Knee Infection* Blister issues

Hyparch

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Knee Replacement Nightmare

So to begin the story my father aged 64 got knee surgery last spring and had a long series of UTIs fainting spells and possibly sepsis at least once which led to a removal of a TKR he has. They put in a spacer and put him on a 5 week regimen of Vancocymin, which he, with his tremendous luck, had an allergic reaction to. They fought through that and about a week ago he had his spacer removed and a second TKR done with a new permanent knee. He has been healing well until recently when a giant blister formed and popped in a bloody pus mess. He was on the way to the doctor when it happened who gave him local cleaning solutions and told him keep it dry and clean. So now he still has a very large blister that didn't completely drain and is in the same boat. Are these types of blisters normal after a TKR? I've read about fracture blisters but I'm not sure it is one. I just am scared of another possible infection for my dad, but they refuse to test for it again. Thank you for your input!

PS we went to the ER and they said to leave it to the surgical doctor but I just wanted some added general input about TKRs and blisters. We are keeping it very clean to mitigate infection since it popped but are worried the blister could be a symptom of an already existing infection. The surgery was less than 10 days ago as well.

The blister picture I received from my mom showed a decent amount of blood as well so that also has me worried.
 
Hi and Welcome!

I’m sorry about all your dad’s complications. I have alerted the rest of the staff about his situation and one of them should be along to respond.

In the mean time, please give us the dates of your dad’s procedures, so we can make a signature for him. Original TKR, the date the antibiotic spacer was put in (called a stage one revision) and the date of the new hardware (stage two revision)

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
ice
take your pain meds by prescription schedule (not when pain starts!)​
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

5. At week 4 and after you should follow this

6. Access to these pages on the website

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.
 
Hi! His first knee surgery was in March of 2023. His spacer was in December 2023 and his new surgery was mid February this year.

Apologies if the dates aren't specific enough but I don't have the information directly on hand for the specific days.
 
Thanks! We really like the actual dates, so we’d appreciate it if you can get that information for us, when you get a chance. I’ll make a signature and we can update it later.
 
Will do. When I call my parents tomorrow I'll ask for them. Might take them a few days but I'll get the information for you. Thank you for all you guys do!
 
That’s fine. Also, was it his left or right knee?

Here is a list of other members who have had infections, if you’d like to check them out. It helps to read about others in a similar situation, one doesn’t feel so alone!
 
Hello @Hyparch

I'm sorry to learn of your dad's woes. That's got to be disconcerting!

We have seen members have blisters, both small and quite large, occuring on the skin apparently as an allergy reaction to tape or to solutions used as skin prep. As you'd expect in those situations, the blisters contains clear "serous" fluid.

What you describe is obviously different, being filled with blood and pus it seems to represent some direct connection with the surgical site.

First, your dad deserves a more robust explanation from the surgeon about what it is and why he's not concerned about it. If your parents weren't able to convey that info to you, it may mean there wasn't an explanation or it may mean they didn't absorb the information. Either way, it's appropriate to follow up with a "we didn't understand, can you explain again..."

Second, I hope that there's been an infectious disease specialist consulting with your dad and the surgeon, at least intermittently, especially since the Vanco allergy manifested. It would make sense to also let that doctor know what's going on, perhaps have an office visit.
 
He is at the doctor's right now getting it looked at more thoroughly. Yesterday he went to his GP because the surgeon was not available but he's there now. The GP thought it was something called a fracture blister, just a very large one. He gave him a silver based cream or something similar to put on it to help keep it clean. I'll update again later today when I hear back about that.

Also we have had an infectious disease specialist involved with him since November and he will be seeing him later this week as well so I'm sure that it will be looked at again there. The infectious disease specialist seemed concerned about the Vamco allergy but since it was mild enough they pushed through to clear out his old infection.

It's just been such a painful process for us all because it seems none of the doctors want to make any changes when things start to go wrong and wait until they are at the absolute worst to do anything. The original infection popped up in April of last year and they did nothing about it with regards to the knee until November. They kept beating about the bush with it and for the life of me I couldn't understand it. Everyone in my family knew it was his knee but we couldn't convince the doctors until he had cellulitis at which point they did a biopsy on it. They legitimately checked for cancers before they checked out his knee.

Anyways, I will update you in a few hours!
 
Aww, I am so sorry for the mental anguish this is likely causing your family.
Hugs to you all. :console2: Please do keep us posted.
@Hyparch
 
It's just been such a painful process for us all because it seems none of the doctors want to make any changes when things start to go wrong and wait until they are at the absolute worst to do anything. The original infection popped up in April of last year and they did nothing about it with regards to the knee until November.
Is your dad seeing local doctors? Sometimes when we have complications it’s better to go to a bigger area, to get doctors who have seen more issues and have more experience in handling them. If you’re interesting in seeking care outside your area, let us know where you are and where they would be willing to travel.
 
I’m so sorry your father is going through this, but it does sound like he’s getting attention that will help get this resolved. Where does your father live? And, is it possible for you to post the photo you received of his knee?
 
Small update for today. Surgeon drained a bunch of fluid from his knee and he will be back again on Monday. My dad says it was a blister but my mom says the surgeon said it w was a hematoma. I will get that picture for you as well and post it. We live in Pennsylvania by the way.
 
Thank you for the updates.

I hope his care is more attentive moving forward; if not, it may be best to consider consulting a second surgeon, not affiliated with his current one or with the same hospital.
 
Your surgeon probably explained to you, but a hematoma results from an accumulation of blood that occurs after surgery. It is fairly common and not usually a big problem once whatever bleeding was occurring is stopped. Sometimes during the surgical process, small blood vessels don’t get properly closed off and this type of bleed can occur. I hope the doctor was sending the fluid drained out for testing just to be sure everything was okay.
 
He didn't test the fluid for whatever reason. Also here is the picture. Warning for lots of blood.
 
1000008079.jpg
 
Thank you for the updates.

I hope his care is more attentive moving forward; if not, it may be best to consider consulting a second surgeon, not affiliated with his current one or with the same hospital.
We would love to but given inability to travel in my family due to me being legally blind and my mother having menieres disease it is very difficult to get anywhere. We also live in a very rural area as well.
 
Thank you for the photo. Please keep a close watch on the wound to ensure it is healing. Should bleeding continue or another blister develop, don’t hesitate to get back to your doctor and insist that he provide testing for any fluid removed for infection. Having survived a sepsis condition, your father is more likely to get it again. As I’m sure you know, sepsis can be a life-threatening situation and, should it occur, fast action is required. Also, ask for the hospital’s social services department to help you get assistance to deal with whatever is causing this. With your father’s history, this is not something to mess around with.

Is the surgeon you’re dealing with now the one who did your father’s knee replacement? Your Dad needs to be under the close care of an orthopedic surgeon.

Are there any other family members or friends in your small town who might help you with transportation when needed? How about members of a local church?

Pennsylvania does have a resource called COMPASS that may be able to help you. Their number is 800-692-7462.
 
Thanks for the advice! I'll let my parents know when I go see them on Monday. We have a home health nurse who comes in a few times a week and looks at it and cleans it and such. He is also going back to the surgeon on Monday as well so I'll let them know to talk to the social services department. This is also the same Ortho surgeon since the very first surgery.

We are also very very alert for infection after the first bout. Any sign of one and he will be at the ER.

It's just worrisome to me that it blistered like that and popped. My dad said it didn't completely pop but that it came out of a weak point on the blister.
The bleeding has stopped completely as well as of the same time it started. It was mostly a sleeping from the open blister or hematoma or whatever it is. Sorry for the long reply but I'm just sharing as much as I know!

Thank you again!
 

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