Knee Infection* Advice - Two Stage Revision and Cement Spacers

[oysteroyster]

Hi all. Looking to get a bit more information as to the current situation and prognosis of my 65 year old mother-in-law, who has recently undergone phase one of a two stage revision.

Her original knee replacement was unsuccessful and resulted in an infection. She has now had the new knee removed and antibiotic cement spacers inserted - as well as receiving a daily drip - to clear the infection. They have told her that she will then likely receive a new knee in the autumn. Her knee is arthritic and the infection has caused some degree of bone loss. To complicate matters further, she is also quite significantly overweight, and has already had her other knee replaced.

Due to several factors - a currently very stretched British healthcare system, poor communication from doctors, and my MiL probably not asking as many questions as she should - she hasn’t really understood the process or its ramifications. She was originally told this procedure was to clear the infection and that it was a temporary solution, but she was also told temporary for some people is keeping the cement spacers for many years, so she has viewed the procedure as much the same as a regular knee replacement and expected to attend physio to regain the bend and relatively normal mobility. She has now been told that this is certainly not the case and movement should be kept to a minimum. This has come as quite a shock to her and potentially renders her housebound for months to come. She may not be in great physical shape but she’s far from a little old lady!

Whilst she will be seeing a specialist again next week, could somebody please advise as to how much mobility one should expect to have during the cement spacer phase and what the likely outcome might be in her situation? Should she be walking with a stick, and if so, how far? Or should she not be walking at all? Will she likely ever walk unsupported ever again? Is there a risk of amputation/fusion if the bone degrades further? From what I’ve read, the antibiotics tend to last up to around 12 weeks, so why are they talking about replacing with a new knee in 9 months - that’s a long wait when you’re stuck at home.

We have so many questions and it would be great if somebody could explain the current situation a little more clearly and realistically what the future holds.

Thanks!

 

[Jockette]

Hi and Welcome!

Here is a list of other members who have had infections:

Knee Surgery Recovery Area

For post-operative knee patients, on the "other side"

bonesmart.org

Some members do have a long term “temporary” antibiotic spacer, but most only have that for about 12 weeks, like you said.

Be sure you have your questions written down so you can get answers at this next appointment.

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

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The 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.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity Progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[bockoman]

Some people can walk with a spacer and some like my wife never could. She waited about 6 months untill a new joint was put in. They will not put in a new joint unless the infection clears which is likely but not certain. Sometimes if the infection doesn't clear they put in a new spacer. There are different types of spacers and some controversy about the mobility. Some surgeons want little or no mobility thinking it will more likely clear the infection but there is no hard evidence one way or another. It is a long haul. The revision surgery tends to have higher rates of infection than the original. There is always a small chance of fusion/amputation down the road but it is rare. The level of mobility when they put in a new joint will be greater than the spacer but may or may not be as good as ther original to some extent what kind of joint they eventually put in.