Be careful of any signs of infection

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TitaniumMan

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I am posting this most serious note to all of my friends here. I am posting this for everyones benefit as well as encouragement. My friend "Scotty" is 45 years old. He just came out of his 6th knee operation and his second TKR on his left knee. The first TKR needed a revision. He was up and fine right after the TKR a few weeks ago and was doing great. He noticed the incision "leaking" a bit and went to the OS where he dressed it and sent him home.

Today, he called me from the Medical Center where we both had our TKR's done by the same OS. He was readmitted last night with an infection and required an operation to clean the infection with another operation scheduled for Friday. To hear a grown man, a biker, a father and best friend cry is really getting to me.

As of this time, he is not on any anti-biotics as he is waiting for a Specialist to come in and prescribe the proper medications.

This all came to light when he thought he was coming down with the Flu and thought it was normal. Turned out, the incision was infected and the Doctor does not know the cause or how "deep" the infection is.

I am going to see him this afternoon after my Doctors appointment. I am taking a dose of anti-biotics prior to going into the Medical Center. Im not taking any chances.

I just wanted to post this to my friends here so we can all know what happens when an infection sets in. Thank God we have done great in this forum as I have not seen any posts where an infection has set in. I am sorry to bring up such a serious note here and I am in no way trying to discourage anyone. I just want you and me to be aware!!! It may not be a simple cold or flu.

Please put Scotty in your thoughts and prayers

Josephine, please give us some expertise and suggestions here??

Thanks,
Chuck
 

gatiger

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Sorry to hear about your friend man. That has to be tough on everyone, him, family/friends and you. I'll be praying for all y'all.
 

Skeet

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Please tell your friend we are pulling and praying for him. He must be so frustrated and disappointed with this setback. I had some weeping and such from my incision early on and I called about it. The doctor didn't seem too worried (the one on call, not my doc) but told me if it bothered me to come in and they'd remove the staples a couple days early. He looked at it and said it was fine... but I was still worried about it. All turned out okay, but I, too, encourage folks to err on the side of caution when it comes to possible infections!

Skeet
 

beachcomber

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My OS said if the infection happened within the first ???? amount of time (4-6 weeks? I think) that they "just" go in surgically and "superclean" it and pack everything with antibiotics.

If the infection occurred after that point it requires a complete, new TKR.

Kath's plight about her dental problems is scary because the bacteria from the mouth can travel through the bloodstream and scootches right up to that new knee. That is why the antibiotics for even routine dental cleanings.

Your friend will surely be in the prayers of many here. We know how powerful that has been for many of us and surely will be of comfort and help to your friend.
 

Pattipoo

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I had an elderly aunt that got an infection in her new hip replacement.....girls and boys, it was a horrible ordeal!!! The pain and the "cleaning out" was icky, icky, icky!

prayers for your friend
Patti
 

Josephine

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You are so right there, T man, and I'm glad you brought it up.

The delay in the eruption of infection also means - obviously - that it is deep. An infection or weepiness along the suture line that becomes evident in a couple of days will be a superficial infection and nothing to get too uptight about though it also shouldn't happen, of course.

Hard news is that if the infection surfaces about 7-14 days post op then it has almost certainly been due to a breach of aseptic technique in the theatre. I was always preaching, preaching, preaching to the staff that orthopaedics demands the very highest standards in aseptic technique and it can be breached in so many almost trivial ways. Also is a fact that since we are operating on a 'clean' area rather than the abdomen and/or gut which is dirty to begin with, infections in joints SHOULD NOT HAPPEN!! There is no excuse for them. That's why I always emphasise the question about infection rates. If the surgeon answers readily and with figures then you can be pretty certain that he will have high standards, that he is aware of the potential of breaches and that he will be similarly demanding of the staff that work with him.

Treatment will initially be oral or even IV antibiotics and most do get brought under control but remain a worry forever as a new episode can be initiated by somethings as simple as a dental abscess or similar infection. A revision for infection is usually accompanied by massive doses of antibiotics and the use of bone cement with Gentamycin in it. This will leach out of the cement into the surrounding tissues over a period of about 8-10 months. Cementless prostheses are rarely used in revisions for infection.

I hope I haven't scared the beejeebers out of you all. This is a side of joint replacements that we try not to talk about as it is generally pretty rare. I know that when I was a theatre manager, we used to get lots of THRs (hips) for replacement and my staff got very depressed about it. So I asked the surgeon why we had so many failures and he looked at me like
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and said "They're not MINE!" Turned out he had become an expert in revision and as a result we were getting them sent from all over the UK!! Thus I acquired a lot of expertise in the subject. One thing I know is that there are surgeons who do primary TKRs/THRs and there are surgeons who specialise in revisions. There are even surgeons who specialise in revisions for infections and believe me, they have rattling good results.

The journey for the patient, however, is not at all pleasant.

Any questions - the floor is open .............
 

kath

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Well, I don't know what to say really. My hurt breaks for TMan's friend, and yet I am breathing a huge sigh that my problem didn't go to my knee and that I caught it completely by accident. It does scare the daylights out of me.
A bit more nervous about next Friday's surgery.
 

Josephine

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Well, you're right, Kath - it's not a very comfortable subject but like a lot of these things, it's as well to be informed about them beforehand and know what to look out for. As my nan used to say "A peck of prevention is worth a bushel of cure!". But please don't get too caught up about it. As I said it is a rare complication.
 

Sue

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Josephine,

I'd be interested in knowing more about infections and their potential of screwing up a TKR, even though it's an uncomfortable subject. (I've heard a few horror stories about infections, which I will NOT share here!)

I know that my doctors were very concerned when I picked up a staph infection on the skin of my arm and shoulder from going to the city pool a couple of months after my surgery. Fortunately it wasn't MRSA, and it went away fairly quickly with a course of antibiotics. It did give me a scare, though--I haven't been back to the pool since. I think about it, but I want more information before I decide whether to go back.

I am going to have my teeth cleaned soon, and I'm supposed to take a bit dose of antibiotics before that happens.

So what is the story on infections for the long term, after you've had a TKR? Do you have to be really vigilant about every scrape you get?

Thanks,

Sue
 

Josephine

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Josephine,

I'd be interested in knowing more about infections and their potential of screwing up a TKR, even though it's an uncomfortable subject. (I've heard a few horror stories about infections, which I will NOT share here!)

I know that my doctors were very concerned when I picked up a staph infection on the skin of my arm and shoulder from going to the city pool a couple of months after my surgery. Fortunately it wasn't MRSA, and it went away fairly quickly with a course of antibiotics. It did give me a scare, though--I haven't been back to the pool since. I think about it, but I want more information before I decide whether to go back.
Not a lot of people realise that MRSA actually stands for Multi-Resistant Staphylococcus Areus. Staph Areus is actually a commensal (i.e. normal inhabitant) of our skin and bowel where it aids some protective and digestive processes. It's only because we have been so laissez-faire about the use of antibiotics has enabled them to regenerate in this dangerous form. So it is possible to get SA infections without it being MRSA. And most SA contaminations can be easily removed with just normal soap and water.

As for the public pool, did you know that the chlorine they use to decontaminate the water is actually odourless? Or that the distinctive smell only occurrs when the chlorine is combined with uric acid? And where does uric acid come from? Pee!! So the stronger the smell, the more people have actually relieved themselves in the pool!! I stopped going to pools a long time ago and especially when I figured that if people weren't too particular about their personal hygiene then it would 'wash off' in the pool! YUK!! If I was a JR patient I would certainly try to find a pool that wasn't very popular!



Sue said:
I am going to have my teeth cleaned soon, and I'm supposed to take a bit dose of antibiotics before that happens.

So what is the story on infections for the long term, after you've had a TKR? Do you have to be really vigilant about every scrape you get?

Thanks,

Sue
No of course not! Not every little scrape! What you need to be careful of are things like dentistry because a) the mouth is very dirty bug-wise and b) it has an almost direct route into the core circulation. Other infections would be any gross abscess, cellulitis, (other) joint infections and appendicitis and really bad septic throats like tonsillitis. Though not upper respiratory infections like colds and their associated sore throats.

Things like scrapes and grazes or a splinter in a finger that's got a bit inflamed and sore shouldn't matter. A big gash that's got inflamed and maybe has pus would. Rule of thumb is, if in doubt, check it out with your doctor.
 

Doug

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Upper respiratory infections. Would you run that one by me again? Are those not as big a threat to the knee??
 

Josephine

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Ordinary coughs and colds are caused by viruses not bacteria. Therefore are not of themselves, a hazard. However, if the cold progressed to having a bacterial infection of the throat or chest, then yes, that would be something to take action on.

But as I said, any concerns you should check with your doctor ASAP
 

Josephine

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Just found this informative website. It says

For the rest of your life if you develop an infection elsewhere in your body (for example bladder infection, infected cuts, boils, dental abscesses) this infection can travel via your bloodstream to the replacement.

Therefore, if you develop an infection you should consult your family physician and have him treat it promptly. Viral infections, such as colds and most sore throats, are not a problem. (emphasis mine)

Dental work can push bacteria into your bloodstream and cause an infection in your joint replacement. We recommend that you take antibiotics if you are to have dental work (other than simple cleaning of your teeth). You will be given a plastic card to keep in your wallet containing information about dosage.

ALWAYS NOTIFY YOUR DENTIST OR ANY TREATING PHYSICIANS THAT YOU HAVE A JOINT REPLACEMENT

If you are to have cystoscopy, bronchoscopy, or colonoscopy you should also be covered by an antibiotic. Doctors vary on their recommendations as to which antibiotics should be used and for how long.

Call your doctor immediately if you develop any infection. Never, ever allow any physician to inject Cortisone or any other medication into or near your artificial joint. It may cause disastrous infection in the knee joint.
 

Doug

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We've got ya workin tonight don't we??? Thanks for the info. Very informative information.
 
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TitaniumMan

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Hi everyone. I just want to thank you for your thoughts and concerns. I saw Scotty today, he was in a "sterile room" with no roommate. I could not even go near him unless I put on a gown and gloves. I stayed by the door. Here is what Scotty and his wife told me. They are going to put him on an anti-biotic regimin for at least 21 days in the medical center, via IV. If that does not cure the infection, they have to remove the prosthesis and replace it with a rod until the infection completely clears up. That means he will be in the medical center or a rehab for a few months if the later happens. As a precaution I took anti-biotics before I went to the medical center and must have washed my hands 10 times while I was in the doorway of his room chatting with him. I know it sounds crazy, but I came home and washed the clothes I was wearing and took a long soapy shower. The problem I have now is that his incision was weeping since he left the Medical Center after the revision. I wonder why it took so long for anyone to realize something was wrong? If my incision even began to look red or anything that would indicate an infection I was on the phone with my OS! His OS is the same OS I used for my TKR. I just cant understand why such a good OS and physical therapists would not notice any problems or find it unusual when his incision was weeping. Anyway...just ranting a bit here. Again, thanks for your thoughts and comments, and please...Watch out for anything that does not look right that may indicate an infection.

On a better note, I went to my new Doctor today, he is a pain management specialist. Just to make it short and sweet. He put me on 900 mg of Neuronton for pain, Percoset 5mg. three times a day (as needed or if needed)and scheduled me for an MRI of my lower back and set me up for epidural injections on March 17. The epidurals will hopefully get rid of the lower back pain and cramping in my quad and calf. All of this was done during a 45 minute evaluation, no begging for pain medicine or trying to explain my pain and discomfort. I signed an "opiate contract"contract with him that I would only use him for my pain management and that I must take the medicine as directed or he has the right to discontinue treatment. I am also subject to urinalisys to determine that I am only taking what he prescribed as well as my Cymbalta and sleep aid. In this medical practice, you are fined $75.00 dollars for failing to make an appointment, $200.00 for failing to appear at a surgical procedure and ultimately, termination of treatment if the Doctor feels I am not co-operating. I am so happy that I found someone who understands my pain and I'm happy that all of you gave me the courage to find another doctor that was sensitive to my needs! Thanks for all of your input and thanks for letting me vent this out and share!!!!
Respects,
Chuck T-man
 

Nursepair

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Hi TM

I am really sorry to hear about your friend Scotty. I really hope that all goes well for him. He must be really low, especially as he is in isolation. I hope they can give him something to help take the edge off all his worry. I fully understand about your clothes washing, no way do you want an infection in your knee. My thoughts are with him and his family and friends. Sue
 

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Hi Chuck,

My thoughts and prayers are with your friend. Please let him know that there are all these folks out here pulling for him.

This discussion about infection is pretty sobering. When I was in the hospital and rehab unit immediately post-op, I was running a slight fever for days. I am glad to say the medical staff was really aggressive about it. They drew blood (a lot - it was a pain, but I knew it was necessary), they did a chest x-ray, put me on IV then oral antibiotics. Fortunately it finally came down, but I never really knew why I had the fever. They said they see it sometimes post-op. I was just grateful that they took it seriously and treated me.

All the information from Josephine was really helpful. Thanks once again to our fearless moderator!
 

Pattipoo

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My two little nieces came into my house last night...3 years old twins. Their dad was outside with my hubbie. They said they were hungry....I fed them. After a while, their daddy came in to get them and said "Did I tell you that Morgan has MRSA on the back of her thigh?".....I said "UH...NO!!!!!....I've been schnuzzling on her....holding her....feeding her....she's sat on me and every chair and sofa in the family room and kitchen!" I told him that I really had to be careful and keep as sanitary as I possibly can and he was SOOOO apologetic. Should I panic?

Do I need to call my Dr?

Help
 
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