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

[LolaBee]

Here's a link for CPK lab info:

CPK Isoenzymes Test: Purpose, Procedure & Results

The CPK isoenzymes test is a way to measure the levels of the enzyme creatine phosphokinase in your bloodstream. This enzyme is important for muscle function.

www.healthline.com

One of the rare, but dangerous side effects of Daptomycin is muscle deterioration. Your kidneys cannot handle the "shredded" muscle byproducts. My first symptom was a stiff neck and upper back muscle pain. It quickly became extreme pain and near paralysis of my arms, hands, and legs.

I took a probiotic Rx called Lactinex for about 8 months, but now I take over the counter probiotics (whichever I can find in my little rural stores and lots of yogurt).

Continued healing, hugs.

 

[Jamie]

@SeekingAdvice ... has your mother had an infectious disease doctor involved in her case at any point. It may be good to have a consult with one.

 

[SeekingAdvice]

@LolaBee Thank you so much for the helpful information!!

@Jamie Hi Jamie, yes my mom has an infectious disease doctor involved. We see him again in a couple of weeks. Thanks!

 

[bockoman]

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 wife had a 2 stage revision with 6 months between stages and a constrained knee was put in, then after 11 months got another infection washout and iv antibiotics and doxy and that lasted 11 months. She is in the hosp now with the recurrence and they are waiting for the culture to see if it is the MRSA from the last time. Just got off the phone with the surgeon. Her said a 2nd 2 stage would have an extensive healing time and only a 20% chance of success. Discussed amputation but didn't think it was a good option because of her comorbidities she would be chair bound. Thinks that, depending on the culture, periodic IV antibiotics when it flares might be best for now or anther washout and then that. (she has a muscle flap and skin graft on her knee so the healing after going in is more problematic.

 

[SeekingAdvice]

@bockoman I am so sorry to hear about your wife's (and your) ordeal. That is a lot for one knee to go through. Was your wife on oral antibiotics when the first infection after the two-stage revision flared up?

My mom's original OS wanted to do a washout for staph epidermidis after her two-stage revision, but the OS we ended up using advised against that because the x-ray showed at least one of her components was loose. So she ended up having a one-stage revision with all new components. She is on Daptomycin for 6 weeks, and then will probably have to take oral antibiotics indefinitely. He told us the rate of success for clearing the infection is about 50%.

 

[SeekingAdvice]

My mom finished her 6 weeks of Daptomycin with the PICC line and was put on oral Doxycycline. We see the ID doc and OS next week. Her recovery seems to be going well (knock on wood), but she has some lingering cognitive deficits which I suspect may be due to the general anesthesia (five times in two years). Has anyone else experienced this?

 

[Jamie]

I'm glad to hear your Mom is making progress. Anesthetic can be a problem for older individuals with resulting cognitive loss. At some point when she is feeling up to it, you might have her tested. There are therapies available that can improve the situation if she has suffered some loss. It's always best to get them started sooner rather than later. This is usually covered under Medicare and most secondary insurance polices, I believe since it's related to surgery. But be sure and check on that.

 

[SeekingAdvice]

Thank you, Jamie! I will look into it. She has noticed that she has been more forgetful, but we will see if I can get her to admit it is something she needs treatment or therapies for. ;)

 

[Jamie]

There are so many other things that can impact here too. Fatigue, if she's not sleeping well. Dehydration, if she's not getting adequate fluids. You're doing a great job trying to keep on top of things for her. She's lucky to have your help.

 

[Celle]

She is dreading the possibility of another surgery, as well as a long recovery, but it seems like it cannot be avoided.

Unfortunately, more surgery couldn't be avoided. You can't continue with a loose implant, as it could move within the bone and do more damage there.
I'm glad your mother had the surgery and I hope she has fewer complications in the future.

 

[SeekingAdvice]

Thank you so much, Jamie and Celle, for your support and advice.