure if Dr. Berger can't see her, one of the others can. I believe Dr. Della Valle does revisions there. I also know someone who went to Dr. Sporer and liked him a lot. Their number is 877-632-6637. They are rated #4 in the U.S.. Good luck to you and your mother….
 
Thanks @Lovestoread I just knew that you would be helpful!! My daughter moved to Minneapolis and she does not miss the hustle and bustle of Chicago. I went prepared to hate Minneapolis, but to my surprise, I just loved it there!!! Even though it is flat!
 
Kelly, I knew she'd love Mpls! It's a "big" city without being "big." I'm glad she likes it! Hope she's doing well with all the little ones. We head up north in a week or so for a long weekend. Last time until next Memorial Day. (Next time you're there….head to Afton Alps for skiing. I believe it's 700 ft. elevation. :heehee:
 
actually, I cannot wait to take Wyatt who is 2.5!! the twins are 4.5 months, so it will be a while for them!!
 
Guys was this site down? I have been trying to reply to you for a week now and I was getting a database error
Does this site go down often?
@Josephine
 
noura,
Sorry you were having troubles with the site, our new tech guy is coming on board and these issues should be resolved soon.
 
No it doesn't go down 'often' but we've been without a forum tech for about a month now and errors have been creeping in because of lack of routine maintenance. The new one started today so all should be okay soon.
 

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