Knee Infection* 4 surgeries, 2 revisions, 1 staph epi infection

laralealu

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I guess I am looking for some support.

I just completed surgery one, for a two stage revision for a staph epi infection. I have had a challenging year and up until now I felt that I could manage. But now I feel overwhelmed. I came home from the hospital Wednesday afternoon and started IV Vancomyicin that night. Fortunately, I have strong personal and professional support and for that I am grateful. But I am am scared about the overall outcome and I am so tired of living in pain. I am looking for other individuals with similar challenges.

I don’t want to say it, but I am looking for hope. Thank you!
 

Jockette

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I am looking for other individuals with similar challenges and I don’t want to say it, but I am looking for hope. Thank you!
:console2:Welcome to Bonesmart, you have come to the right place!

I’m sorry you have been through so much. @KarriB has been through an infection and she’ll be along to talk with you.

Here is a list of other members who have had infections:
https://bonesmart.org/forum/view/knee-replacement-recovery-area.9/?prefix_id=33

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.
 

Jockette

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I will also leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: Guidelines

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. Here is a week-by-week guide for

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only
ONE Recovery Thread.
This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Celle

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Hello @laralealu
I'm sorry you've had so many problems with your knee replacement.
I hope that the current surgery and its successor will finally cure your infection.
Do you have a doctor whose experience is with infectious diseases on the team supervising your care? An ID doctor can help with suggestions for infection control.

When you say you've had the first stage of a two-stage revision, does that mean that you have had the original knee replacement hardware removed and an antibiotic-loaded spacer inserted instead? That's the usual procedure.

As Jockette said, we have had several people whose knees became infected. For most of them, it took a while, but they have all recovered successfully.
 
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laralealu

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Thank you for your response. I am working with a team that specializes on revisions, including an I.D. doctor. Everyone is great and we are “cautiously optimistic”. Yes, last week all of the original hardware was removed and an antibiotic spacer was placed in the first surgery.
 

Celle

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Thank you for clarifying what you've had done. It sounds as if you have a good team looking after you.

We'll be here to listen and support you.
 

Izabel

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Hi @laralealu and welcome. I am 'visiting' from the hip forum having been on the knee forum earlier in the year so I do look in from time to time.

I have a spacer in my hip due to E-Coli infection. Between my knee and hip issues it has certainly been a journey but I am beginning to see the light at the end of the tunnel.

Do you have any restrictions and, if so, how are you coping with them?

If you click on the red bar that says Knee Infection, you will get a list of those dealing with/or have dealt with this issue.

In the meantime I would like to wish you a happy and healthy New Year.
 
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laralealu

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Hi! Thank you for reaching out. Knee and hip? Phew.

I’m wearing a knee immobilizer 24/7. I have a tough time getting it tight enough to stay up. Gravity does not want the brace to stay up around my much wider thigh... Also, I’m administering Vancomyicin by IV into a picc line. I’ve had a lot of education, but it still makes me nervous.

My mom, who is an amazing retired nurse is here helping me. She’ll be leaving this Thursday, it’s time for me and my husband to cope and for her to resume her life. She’s spent a lot of time helping me this year.
 

KarriB

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So glad your team includes an ID. I totally understand where you’re coming from even though I didn’t have a 2 stage revision it was still a hard road to hoe.

My infection began at 4 weeks post op with a high fever along with massive seeping and my revision surgeon performed a washout/spacer exchange. I was on IV and oral antibiotics for 6 weeks along with an immbolizer. It was really hard to keep it up because it would slide down with any walking I did, but my OS wanted me to keep activity at a minimum which was good because I had no energy after two surgeries and fighting an infection.

I worried quite a lot about how much flexion I’d have when the whole process was complete and my OS said he’d be happy with 90 degrees flex. But the good news is I have a great ROM! When the immbolizer came off (about 6-7 weeks post op) my OS ordered non-aggressive PT, just heel slides with no pushing or pulling and only moving my foot 2-3 inches at first. I concentrated on walking around the house and bending my knee a bit after walking like a peg leg pirate for so long. After a few weeks I began to rock the pedals of an exercise bike and was able to get a full rotation after another few weeks.

The hardest part was giving my knee time and let it work at it so own pace. I continued on the exercise bike and now ride 9 miles a day (but in the beginning it was just after few minutes a day) and walk a few miles. I understand how very emotional this process is, but know a good outcome is possible. It sounds like you have a good team to lean on. We’re here to answer any questions you may have or provide a shoulder when needed.
 
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laralealu

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Thank you for telling me your story. Your outcome sounds great, it also sounds like you did a lot of hard work. Having patience during theses early weeks is one of the hardest parts, don’t you think? How was your pain and pain management? It’s challenging, as even the most simple things can be so painful. Congrats on your ROM. The team is pretty quiet about it and one resident blurted out that I might never achieve a good ROM again. I’ll be patient for now and when the time comes, I’ll put my heart into flexion. Thanks again!
 

Celle

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Congrats on your ROM. The team is pretty quiet about it and one resident blurted out that I might never achieve a good ROM again. I’ll be patient for now and when the time comes, I’ll put my heart into flexion.
Don't worry about ROM yet. Concentrate on getting the infection cured first.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer. There isn't any deadline you have to meet. Time is on your side.
Myth busting: the "window of opportunity" in TKR

When the time comes to start thinking about ROM, don't work hard at exercises. Just take it gently.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.
 

Josephine

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I guess I am looking for some support. I don’t want to say it, but I am looking for hope.
Why don't you want to say it? That's what we major on here - support and hope. I see our Karri has already spoken to you so you already know that this forum's main focus is on support, advice, encouragement and hope! All to be had in abundance!
 
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laralealu

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Hi Josephine, I think it’s hard for me to admit that I can’t manage all this on my own. My support network is remarkable, but I think finding another source for emotional support is really important. You guys have been through it all and connecting with this group is already helping.
 
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laralealu

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4498AD14-526A-4A7E-A75F-368EFBAD2772.jpeg

I took a shower today, my first since surgery and wow did that feel great. I have a really good transfer chair and had help reaching everything. After that, I had my first dressing change at home. The wound looks really good and dry. Since I’ve had four surgeries on this knee the skin is pretty fried. A plastic surgeon did the close using a combination of sutures and glue. It looks a little Frankenstein-y, but the tissue looks really healthy.
 

sistersinhim

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I remember how heavenly that first shower felt! It was wonderful, but oh, so tiring.
 

KarriB

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I will tell you that going through my TKR and infection was the hardest thing I’ve ever done. I had never had surgery before, then had 2 within a month. After the infection my emotions were all over the place, I cried 18 hours out of the day, had a hard time admitting I wasn’t independent, couldn’t concentrate on anything and worried every day I’d never bend my knee again. That was all very hard work, much harder than what I did to gain ROM.

Even harder than gaining ROM was waiting to work on strength. But waiting was the best thing I could do for my TKR. Now, 5 years later my TKR is stronger than my natural left knee.

I’m glad you got to shower, no showering for me until 4 weeks infection post op. Did you use Cling
Wrap around your PICC line? I found it worked best, but I did use 2 layers, wrapped in opposite direction.

I took 5mg of oxycodone a few weeks after the infection surgery, then Tramadol. But by week 3 I wasn’t in too much pain (remember I had a washout/spacer exchange so no messing with the bone) and didn’t take anything really. I imagine you’re pain is worse with the antibiotic spacer going in.
 
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laralealu

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Waiting really is the hardest part and since I’ve had so many surgeries on this knee in such a short amount of time the surgeon really wants to leave the spacer in for as long as possible. So the current goal is to kick the infection, regain my mobility, resume my life and let the soft tissues have some time to heal. He said it would be great if I could go two years before doing stage #2. In a way it seems like limbo.

I used a specific plastic shower cap type cover for the shower. It’s a tube with really tight elastic on either end, which we taped just to be extra careful. I’ve had a year of mostly acute pain so my tolerance is higher than I’d like. I’m sticking to the schedule for pain meds right now, but I’m feeling a bit better so I’ve been able to spend a bit more time up and about.

I know what a wash out is, but can you please explain what a spacer exchange is...
 

KarriB

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There is a plastic spacer placed between the two new joint parts that acts sort of as cartilage . Usually the spacer isn’t visible on an x-ray because it’s plastic, you just see an empty space between the two implants. Before my OS washed out the knee he removed that spacer, washed out the knee, removed the OR staff who then had to scrub again before coming back in to the OR to be sure no one carried anything on there scrubs etc. Then they all returned, he washed out again then put in a new spacer before closing up my leg. So my tissue was very compromised from the double washout and infection so that’s why the immbolizer and non-aggressive PT.
 
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laralealu

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I gotcha... it’s the piece that I always think of as replacing the meniscus. So since your infection happened fairly soon after your initial tkr they didn’t have to take out all the hardware?

Right now it’s 8pm and I’m waiting for the IV nurse to arrive to change the PICC line dressing and draw blood for lab work. It’s going to be a late night as then I’ll have to run the vanco. Next week the agency promised to get a nurse out in the morning. There are a lot of moving parts to manage. I see my surgeon Friday, I imagine he’ll take out my stitches. I’d love for him to say I’m done with the immobilizer but that’s kind of a dream. It is just really difficult to pull up your pants when you have that thing on. It’s the middle of winter and I’m wearing shorts around the house. But I’m feeling better every day so that’s what matters.
 

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