Revision TKR CUBBY217's has a new Oxinium knee implant!

[Josephine]

The culture of that came back as reactive Mesothelial which was supposed to be further examined. No one did.

Mesothelial cells are flat cells that produce a small amount of lubricating fluid in all parts of the body like the lungs and abdomen. It allows the 'glideability' so organs can move against one another. So the culture was simply showing an excess of a normal commensal.

Something about my calf muscles being stuck together. Massage therapy tried to separate them with no success.

This is a typical case of there being a LACK of 'glideability' between the muscle bodies. This is more commonly referred to as adhesions. I suggest you read this MUA (Manipulation under Anaesthetic) and Adhesions to get more information. And whilst not wishing to decry your therapist's skills, it's highly unlikely that massage will ever 'separate' adhesions. Only an MUA will do that. Has anyone ever discussed an MUA with you. And also, what is you r ROM just now? Unless the flexion is under 90 it's unlikely an MUA will be effective either.

I have often wondered if that infection was a post-replacement infection.

The only way you can be certain of that is to consult an expert in PPI (per-prosthetic infections) and the only one in the US that I can recommend without reservations is broken link removed: https://www.dfwsarcoma.com/ in Plano TX. He is the 'go-to' person for these kinds of issues.

I had so many antibiotics during that month and a half that I wonder if it cleared up a knee infection.

Do you mean you wondered if it HAD cleared up the infection or if it had NOT?

my right partial will not straighten out and is painful. My LTKR has been stiff for 4 years. I did a lot of PT trying to get it working but maybe I did more damage instead of helping it?

Quite possibly therein lies your problem. If your knees have been stiff like that, doing 'lots of PT' will only make a bad situation worse. So based on that declaration, I would hazard a guess that this problem is nothing to do with the implants but sadly, everything to do with poorly managed recovery. This may be a fairly typical case of long term inflammatory condition.

I suggest you read this story PT: the seriously grave consequences of doing too much of it which, while rather scary, is a good example of this very thing. But it is a good cautionary tale showing that PT rarely fixes anything and very often makes things worse.

 

[cubby217]

@Josephine You are amazing wealth of information!
As for the infection vs. all the antibiotics that I had in 2012, I meant that I wonder if I actually already had an infection in knees and the antibiotics worked to clear them as the two aspirations I had done, showed no sign of infection.

 

[KarriB]

My infection, just a month after TKR would not have cleared with oral antibiotics. I experienced an extremely high fever and seeping through a closed incision. Not every infection presents this way, but I believe it's difficult to treat a peri-prosthetic infection from an aspiration. Cultures were taken during surgery for the infectious disease docs to grow, analyze, ultimately diagnosis the infection, prescribe two antibiotics (oral and IV) that would fight the specific infection. My soft tissue and implant was scrubbed with antibiotic wash during surgery. I was on one antibiotic directly after surgery for 4 days until the infection was diagnosed, then I was put on antibiotics specific to my infection. Even with that it took a month to begin seeing a difference in the infection, I was on those 2 antibiotics for 6 weeks and still take a low dose of doxycycline once a day.

It took quite a lot to rid my leg of infection and I've read similar accounts here as well as another friend who had her implant removed to put in an antibiotic spacer due to infection.

After my infection surgery my OS said no PT at all, no bending at all until the infection was showed signs of clearing because the soft tissue was so compromised. After a month I began non-aggressive PT to keep the soft tissue from becoming aggravated. Clearing an infection can be a long long process.

 

[Josephine]

As for the infection vs. all the antibiotics that I had in 2012, I meant that I wonder if I actually already had an infection in knees and the antibiotics worked to clear them as the two aspirations I had done, showed no sign of infection.

Yes, I understood perfectly what you meant!

 

[cubby217]

Quick update. I did order the Nickel test from JNL in Denver. No results yet. Surgery is the 31st, my mom's 96 birthday. I am getting an Oxinium knee as far as I know. OS says he will not know anything until he gets in there but my diagnostic codes showed loosening of knee. I am also moving soon to a cottage by the shore and selling my home. Hope to be in by March and hoping my house sells quickly. Running to cottage to have it ready so I don't have to think about it while I am recuperating. I have been waiting for this cottage to be available and it couldn't have come at a worst time! But it is one story and lovely with a view to die for.

 

[Jamie]

Cubby.....so sorry you are facing a revision AND a move at the same time. I guess the good news is that it will all be over quickly and you'll be blessed with a good new and a drop dead view. I'm so happy to hear you got the cottage of your dreams! Now we'll just get that knee fixed up so you can enjoy it. Keep us up to date on your progress.

 

[cubby217]

TEST RESULTS ARE IN FROM DENVER!!!A My nickel test came back normal. They did put a rush on it for me. I feel so stupid for going through all this for nothing. Now I don't now what to do.

Surgery is the 31st. Do I call the OS and tell him he doesn't need to put in an Oxinium knee anymore?

 

[Pumpkin]

Do I call the OS and tell him he doesn't need to put in an Oxinium knee anymore?

Yes, and send them a copy of the report. Your OS will decide which knee he wants to use.
Wishing you all the best for an uneventful surgery.

 

[cubby217]

Had my revision surgery on Jan. 31st and have a Oxinium. Interesting thing is that drew blood and someone, not sure if it is my OS, is going to do research on metal allergies. My OS walked into the room and said "I am so sick of hearing about nickel and metal allergies". I was taken aback until I realized he was teasing me. He said he had just done a revision on a man with multiple allergies and he was becoming intrigued with the whole thing. We had a nice discussion about it and he was great. When I woke up, he said I had an awful lot of osteo-arthritis in that knee. He said he wasn't sure about nickel but knew that I no longer had any arthritis because I no longer had a knee. I was kind of out of it and didn't get the joke.

The next day the incision started to bleed (of course that would happen to me) andhe said it was from the Eliquis. He put a Knee Immobilizer on it which just came off on Saturday. Incision looks pretty good but wearing the brace has hampered my PT.

I am on Dilaudid 4 mgevery four hours and now I seem to be able to stretch a it a little to 4 12 to 5 hours but always take a hour before PT. Also on Tramadol 50 mg every 8 hours. My OS tried to keep me in the hospital a fourth day because he wanted to get my meds stabilized. Some doctor came two hours later and said I was leaving in an hour. Very rudely said that he had already told my doctor. Send my to Rehab with a script for #10 Dilaudid. The doctor here in a member of an organization of doctors who are fighting opiod addiction and does not give those meds out. How can you be house doctor for a Rehab place and not give pain meds? Fortunately the doctor who was covering for him does not believe you should suffer after surgery so at least she gave me some meds. Do you think I am on appropriate meds The knee never seems to stop hurting and when they ask what the number is, it is always between 7 and 8 but will wake up in the middle of the night at a 10, stingng, throbbing and just painful. I am icing with a Cold compression machine that I bought and brought with me. I just can't seem to find a comfortable way to sleep.

I was supposed to leave on Friday but the team meeting has decided that I should stay another week. I don't think I can handle that. I think the PT will get to extensive. What do you think?? MY OS goes along with Josephine's protocol and stresses walking every day.

Rose

 

[Pumpkin]

Can you get in and out of bed, walk to the bathroom, do the stairs in your home independently? For bathing if you need help ask for home health, if you need PT or nursing care they will send an aide to help you.
If so go home, unless there is some other medical reason you need to stay.
You are under medicated, your pain is way too high. Be sure you have adequate pain meds to go home, call your OS or you primary surgeon if you need to.
The house Dr is sadistic.

 

[Celle]

I agree with Pumpkln.
You need adequate pain relief.

Phone your surgeon direct and tell him what is going on.
It is important to your knee's recovery (as well as to the way you feel) for you to receive adequate pain relief at this stage.
Pain management: importance of managing pain after a TKR and the pain chart

 

[Jamie]

Hi, Cubby! So great to see you on this side of your surgery. You may notice that I merged your latest thread with your recovery thread from earlier in the year. I think it's important not only for you, but also for others reading about your revision recovery to know all the history of what you went through to be where you are today. So, please consider this as your new recovery thread and post your updates, questions and concerns here.

It sounds like you did find an excellent surgeon and I'm glad for that. However, your rehab center sounds like a nightmare! My guess is they are working you way too hard with therapy and that is at least part of your pain problem. Celle's suggestion to contact your surgeon directly is the right thing to do. If you are able to do some walking on your own (enough to get to the bathroom and to be able to prepare simple meals if you were home), then go home under home health. You can get so many services you need through a good home health agency!

Remember, that you do have the right to tell them you don't want to do some of the therapy if you are hurting. Many times the pain doesn't occur immediately and increases 12-24 hours after therapy or activity. The only thing absolutely necessary in these early days is walking to the bathroom or around your room a bit every hour or so along with gentle bends and stretches. No bending that hurts beyond mild discomfort. No strengthening exercises (it's too early for that!). Lots of ice and elevation. And if those pain levels continue, demand that your pain medications be adjusted so that it stays in the 3-5 range. Being in as much pain as you are will irritate the sensitive tissues that are trying to heal.

 

[cubby217]

Hi Jamie,

>>Many times the pain doesn't occur immediately and increases 12-24 hours after therapy or activity. The only thing absolutely necessary in these early days is walking to the bathroom or around your room a bit every hour or so along with gentle bends and stretches. No bending that hurts beyond mild discomfort. No strengthening exercises (it's too early for that!). Lots of ice and elevation. And if those pain levels continue, demand that your pain medications be adjusted so that it stays in the 3-5 range.


I swear they all find me. LOL Am home and started home care yesterday. First let me say that I can walk up my stairs to my bedroom using a cane and handrail. Can get to the bathroom fine. Seem to be zero out. I ice with the cold compression machine as often as I can. I think I am doing well but in pain which wakes me up in the middle of night. I take the Dilaudid before I go to bed and I will wake up in pain 4-5 years later. I keep telling myself it is because it is a revision. That the implant had to come out and a new one had to go in its place so maybe I will be in more pain. Knee is very swollen but incision looks good.

So now to the new PT who started yesterday and wants my knee to bend back as much as I can. HURT!!! I let it hang freely when sit at my computer desk; the chair is higher than most.

As for pain, I think I did better on Vicodin with acetemenophen that straight Dilaudid. Could I be imagining that it does not work as well? I want to head her off before she starts hurting me. Plus I did PT at the rehab and 4 weeks has gone by. Shouldn't I be able to go to outpatient instead?

 

[Pumpkin]

Shouldn't I be able to go to outpatient instead?

If you have transportation, of course you can go to out patient. Suggest you fire this PT, call the agency and ask for someone else.
You can cancel all PT for now. You only need the activity around the house including your stairs. Here are two gentle exercises you can do by yourself.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

 

[KarriB]

Whichever PT you do, don't let them hurt you. Set the parameters from the beginning and let the PT know what you're willing to do and what you want.

As Pumpkln said, you're not stuck this PT. I left one group and went to another because I wasn't happy. You're perfectly fine do your own as well.

 

[newlybionic]

After my revision I had one rule that I always followed regarding PT either in my home or outpatient. I would NOT allow anyone to touch me. I allowed a little massage occasionally. I skipped all the tough exercises and if I was hurting afterwards I wouldn't do it again.

 

[Jamie]

I take the Dilaudid before I go to bed and I will wake up in pain 4-5 years later. I keep telling myself it is because it is a revision.

All pain medications are really only good for about 4 hours. This is why we tell people to stay on a set schedule for the meds that includes setting an alarm for the dose when you're sleeping. I'm assuming your prescription would allow you to take another dose after about 4 hours. If that's the case, set an alarm and do it. Don't wait for the pain to wake you as you want to stay ahead of it. Waiting until you hurt means you play catch up and that is not an effective use of the pain meds. You'll end up taking more medication overall.

So now to the new PT who started yesterday and wants my knee to bend back as much as I can. HURT!!! I let it hang freely when sit at my computer desk; the chair is higher than most.

No pain with therapy!! Only minor discomfort allowed. Be sure not to take pain meds just before your session as than can mask the pain that tells you you're doing too much. Sitting with your leg down actually is quite hard on your new knee. It is better to prop it up if you can or at least put something under your foot so your leg is not dangling. Get up and walk around every hour for about 5 minutes if you're sitting for any length of time.

I think I did better on Vicodin with acetemenophen that straight Dilaudid. Could I be imagining that it does not work as well? I want to head her off before she starts hurting me. Plus I did PT at the rehab and 4 weeks has gone by. Shouldn't I be able to go to outpatient instead?

Pain management is a very individual thing. Some meds work better than others for pretty much everyone. Go with what is working best for you. The goal is good pain management. And do inform your therapist up front that she is not to push on your knee at all. That just inflames tissue and is counter productive. If you prefer outpatient therapy, there is no reason why you cannot do it instead.

 

[cubby217]

You all are amazing. Setting alarm nowt but
I always assumed you took the pain meds before pt. So confusrd.

 

[KarriB]

You definitely want to stay on a schedule for pain meds as it will keep a continuous flow of medication in your body. It's far too difficult to get rid of the pain after it breaks through. Some PTs like you to take meds before so you don't feel the pain they're inflicting on you, however a good PT doesn't want to inflect pain, wants you aware of your body and what's causing pain because they know pain isn't a good thing so soon after surgery.

 

[cubby217]

Med changed to Vicodin. ROM is only 60 and leg is so swollen down to ankle. Put me on Lasix. Hoping exercising will be easier.