Revision TKR August 1st 2023 Second TKR Revision Left Knee

I’m so sorry that medical teams are failing their patients, especially when it concerns an infection. We had a new member post last night whose father is in a similar situation.
 
I am so sorry to hear this. And I am really sorry you are not getting prompt care.
I had never heard of this form of staphylococcus before.
I just found this interesting case report
in Arthroplast journal
2018 Sep; 4(3): 257–260. Published online 2018 Jul 30. doi: 10.1016/j.artd.2018.06.003
PMCID: PMC6123340PMID: 30186900
Small-colony variant of Staphylococcus lugdunensis in prosthetic joint infection
Mohamed Askar, PhD, MRCS,a Benjamin Bloch, PhD, FRCS Orth,b and Roger Bayston, PhD, FRCPatha,∗
Apparently it can be mistaken for staph aureus, is commoner than previously thought and prefers knees to hips.
This case report patient did well with antibiotics and a single revision so far.
The full version is a bit technical but it might be worth printing off to discuss the antibiotics regime used here with your ID consultant when you see them.
 
Good luck on the new ID consultant front.
Really hope the Wednesday appointment goes well and you get a clear plan of action.
I was very lucky when I had septicaemia last year that it didn't go to my knee- but infection remains my biggest dread.
Keep us posted- really rooting for you.
 
This is so discouraging, WFD. I am sorry you have to endure all of this. I do hope Wednesdays appointment
goes well for you and you're able to get something in motion. Know that we care...know that we're here for
you always. @WFD
 
So I just read in another thread you're just now getting a new PICC. Sending a huge hug.
 
Hugs and best wishes. Keep us posted, we care.
@WFD
 
Got the infusion, and I’m home and had dinner. The vancomycin is making me sleepy.
 
You’ve been at this a long time and it’s amazing how you have continued to be such a great encourager to others shile you are going through it. I’m also praying for your recovery.
 
I hope you had a nice dinner, slept well and you're having a good day so far.
Happy weekend, WFD. I hope it's a good one for you!
@WFD
 
Eight months after second revision of left knee -

So I saw my new ID doc on 3/6, and man, what a difference. She had nothing but scorn for the last ID doc that treated me. In addition to his other failings, it turns out that one of the antibiotics he prescribed was one the infection was already resistant to, despite the fact that the culture results that he already had access to clearly showed the resistance.

Her staff is super efficient and they got me in for a PICC line and first infusion the next day, on 3/7, anticipating that home infusions could start the day after. It turns out that all the visiting nurse organizations were full to capacity, and it took nearly a week to get one set up, despite me, her staff, and two nursing agencies beating the bushes. The delay was tough but it was not for lack of trying on their part - they really made the effort.

So I started home infusions on 3/13 and have been doing it since. Antibiotics sometimes enhance the absorption of caffeine, and this happened to me dramatically. I had a single cup of tea and it was if I'd chugged five cups of coffee. I have had to go off caffeine completely for the duration. That left me fatigued for about a week but I'm over it now.

After 2-3 weeks of the antibiotics I'm starting to feel significantly better. Once I get the #!$%* PICC line out (tentatively around 4/23) I can get back to being a lot more active, work out more, and get more chores done (having a PICC line sharply restricts what you are allowed to do with your upper body).

The first few of the weekly blood test results show the CRP levels decling dramatically, from 24 to 10 ug/dL (0.5 is the upper limit of normal) so I'm happy with the results so far.

Once I'm through this, I have to decide on next steps. The ID doc and others agree that since I've had the infection for more than 2 1/2 years now, the chances of killing it with only antibiotics are zero and the only way to kill it is with a two stage surgery. The problem is that in my case I've lost so much bone from the ends of the femur and tibia (due to surgeries) that they cannot use a regular articulating spacer, and would have to use a carbon fiber rod and lots of antibiotic cement to fuse the leg straight. This would be in place for up to four months while I would be (once again, for the third time) on a PICC line, this time for at least the full four months, followed by the second stage, which might be a rotating hinge knee. This would really stink, and given my ability to generate scar tissue, might leave me with little flexion when all was said and done. On top of this, the ten year success rate for two-stage revisions is 80%, so a 20% chance it would be all for nought.

The only other approved option is to stay on antibiotics (probably doxycycline) for the rest of my life, which has its own problems.

Two crummy options for sure. My plan for now is to go with the antibiotics and give myself some time to recover and gain strength, mentally as well as physically. Then I'll think it through with a clear mind.
 
I pray that you are led to making the right decision for you. You have been fighting this long enough!
 
My plan for now is to go with the antibiotics and give myself some time to recover and gain strength, mentally as well as physically. Then I'll think it through with a clear mind.
That sounds really sensible. I am so sorry you are having such a tough time.
I am glad though that you have a really good infections specialist.
 
Wow such big heavy decisions. I can’t believe the past surgeons didn’t order X-rays or bloodwork sooner. You must have a very high pain threshold! I do wonder about who are the study subjects in the 80% vs 20% success/failure groups, ie if the 20% group had a whole host of other medical problems that you don’t have. Your posts make me think you make good logical decisions and I wish you all the best.

I hope you are feeling ok on the antibiotic and able to do some things that matter to you. I’m so sick of everything with my knee , the pain, life revolving around ice, limping and hurting other body parts. I can’t imagine years of this!
 

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