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Knee Infection* Increased knee pain

NFenske

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I maybe the oddball but the current situation with my Left Knee stinks. Having had 18 surgeries on my Left Knee 6 of which have been TKR ( last one June 18 ) I am well aware pain is going to be part of my life however I have begun to notice an increase in pain over a period of several months. Currently taking 600mg. of Gabapentin 3x day which helps but not enough to ease the discomfort. I use ice thru out the day have to use a cane otherwise the risk of falling increases. The part that concerns me is I have no idea what to do since x-rays look fine labs look fine however I have constant swelling ( Left is approx twice as big as Right Knee ), the surgeon I have is the go to guy when others have tried and failed. Pain meds are not the answer too many issues in regards to them, considering what I have been told surgery is not a good option either ( what are the odds after 18 that any further surgeries will help?? ). Going by signs of infection yes Left is warmer then Right but not major difference color is normal if it was not for swelling knee looks okay. When walking knee has a tendency to give out ( a good reason for using cane ) which is starting to happen more frequently ( not everyday but several times a week ). Anyone have any ideas on is this normal or if not what I should do?? Going by pain scale 1 - 10 the way I rate pain 10 severe trauma end of life, 8 to 9 in recovery room waking up from surgery or in hospital due to surgery, 7 the highest I will give my pain at home and yes a 7 hurts pretty bad, 5 to 6 miserable but somewhat manageable, 4 and below piece of cake. As of now my level is pushing a 6 several months ago ( summer ) a 4 and prior to that before going on Gabapentin pushing a 7. So yes frustrated any ideas??
 

Roy Gardiner

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Welcome to BoneSmart.
Having had 18 surgeries on my Left Knee 6 of which have been TKR ( last one June 18 )
6 TKRs? Goodness, that's the kind of record no-one envies. I will give you our standard guidelines, but they may not be a great deal of help at your stage.

Staff members with proper medical knowledge will be along in due course and may be able to help more.
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. Here is a week-by-week guide for Activity progression for TKRs
6. Access 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 a 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 history before providing advice.
 
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NFenske

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I think I wrote my last surgery date wrong lets try again June 6 2018 over a year ago. As far as what you sent for those not familiar with what is involved with postop great advice!!! In my situation well I have done all the above now looking into pool therapy so hate to say I am grasping at straws but willing to try anything if there is a chance to feel better.
 

Jamie

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Hi, NFenske.....I see you've been a member here since 2010 and with all those surgeries, we have a lot of catching up to do to understand exactly what you and your knee have been through. I've created a signature for you based on this latest surgery, but could you please give us at least the month and year for the other procedures you've had? Also, it would be helpful to know a bit about each recovery and what led to all those revisions.

It also would be helpful to know a bit more about your current pain. When do you experience pain? What does it feel like? What makes it better or worse? Are there any times when you are pain free?

Can you show me the coordinates on this chart where your pain is located?

1572198070542.png
 
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NFenske

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The last 3 revisions are easy prior well its vague. It all started in 2003 I used to be an electrician doing lots of commercial work. This involved steel toe shoes. ladders, steps, kneeling on concrete, not to mention overweight.

The nightmare started with a torn meniscus, which led to 2 more surgeries to fix the 1st one. I have had numerous outpatient several partial along with all good surgeons.

My first TKR I was told it would last 10 to 20 years ( maybe in 2006?? ). Surgery went okay, was in hospital for 5 days - nothing unusual except still dealing with pain.

After a couple of years, pain got worse instead of better. I went to another surgeon. He felt the first replacement was not aligned properly and did my second revision.

Once again, after a couple of years, same thing with the 3rd revision. I was told the spacing of the joint itself was off and another surgery needed.

After a period of over a year, the pain was not getting better. The surgeon said he was not going to do anything, so I put up with it for almost 2 years, but pain got bad.

Having been through several surgeons already, I decided to take a chance and go with someone new. The next surgeon looked at my knee and knew something was wrong, based on the swelling. He removed a great deal of fluid and wanted to do a follow up, but he had to pass due to he needed back surgery.

The surgeon I had for the 4th revision, after x-rays and examining the knee ( wish I could remember exactly sorry ) thought that with another TKR things should get better. Ha Ha!!.

Surgery went well out of hospital in 2 days and yes the usual no driving, in home PT etc. but after 2 weeks ( this was in July 2015 ) I was watching TV and my knee started to hurt and I felt a little under the weather.

This was a Thursday. On Friday, when I got up. I felt like I had a cold. I had a slight fever 99F. By Monday morning it was at 103F. I was told by the nurse to go back to the surgeon. I waited for several hours. He told me I had an infection and he would have to operate the next day.

From what I understand, he took the revision hardware out cleaned, it along with inside the knee, and sent me home with a PIC line.

in October the PIC line came out, but they were still checking for infection. In December I was told I still had an infection and on Dec.30th had an antibiotic spacer put in.

Once again another PIC, line crutches for 4 months, plus in Feb. I Developed a clot. My right arm looked like Popeye ( cartoon ) and I had to go back in hospital for 3 days to get that fixed.

Finally, in May I had the 5th revision done. So okay, revisions take a while to heal. After a year, mine was not getting much better. My last surgeon retired and consulted with one of the other surgeons I had and he did not want to do anything because of the amount of surgeries I have had.

After almost 2 yrs, I went to another surgeon. I explained everything once again. X-rays looked great, except when they compared left to right the left was misaligned, off by almost an inch. They also did a bone scan. The results looked like a kids toy - all lit up.

Based on what he saw,, he referred me to my current surgeon, since he felt I was going to need extensive surgery to get it fixed. The new and/or current surgeon did not see a problem with fixing this. He said it did not matter how much bone was gone, he could get a prosthetic any size or length.

The last surgery was June 6th 2018. As of last visit, X-rays look fine, labs look great. However, this past summer (August) my left knee locked up. The pain was really bad. It took about 15 minutes before it loosened up. That was a first. I was walking 3 to 4 miles a day at the start of summer and at the time my primary care Dr. put me on Gabapentin 300mg, 3x a day and pain level dropped to a 4 from a fairly solid 6.5 to a 7.

So now, the pain has increased. It's currently now at 600mg, 3x a day. I saw my surgeon in Sept. Once again, all looks good, but where my knee would give out once in a while before, 2 to 3x a month maybe,now it happens throughout the week.

No I do not fall,but I have to catch myself when it gives out. I have to grab onto something, cane furniture, something.

So what do I do? I'm running out of ideas and what at one time was a 4 is now going towards a 6.
None of this is even remotely fun.
The surgeon I have is going to retire after my last visit in Dec. he will refer me to another surgeon. so what happens next I have no idea!
 
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NFenske

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Per the image, D to LF4 along with where the prosthetic meets the tibia the femur is okay. The most painful spot has always been the D to LF4 area it hurts when pressing on that area. So there you have a history.
 
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NFenske

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It also would be helpful to know a bit more about your current pain. When do you experience pain? What does it feel like? What makes it better or worse? Are there any times when you are pain free?

Can you show me the coordinates on this chart where your pain is located?
Forgot to answer - my apologies. I experience pain 24 / 7 everyday some days worse then others. What causes the pain? Well, besides too much activity, change in the weather, standing too long, sitting for too long, sometimes I have pronounced pain for no reason, Let's just say as of right now a good day the pain level is a 5 plus. A bad day is a 6 plus. Take your pick.
When its on the borderline, 6 or better, there are 3 things that help - ice number 1, number 2 Diclofenac lotion helps, number 3 elevate.

Pain free what is that?? I go to bed in pain and wake up the same way the closest I get to pain free is lying in bed, Then its a 5 and because I have been dealing with pain for so long, while for the average person 5 may stink, I can fall asleep but that is also using my pillows to help cushion the knee.

All I can say is I was not hoping for any of this to happen and now I am stuck 59 and been on disability going on 7 years not fun.
 
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Cjackso21

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Hello, I too have a complicated history or many surgeries and scheduled for my 5th revision after my first TKR in 2012. This was after 4 scopes and 1 ACL repair. Jamie (above administrator) is awesome. She connected me with a fantastic surgeon as I moved states in the middle of continued problems since my last revision in 2017. Both the initial new surgeon and the new fantastic one agree that the instability is likely from many surgeries. Hard to know if the instability was was the cause of the latest loosening but that is was they feel. I was told each surgery will stretch and sometimes remove tendons and ligaments but no way to know. Did your doctors check your knee for stability? My previous surgeon who was supposed to be the go to guy for revisions, never checked for that. He had no idea why my knee continued to hurt. The new doctors all checked and said it was severely unstable. So I am wearing a huge brace to help with stability which is helping with the pain and allowing me to walk at work (my new job is at a huge site and lots of walking required). Good luck and I can totally feel for you. Hopefully we can compare recoveries. I also have a surgery scheduled for Dec. with the first less experienced surgeon in case I can’t make it until Feb. but am trying to wait.
 
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NFenske

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Thanks for reply as far as recovery I wish you the best as far as me what is that? I am convinced me knee will never be the same there is always going to be some degree of pain ( which stinks ) my only wish is to be able to find someone in the area where I live Richmond Va that can help with the pain and swelling even if its only a slight percentage ( better then no improvement ). Today is starting off okay just got back from a walk 1.5 miles so yes the pain level has increased due to the walk but the level is okay maybe a 5 or just a tad more in other words I can deal with it. Reading your post reminded me of why I had either the 2nd or 3rd rev. and the other part that holds very true for me is the stability or lack there of! yesterday I went to grocery store parked car got out walked toward store knee gave out right beside rear of car glad no one was looking I fell but the car was right there so it looked like a slight trip. Really hope you do not catch up with me as far as surgeries its no fun.
 
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NFenske

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Well decided to be a tad pro active found out who will be replacing my current Dr. ( Dr. William Foster ) and made an appt. with the one he will refer me to. His name is Dr. Ross he trained under my current surgeon. Not expecting any miracles but fingers crossed that hopefully a younger set of eyes might have a different way of looking at the knee? So see current Dr. in Dec the new one in Jan hopefully maybe something good will come of it??
 

Jamie

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Sorry for the delay in getting back to you. I neglected to ask that you tag me when you want me to quickly see information you have posted. Please do that in the future so I receive an alert that you have additional information for me.

Let me take a look at the very detailed information you provided (thank you!) and see what options we may be able to offer for you. Good for you for taking that proactive step of meeting with another surgeon for a consultation. Don't give up hope!!!
 
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NFenske

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Sorry for the delay in getting back to you. I neglected to ask that you tag me when you want me to quickly see information you have posted. Please do that in the future so I receive an alert that you have additional information for me.

Let me take a look at the very detailed information you provided (thank you!) and see what options we may be able to offer for you. Good for you for taking that proactive step of meeting with another surgeon for a consultation. Don't give up hope!!!
If you can come up with something great but odds are slim at best. From what I know about current surgeon he is the go to guy when others cannot help he works alot with cancer patients supposedly 1 of 3 in the US that does what he does ( what I was told but do not know for sure ). Like I wrote Dec. is his last month the new surgeon
was trained and worked under Dr. Foster so really not sure what to expect. I feel like as the saying goes between a rock and a hard place reason being what if ( key word if !!!! ) I need another surgery what are the odds that things will get better or by the same token will they get worse??I have already been told due to having 18 surgeries all on the L knee pain is going to be apart of my life. Yes its fine to say that but its another thing to deal with it. As it stands a good day the level as I wrote how I due the pain scale is a solid 5 and that is a good day ( not many of those trust me ) after I walk for 40 minutes I am at a 6 the same holds true if I sit in one place to long without getting up or stretching the leg out but even then still blah, there are even days with no excessive walking other then home and yard I still hit the # 6 level really all I would want is my pain level to be a 4 or less it would also be great if the knee did not give out like it does ( it seems as time goes on it happens frequently 1 to 2x a day ) maybe I am asking for too much but unless you are in the same situation no one can really understand what I go thru. Sorry for the drama
Norman
 

Jamie

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No drama, Norman. I want what you want - to see things get better for you.

Do you know what implant you currently have? That would be helpful for me to know....especially whether it is a hinged knee or not.
 
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NFenske

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No drama, Norman. I want what you want - to see things get better for you.

Do you know what implant you currently have? That would be helpful for me to know....especially whether it is a hinged knee or not.
Hi Jamie this may sound somewhat dumb?? Based on what you just wrote my guess I have a hinged knee since I am able to bend like the good knee if it was not a hinged knee my guess bending would be impossible?? If you really need to know I can contact Dr.'s office??
 

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@NFenske
I'm sorry you've had so many problems with your knee. I do hope that Jamie can find someone who can help you.

I've done the best I can to summarise the information you've given us and put it into a signature that contains your knee history in reverse chronological, beginning with the most recent surgery.

If you have time and you can supply any more dates, that could be helpful, but don't worry if you can't - you have enough on your plate, dealing with what's happening now.
 

Jamie

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Logic might say that a hinged knee implant is what you have if you can bend your knee, but that's not the case. Most knee replacement implants look like this:

1572566651706.png


A hinged implant, sometimes called a constrained hinge is different.

hinged 1-horz.jpg


rotating hinge 2.jpg



You can see on the left image that there is a stem that goes from the top part into the bottom part - that's what constrains it or prevents sliding of the femur in any direction. But the image on the far right shows how the center pin does allow some natural rotation.

A hinged implant is used in cases where there is a problem with joint stability. It's not mandatory for us to know what you have, but I was curious if your surgeon had placed this more stable implant in your knee. If you had time to call your doctor's office and ask them to tell you what implant you have, that might help me determine some options for you to check out.
 
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NFenske

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Logic might say that a hinged knee implant is what you have if you can bend your knee, but that's not the case. Most knee replacement implants look like this:

View attachment 75867

A hinged implant, sometimes called a constrained hinge is different.

hinged 1-horz.jpg


rotating hinge 2.jpg



You can see on the left image that there is a stem that goes from the top part into the bottom part - that's what constrains it or prevents sliding of the femur in any direction. But the image on the far right shows how the center pin does allow some natural rotation.

A hinged implant is used in cases where there is a problem with joint stability. It's not mandatory for us to know what you have, but I was curious if your surgeon had placed this more stable implant in your knee. If you had time to call your doctor's office and ask them to tell you what implant you have, that might help me determine some options for you to check out.
I am not 100% sure but if I were to bet considering how lucky I am to have had so many surgeries the constrained seems to be the logical choice. By now I should know make model when the implant was built and who built it etc!! Yeah right!! I wish I could remember specific dates or years on all the surgeries I have had. I do know the first 3 were all in the same year all related to a torn meniscus go figure?? Really wish I was like most a couple revisions a scope or 2 not a biggie but NO I follow Murphy's Law!!!! Today has been another one of those lovely days ( very sarcastic!!!!!!!!!!!!!! ), my daughter ( high functioning form of autism ) is getting ready to move into her first apartment ( 25yrs old ) so today my mother myself and daughter went to Ikea to get the furniture and items she needs after 2 hours my mood was less then pleasant ugly is a better word. Then of course the drive what normally takes 90 minutes took 2 plus hours then had to unload ( did have some help Mom and daughter plus a handcart works wonders!! ) so now I am done miserable but done. What really gets me here I am 59 my L knee is shot have to use a cane knee has been replaced way too many times and yet most people may only have 1 or 2 TKR's and their fine and little if any pain why have I had to put up with this much BS?? Must be lucky?? By the way did call Dr's office left a message so should find out next week concerning type of knee I have.
 

Jamie

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Thank you. That will be helpful to know.
 
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NFenske

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Thank you. That will be helpful to know.
I know I am not the only one with issues so I know your also busy but really if you think you might be able to help by at least suggesting someone great!! At this point there is no such thing as being pain free ( gave up on that years ago ) and right now I am pretty much miserable after getting my daughters furniture put together for her first apartment. To define what I mean by miserable trying to walk it stinks!! ice and elevation are great!!. Really trying to figure out how you can help since your in Kansas and I am in Va?? To be honest I would not be surprised if anyone can. WHat is bad still have to move daughters bed tomorrow as bad as this sounds sometimes the thought of getting rid of the knee completely has crossed my mind but then with my luck how do you treat phantom pain so I am stuck.
 

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