Knee Infection Artificial knee, hip and a possible amputation required :-(

[Dem1979]

Hello Everyone,

I'm really new to the group and i'm after a bit of support if that's ok. I'm sure you guys may have heard this sort of story and maybe able to offer some advice.

I'm on here to discuss the case of my father-in-law. He's in his late 70's and has suffered with joint issues for decades. He has two artificial hips, an artificial knee and a fused ankle (these last two are on the same leg).

About 5 years ago his ankle was fused and all seemed to go well. Until the week the cage was due to come off and a horrendous infection hit. He was extremely ill. The artificial knee in that leg bore the brunt and it was removed and a spacer added temporarily. After 9 months a new knee was put in and we thought we had got over the problems. Sadly not. There has been repeated infections since and now we are told there is no way to kill the infection which has overwhelmed the artificial knee.

To make things worse the new knee joint was so extensive they don't think a new joint could be done. Instead he has to live with a horrendous wound which weeps all day and night. We've been told this will get worse until we are likely to face the decision of limb removal. As its his knee that's effected this could mean taking his leg off extremely high up and having an artificial hip as well puts hip at risk of the infection trying to travel to that foreign body.

We are remaining positive but I'm interested in hearing people's thoughts on firstly living with a constant infection and secondly on the chances of having a prosthetic leg. Would an artificial leg be successful with his artificial hips and generally how do people in their late 70's cope?

I'm really grateful for you taking the time to read this and any comments would be really gratefully received.

Thanks
D

 

[SusieShoes]

Welcome, D! You've been through quite an ordeal already. I have a family member who had an infection in her knee replacement that required a spacer and months of care. It's a lot for a family to cope with already, and your concerns go far beyond that. You are doing the right thing to seek out what information you can gather.

I'm tagging our Nurse Director, @Josephine, for her experience. She has decades of orthopedic experience.

I'm sure other members will be stopping by to offer their perspectives. We'll help in every way we can!

 

[Dem1979]

Thank you so much for your kind words. Its been rather traumatic already i'm just hoping that as we research more our knowledge increases and we have options on the table.

 

[Josephine]

I should think it has been traumatic! That poor man - my heart goes out to him.

However, let me address a few of your comments

Until the week the cage was due to come off

Can you tell me more about this 'cage'? Was it an external fixator similar to this?

And I presume it was the for the ankle, yes?

The artificial knee in that leg bore the brunt

Meaning the infection was actually in the knee rather than the ankle or the fixator pins?

Had the fixator pins become infected?

living with a constant infection

He cannot live with a constant infection. The ultimate consequence of that as septicaemia which is extremely serious.

on the chances of having a prosthetic leg. Would an artificial leg be successful with his artificial hips

Yes, of course he can use a prosthetic. We've had a couple of members who were mid-thigh amputees who actually had hip replacements! If he is supplied with an all encompassing prosthetic, the hip replacement will be fine.

This runner might not have a THR but he's certainly active on his midthigh prosthetic1

generally how do people in their late 70's cope?

Don't be ageist! People in their 70s cope as well as any other patient, no matter what the age!

BTW, I see you are in the UK - which hospital is treating him?

 

[Dem1979]

Hi Josephine

Thank you for coming back to me. Yes the cage was an external fixator designed to fuse his ankle in place and although we believe its possible the infection got inside because of the cage it was the knee that was targeted. The fixator points themselves were not infected and around those his leg seemed perfectly healthy.

I'm so pleased to hear that a prosthetic would be an option, i think he not only fears the loss of his leg but any potential loss of movement enabling him to get around.

Your comments regarding the infection however fit perfectly with my own thoughts. I didn't think it would be possible to live like this indefinitely. My concern is the amount of fluid being lost is increasing rapidly, the knee comes up in lumps and these then burst and more fluid is lost. This weekend we had such an event and as a family we are trying to deal with this and dress it to keep it as clean and sterile as possible to prevent further infection setting in. I'm not sure how you go about treating this in the US but here in the UK we have been told there is nothing that can be done. The joint itself is working fine but the infection that surrounds seems untreatable. He is on 3000mg of a broad spectrum antibiotic daily and he's been told to remain on them for the rest of his life. We have been advised there are no options except to live with this. My most major concern is the risk to his life. When he was rushed into hospital 5 years ago he was completely over ridden with infection, he wasn't aware of who we were or where he was, he was delirious and it took IV antibiotics and numerous knee rinse outs and the knee removal to get him back to normality. Having seen how quickly this can overwhelm him i fear a repeat.

Yes I am in the UK in the South West and he is under the care of Gloucester Royal Hospital albeit he has also been assessed by Southmead Hospital which is in Bristol.

Thank you for your comments I do really appreciate your time.
Dem

 

[Josephine]

Are you accustomed to using Facebook? Because there is no need to hit "quote this message" to reply to someone.
Just scoot on down to the bottom of the page and start typing! Unless there is some specific phrase you want to address, of course - like I do! Then do it like this How to quote a post.

I'm not sure how you go about treating this in the US but here in the UK we have been told there is nothing that can be done.

Hey, did you miss the Union Jack in my post? I'm in the UK too! And I totally refute the notion that nothing can be done!

the knee comes up in lumps and these then burst and more fluid is lost.

Those, my dear, are abscesses!

When he was rushed into hospital 5 years ago he was completely over ridden with infection, he wasn't aware of who we were or where he was, he was delirious

And that is septicaemia! Lately referred to as sepsis.

I think you need to see somebody with more common sense. Is he fit to travel? Can you take him elsewhere? I'd suggest The Robert Jones and Agnes Hunt Orthopaedic Hospital Gobowen, Oswestry SY10 7AG, Tel: 01691 404000. I suggest that you phone first and ask to talk to an infection specialist then give him/her a brief outline of your father's situation and ask if they will/can review him and give you an appointment for a consultation.

 

[newlybionic]

I hope your dad can overcome this infection. I’m sure it’s very difficult dealing with the constant abscesses. Hopefully you can get him to have another consultation.

 

[Dem1979]

Hi Ladies,

Thanks for the messages

@Josephine I think that i am finally mastering the forum haha.

I'm sorry I totally missed the flag. Its fabulous to have you make a suggestion of the Robert Jones and Agnes Hunt Orthopaedic Hospital. I will most definitely be giving them a call to suggest a visit. He can travel. Its a lot of effort but my husbands car has the space to get him in.

At the moment we have been suggesting for him to avoid any environments that could risk further potential infection an example is fishing. He tends to go to a lake where disabled people can go where its flat and he can use his mobility scooter. His family however panic thinking that with the risk of bacteria and infection from contact with fish and rats etc he could overwhelm his body and the result being full blown septicaemia and a hospital admission. Are we being unnecessarily concerned do you think? Are those with infections perfectly fine to do these activities or is it possible that any addition infection of his wounds or a cut to the hand etc could make things worse? I appreciate he wants to live his life and sometimes i fear we maybe trying to wrap him up in cotton wool.

Thank you for all your advice.
Dem

 

[sistersinhim]

I can understand wanted to shelter your FIL from any possible increased infection areas. But, put yourself in his shoes, and ask what his quality of life is. Explain to him the possible risks and let him make the decisions on whether to do something he enjoys. I know I'd be terribly afraid to go, but he's probably tired of 'not living' because of his infection.

I pray you can get him in to the new place and that they can come up with a favorable solution. He, and all of you, have been through enough!

 

[Jennszoo]

I am not a medical professional, but while I don't think he should swim in lake water, it seems perfectly ok for him to visit the lake. I am drawn to water. It's my happy place and breathes life into me. If that's the case for him, let him have that.

 

[Josephine]

I think that i am finally mastering the forum haha.

Brilliant!

At the moment we have been suggesting for him to avoid any environments that could risk further potential infection an example is fishing. Are we being unnecessarily concerned do you think? Are those with infections perfectly fine to do these activities or is it possible that any addition infection of his wounds or a cut to the hand etc could make things worse?

Yes, I think you are. Let the poor chap have a life. But one thing you have to take on board is that he already has an infection and it is that which puts him at risk of sepsis. Obviously he will want to avoid any other injuries such as you describe but I don't suppose he will be dehooking any fish he catches or gutting them himself, yes?

Just because he has a pre-existing infection, don't let everyone go five flips and a heart attack over anything he might be exposed to from here on. If he has any open wounds, obviously they should be carefully dressed and covered to protect them from additional contamination. Good luck!

 

[Bikesouth]

@Dem1979 can you tell us what bacteria has been identified as the culprit.

In reading your post it appears as if your FIL is a tenacious fighter which makes a big difference in dealing with infection.

 

[Jamie]

I agree with Bikesouth.....do you know if the infection was MRSA/MSSA?

I think you have done a wonderful job of advocating for him! He is fortunate to have you. I'm glad you're willing to follow the lead Jo gave you too.

 

[Steve4kids]

I just got out of a cage for my ankle, look like the same. Got infection and sores from the pins. The infection in his knee is deep. I feel for him. He just has to go forward. If he can go fish and enjoy himself well that's really good. All I can say is he's not alone and he can endure.

Very important you research your doctors, they are not all the same. Find one who does only revisions due to infection as they would know a good ID doctor to attend to the infection.

I was so fortunate, 20 miles from me in L. A. was USC Hospital with a world leading surgeon who only operates on what I and your FIL has but I had to research and find him. So, I would think in the UK there is a Dr with that expertise also. You must find them to give your guy the best chance to save life and limb.

Good luck to you on finding the right doctor.