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Knee Infection* Failed Two-Stage Revision - what now?

Question for those of you who are on long-term suppressive antibiotics for infection after having had either a washout, single-stage revision, or two-stage revision: Did your OS discuss the possibility of potential loosening of the implant within a few years? My mother's OS is saying that if she goes through a single-stage revision (after having had a failed two-stage revision), her implant will likely be good for about 5-7 years. He seemed to think that this is approximately how long it would be before the infection (even with the suppressive antibiotics) eventually causes loosening of the components.
 
My only experience was with my Mother in Law, she had her washout in 2001 and passed of other causes at 98 in 2009.
She did not have a problem with loosening, and it was never mentioned by the surgeon.
She was on doxycycline until the end of her life.
 
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Has anyone heard of a connection between thrombocytosis (excess platelets in the blood) and complications during joint replacement surgery? I am trying to help my mom who is about to have her fifth surgery on her right knee for a staph epidermidis infection and replacement of at least the femoral component. I am wondering why she keeps having complications with her surgeries - hematomas (twice); then supposed infection (cultures were negative) necessitating explant; and now staph epi infection necessitating a single-stage revision. And if this upcoming surgery does not work, what then?
 
@Celle may be able to answer you questions about thrombocytosis. What does your doctor say?
Do you have a hematologist helping care for mother?
 
I don't know a lot about thrombocytosis, which is an excess of platelets in the blood.
All I know is that people with essential thrombocytosis (primary thrombocythemia) undergoing surgery are at increased risk for bleeding and thrombosis. They should have therapy before surgery to decrease the platelet count to a normal level range before surgery.

I don't think there's any relationship to the risk of getting an infection.

Pumpkln's suggestion that a haematologist should be involved is a good one.
 
Thanks, Celle and Pumpkin.

My mom did have a hematology/oncology doctor working with her after her explant. But we don't have one currently working with her as we switched to a new OS for her latest surgery.

We actually never discussed the thrombocytosis with the new OS in person. But it is mentioned in her records and I will make sure we mention it in the pre-op interview.
 
Great question. No, I don't believe she has been tested for a metal allergy. I asked the OS about it, but he said he did not think it was necessary. As far as I know, my mother has never had a skin reaction from the implant, but I am not knowledgeable about metal allergy symptoms in TKR patients.
 
Read this thread you might find it informative.

bonesmart.org

Revision TKR - Never give up, keep trying, don't settle - that's me, Bonnie

I have a lot to talk about and can't really write a lot right now so I can give you a few short chapters. Yes I had my RTKR on Monday morning and yes I am still here in the hospital and should be going home today, as everything is all good with vitals, blood, and PT., but have not seen the...
bonesmart.org bonesmart.org
 
Thank you, TimeBuster. Bonnie's story is so inspiring.

My mother is having a single-stage revision (5th surgery since her first TKR) tomorrow morning. If we had more time, I would insist that she be tested. We were "lucky" to have her surgery scheduled quickly, given COVID and the holidays.

I had raised the issue of the metal allergy with her former OS as well, but he also did not seem to give it that much weight. I guess it is a rare occurrence??
 
TimeBuster, thank you so much! I'm glad to see you had a successful outcome after enduring a staph infection.

I spoke to the OS after dropping my mom off at the hospital. Given my mom's age and her prior complications, he said his goals are simply to extract and replace any loose components and debride. He cautioned that eradication of the infection is unlikely, but that hopefully my mom will get some comfort for a few years.
 
My mom's surgery went better than expected. Because the components were "grossly loose," it was easy to remove them, avoiding any "trauma" during the extraction process. My mom is now on a PICC line for Daptomycin. I believe all cultures have been negative thus far. I am still trying to get my hands on the lab results from her September 18, 2020 knee aspiration which showed the staph epidermidis infection. Who knew it would be so difficult to obtain those records? I have been trying since late September and three of my requests have been denied for various bureaucratic reasons (for example, not specifying that it is an "outside pathology report," stating I would pick up the records not knowing the office is closed to walk-ins due to COVID, etc.).

Happy New Year to all!!
 
I‘m so glad the surgery went well! Hugs and prayers to your family and that your mom will recover well!

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.

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!)​

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.
 
I'm so happy your Mom surgery went well. Do you know the name of the new implant?

By the way, I also was taking six week course of antibiotics via a PICC line. When I got my antibiotic delivered to my house it came with ice packs to keep the antibiotic cold during transportation. I used the icepack's to ice down my knees when needed.

COVID has made it impossible to get medical professionals to cooperate with us.

Prayers to you and your mom recovery go well.
 
@TimeBuster Thank you so much! The implant is a Zimmer (if I find any further details, I will let you know). Good idea to make use of the ice packs. Happy New Year!
 
@SeekingAdvice
Happy to hear your Mother's surgery went well, and you are looking forward to a better 2021.

Be sure to join us in the Community forums for our New Years Party, you can even bring a virtual snack.
Here is a link to the forum were the party will be held. Community Room
Hope to see you there.
 
So glad the surgery went well!
I was one of the rare ones to have a horrible reaction to Daptomyacin. Be sure the ID is on top of CPK lab numbers. You can read my 2 stage revision story for details.
 
@LolaBee Thank you!!

I am not familiar with "CPK lab numbers." What does that refer to?

I'm glad to see from your story that you are doing so well more than 1 year later. May I ask what probiotic you have been taking?
 
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