TKR Incision opened when staples removed<

[Jamie]

What a great post! It means so much to a worried member to hear someone else's personal experience and to know things came out okay for them. Thank you so very much for taking time to write.

 

[fours2many]

@mlwreader
Thank you. It’s a relief to know you are doing much better at 4 months. My husband goes along with me. I couldn’t drive, so he has no choice. Lol! I did the same thing with taking pictures. 4 days after surgery my leg swelled twice the size and bruised from my hip to my ankle. I snapped a picture and sent it to the homecare nurse. She sent it to the Dr. he had me stop using the cpm machine. He wouldn’t have believed me without the picture.
I have to admit one thing, it was quite terrifying seeing my incision open up. The nurse didn’t help, as she panicked. It was as if my incision didn’t even heal at all. I didn’t get a picture of it opened. I think I was a bit out of my mind right then. So we could only explain what happened to the OS. The Drs nonchalant attitude surprised both my husband and myself. He’s a good surgeon with terrible bed side manner.

I am holding off all exercise. Just doing stuff around the house. Called Pt and canceled upcoming visits. They were very understanding.

Called OS, talked to his nurse. She is giving the message to him. Hopefully he orders antibiotics. I haven’t been on any, except one bag in the hospital right after surgery. The nurse said he will be fine with stopping PT.
Dr said I must keep my incision covered in the shower. Well, I wish he would’ve said something sooner. I did shower once with out it covered.

Just to clarify, I sit with my leg raised most of the day. Usually in a chair or recliner, with a pillow to raise it a bit higher. I get up as needed and keep ice on it most of the day. Yesterday I made it on the bed, with my toes to my nose, twice. I’m going to try and do it more often. Also, I started putting an ice pac behind my knee. That helps a lot.

I took one Percocet and 2 Tylenol 325 last night. It did help a lot. If I did math correctly, it was under 1000mg of Tylenol. Which will still keep me under the 4000mg mark for the entire 24 hour day.

Thank you everyone for your responses. It has helped me a lot. I feel so isolated. I guess most of you know how that feels.

 

[Angiebabe]

When I had my staples out the nurse took them out alternately in case anything opened up sounds like a good plan. She told me she used to work in our local and famous burns unit and that staples are often used in skin grafts. I was lucky to have someone who knew her stuff. The surgeon then inspected it before giving the thumbs up.

 

[fours2many]

OS called back. He is starting me on antibiotics, also wants me to rinse incision with peroxide and water every day and cover with bandage. He wants to see me on Thursday morning.

Thank you for all your help.

 

[mlwreader]

OS called back. He is starting me on antibiotics, also wants me to rinse incision with peroxide and water every day and cover with bandage. He wants to see me on Thursday morning.

@fours2many Thank goodness OS is finally paying attention.

I am not a medical professional but here is my understanding of what my doctor's assistant explained to me: The wound after knee replacement receives three layers of stitches. Not sure what the deepest is, but one of them is the muscle layer. The top layer is the skin, which gets the staples. But under the top layer there are two other layers of stitches, held together by self absorbing suture material. So even though your top layer opened up, I would guess that the underlying two layers were holding. Of course, no one explained that to you, and my doc's assistant only explained all that to me the day I had the meltdown with her on the phone. Once she explained it to me, I could feel the tension release from my stomach, because I had previously been so terrified of a direct route from the surface of my knee and the staples to the brand new knee joint inside. So to me if the top layer of stitch opened up, then it was all over but the shouting because the deadly germs would march right down into the joint and ruin everything. Not the case at all.

One other thing I learned post surgery, but I learned it here on bonesmart. (Well I've learned a lot on here. . . .) The elevating needs to put your toes above your nose. Just to prop up the leg in a recliner, for example, while the upper half of your body is sitting upright, is not going to help reduce your swelling. My PT explained to me that the ice shrinks the blood vessels, and if the leg is elevated above the heart, the fluid gets drained more effectively, and you can then, after a bit, deposit it in the used knee fluid room, also known as the used coffee room, also known as the loo.. So I have a slant pillow that I used to use for acid reflux, and I place it on top of two side by side memory foam pillows on my bed, and I elevate my legs on the slant pillow, with ice. The slant part of the slant pillow elevates my feet but at the same time supports the back of my leg. Not sure if you can visualize this as I'm describing it, but that's about the best I can do. A suggestion is to go online to Amazon and see what's on there for elevation after knee surgery.

Ok friend, that's from me today. I am sending you so many positive thoughts and good wishes. Oh, one more thing, I took probiotics all during my course of antibiotics and others on here have recommended that as well. And don't forget to ask the cowboy when you see him about the steroids and how they might affect healing.

Best,

Mary Lou

 

[Celle]

The slant part of the slant pillow elevates my feet but at the same time supports the back of my leg. Not sure if you can visualize this as I'm describing it, but that's about the best I can do. A suggestion is to go online to Amazon and see what's on there for elevation after knee surgery.

We do have an article that shows how to elevate properly:
Elevation: the do's and dont's

 

[fours2many]

We do have an article that shows how to elevate properly:
Elevation: the do's and dont's

Thank you. I just purchased a lounge dr on amazon. It won’t be here for a week though. I am using stacks of blankets and pillows right now. I figure with how slow the healing is going, I’ll get plenty of use out of the lounge dr. I have been on the recliner off and on with 2 pillows under my right leg. It does raise it above my hip, but not heart. Today I’m making a conscious decision to get back into bed with my leg raised higher. It’s lonely back there though. No tv, or anyone to talk to. I guess there is worse things though.

I am starting to get wishey washey. Feeling sorry for myself. It just comes on out of the blue. I’m sure pack of a solid nights sleep isn’t helping. My husband is a good man and very helpful. I guess it’s just frustration. Hoping the next few weeks goes by fast and this incision closes quickly. I miss going to the pool every day.

 

[SusieShoes]

Ah, but you will get back to the pool every day! You just have to get through the first couple/few months of recovery first.

What you'll run into soon (if not already) is that point where you start feeling pretty good except for the knee, so you'll want to do more. More chores. More getting out and about. More of your life. But your knee will not be happy about that. You're still going to be spending a lot of time reclining with your leg up, icing and resting. That's a normal recovery: it will feel like your knee is holding you back and many people wonder if they're not healing well.

It's natural to be emotional and frustrated. Lack of sleep is a real killer. Needing to baby your knee gets really old. Find fun things to do with your wonderful husband: order take out and make popcorn for a movie night; take a short drive just to get out of the house; start planning a project for spring.

Hope your incision heals quickly and you get the green light for the pool!

 

[Jamie]

Here's the article from our BoneSmart Library that you may not have read that should ease your mind about your "open" wound:

Closing surgical wounds: how is it done?

Your regimen of resting and activity sounds perfect. The Lounge Doctor will help you elevate properly so I'm glad you purchased one.

 

[fours2many]

I went to see my OS this am. Infection is getting better. There is still drainage, but getting less and less.
I took off most of the steri-strips. They weren’t coming off on there own and the peroxide wasn’t getting to where I needed it. Incision is holding closed on its own now. Still looks gnarly. I haven’t bent my knee in a week. It’s pretty stiff. I’m just so relieved it is healing. I have another appointment next week. Hopefully we caught the infection before it went inside.
Thanks for all your help.

 

[SusieShoes]

So there is an infection? Do you know if it caused your incision to open as it did, or whether it set in after? I'm sorry you have to deal with it at all, but glad you're on antibiotics and the OS is overseeing the healing. I'll be crossing my fingers along with you hoping there's no more to this than a superficial skin infection. You have a knee to start moving again. Places to go and things to do.

 

[Celle]

Did your surgeon take swabs to establish there's an infection? If so, a course of the appropriate antibiotic would help your wound to heal.
However, since he told you to start treating your incision with hydrogen peroxide, that could have masked any infection.

 

[fours2many]

Did your surgeon take swabs to establish there's an infection? If so, a course of the appropriate antibiotic would help your wound to heal.
However, since he told you to start treating your incision with hydrogen peroxide, that could have masked any infection.

He didn’t swab my incision. He put me on ciprofloxican. I’m on day 4. Also rinsing several times a day with peroxide mixed with water. I can see a huge difference. It’s still oozing, but very thick. He has me covering it with a non stick pad, but they still stick to my incision. It is very irritating.

I pray it’s just surface infection. He feels that is all it is. Still wants to see me next week and do a recheck. X-rays look good. No fever, although I’d think Tylenol would reduce fever if I had one??

So there is an infection? Do you know if it caused your incision to open as it did, or whether it set in after? I'm sorry you have to deal with it at all, but glad you're on antibiotics and the OS is overseeing the healing. I'll be crossing my fingers along with you hoping there's no more to this than a superficial skin infection. You have a knee to start moving again. Places to go and things to do.

I’m not sure if that’s what caused the incision not to heal. I didn’t even ask the dr about that. I just assumed I got the infection after. OS took my knee much more seriously this time.

I agree, I have life to attend to! For now though, it’s toes to the nose and no bending, at least until next week.

 

[Celle]

OS took my knee much more seriously this time.

He should have the first time, but he probably wasn't informed fully.

 

[fours2many]

He should have the first time, but he probably wasn't informed fully.

Well, when I went after my incision opened. He barely looked at it. He sat in his chair a desk, while I sat in a chair and he didn’t even come close. When I asked about antibiotics he said it wasnt necessary. My husband said my incision opened the full length and said the nurse put layers of steri-strips to hold it closed. OS just shrugged it off and said to start PT. We both tried to stress how far it opened.
This time, he had me sit on a table. He came and looked and squeezed the incision. Made notes of color and oozing. Took my temp. Told me I have to keep it straight, no PT. To keep taking the antibiotics he order 4 days earlier by phone. He seemed concerned, where he didn’t at all when we went for the appointment for it opening.

Last night I felt a sharp sting. Both my husband and I looked at my incision. Right in front of us, it opened again. I still rinsed with peroxide. It didn’t bubble though. I had to put butterfly bandages back on. I only put a couple on... covered with a non-stick pad. Sigh...

 

[fours2many]

I’m also having pain half way up my thigh. It wraps around it. The pain takes my breath away. It doesn’t hurt constantly, it just starts out of the blue. Could it be from the surgery? Hopefully nothing to do with infection...

 

[Celle]

Well, when I went after my incision opened. He barely looked at it. He sat in his chair a desk, while I sat in a chair and he didn’t even come close.

That's very slack.
Of course, with all the steristrips the nurse put on, he wouldn't have been able to see much anyway - but he should have removed them, so he could see the incision properly.

It is possibly too late for the cut skin edges to bind together again. What will probably happen is that your incision will heal by growing new scar tissue from below, until your skin edges heal together. That will take longer than the usual healing time, but it will happen, once the infection is gone.

 

[fours2many]

Just an update.
Incision is finally holding closed. I haven’t bent my knee, although just moving around was opening it. So, really hopeful. I go to see OS tomorrow. Hoping he agrees that things are turning around. I’ve been using peroxide and water several times a day. My skin is very dry from it, so one night I tried some triple antibiotic on it. Well, it stuck to the non stick pad... so I won’t do that again. Although I think that the triple antibiotic ointment had a lot to do with the stopping of my skin slitting opened. I’ll ask OS what he recommends.


I finally received my lounge doctor. Wow! Everyone was right, this was worth every penny. So much better than the piles of pillows. It’s much softer than I thought. I was picturing rock solid foam, but it has a nice cushioning feel. Just the right height too.

Sigh... back on antibiotics as a preventive. OS drained my knee. Fluid was clear, not cloudy. Thankful.
Incision is still opening so no bending yet, stopped oozing.
I am so stiff is there anything anyone could recommend? I have been elivating all the time. I get up, do a bit, then lay down elevate and ice. I’m not over doing it at all. My muscles are so tight, it’s even making it hard to walk. I wish I could just get in a hot tub.(I know I can’t) I think that would help, it always did before tkr.

OS did say lupus and 30 years of steroid use is why I’m taking forever to heal. I wish I would’ve known this before hand. I might if held of from surgery. Oh well, it is what it is.

 

[sistersinhim]

I believe there are some herbs that help with tissue healing. You might want to google it and see if you can order something to help aid in your healing.

 

[waunaking]

I too had my TKR on Dec 13, 2017. When they removed my stitches I had one spot above the tibial implant and next to shin that would drain during PT and activity. It did scab over but at about Week 4 it reopened after a shower! I saw my surgeon and they were very conservative, stopped PT and exercises at home except for a little extension and flexion. Of course I didn’t listen and continued strength training and walking! I’m a nurse and trying to get back to work at 8 weeks. However, saw the surgeon again and he reiterated how important it was to rest the leg, discussed nutrition requirements for healing and reiterated the importance of “not acquiring” an infection! He said, we are supporting the long term goals not the short term! He gave me his email and said if I had any questions or concerns to contact him directly! Keep it clean above and beyond anything, rest, elevate and ice! I’m now off work for 12 weeks... too much too soon.