Revision TKR Revision surgery

[Crowwood]

I am nearin the end of six weeks antibiotics to treat a Streptococcus infection of my knee, replaced in 2016. It’s been a long haul and got me very down even though support from NHS Hospital At Home service has been brilliant. I am seeing the consultant on Monday to review and dreading that he will say that the infection has not gone away and the implant will need replacing in a two stage operation. My infection markers have recently been going up again and the knee is still swollen. I am really worried about going into a long period of treatment low in morale and energy and with leg muscles already much weakened

 

[Celle]

Hello @Crowwood - and

I'm sorry to hear you have a knee infection. Do you know what caused it?

Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Knowing that, plus a little more information about the treatments and procedures you've already had, will make it easier for us to advise you appropriately. Thank you.

Has the infection been inside your knee joint, or was it more superficial? Did your surgeon aspirate fluid from your knee and send it away for testing, to identify the bacteria causing the infection? Did he/she perform any procedure, such as a washout, on your knee? Have you had a course of Intravenous antibiotics?
Is there an infection specialist doctor attached to the team treating you?

I know how worrying this must be for you, but rest assured that, even though treatment may be protracted, almost everyone eventually has a successful outcome and ends up with an infection-free knee joint.

If you select the red prefix that says "Knee Infection" at the start of a thread, a listing will come up of all the threads by people who have had knee infections and you can read about their progress.
Here is a link to that list:
https://bonesmart.org/forum/view/knee-replacement-recovery-area.9/?prefix_id=33

Do keep in touch and let us know how you're getting on. We'll be here to give you virtual support through this.

 

[Crowwood]

The knee joint was replaced in Dec 2016, full TKR, left knee. Infection identified at the end of August this year. Emergency admission to hospital, knee aspirated under general anaesthetic and culprit identified as Streptococcus agalactiae, two days later on the 5th September, knee joint opened out debrided etc( a procedure known as DAIR) and I was put on a course of Teicoplanin. Stayed in hospital for 8 days then home with daily intravenous injections of 1gram Teicoplanin and weekly blood tests. Antibiotics due to finish on the 18th October, CRP still raised at 66, at last count, and knee still swollen but I am able to flex and walk on it without crutches. Taking Paracetamol and Ibroprofen, four times a day. Consultant cannot say how the bacteria got in but he says there is a possibility that its been in the joint since 2016 or simply entered via cut.

 

[Celle]

Thank you for all those details. I've put them into a signature for you, so that we'll be able to see them at the bottom of every post you make, so we'll be able to see them without having to go back to your early posts.

When you see your surgeon on Monday, do ask all the questions that have occurred to you. Write them down before the appointment, so you don't forget any. As your infection markers have been going up again and your knee is still swollen, it is possible that you'll need further treatment. Maybe another knee aspiration could be done, to see if any obvious infection is still present.

Your surgeon may recommend the two-stage treatment - removal of the implant and insertion of an antibiotic spacer, IV antibiotics, and later re-insertion of the implant once all traces of infection are gone. Rest assured that he/she won't recommend this lightly, but would be recommending it, knowing it presented your best chance of a permanent cure.

If that is the course of action your surgeon recommends, it would be a good idea to also have a doctor on your team who specializes in infectious diseases, as he/she will be the expert on assessing infection markers, and recommending appropriate antibiotics.

If the two-stage treatment is recommended, it's will be a long road to complete recovery, but it would most likely give you a complete cure.

We've supported other people on that journey and we'll do the same for you.

One of our Forum Advisors, @KarriB , has had a joint infection that was successfully treated with the DAIR washout method, She will understand your fears and apprehension.

 

[Izabel]

Crowwood, albeit not for the most pleasant of reasons!

I am sorry to read of your infection following your replacement in 2016. I too had an infection in my hip in November 2018 following a replacement in 2014 ... and it was worrying as I had had a TKR in March 2018! However, I was fortunate in that it did not migrate.

Goodness your CRP is high but hopefully the antibiotics will soon assist in lowering that. I finished my two-stage replacement and it is a long, arduous journey and three weeks ago I was declared totally clear!. There is always the fear this unwanted visitor may come back but hey ho we will deal with that if it does show it's ugly face on my doorstep again.

In the meantime, take a deep breath, keep your chin up and have positive thoughts. If you need a shoulder, please visit here ... there are many who can support you as there are some of us who have been where you are.

Sending best wishes to you for a peaceful weekend.

Izzy xx

 

[Crowwood]

Thank you for positive responses. I am rather pre-empting what the consultant might say but when I saw him ten days ago he admitted to not being very optimistic. I am a very active person so finding this all very demoralising. In the run up to my TKR in 2016 I did a lot of work on my leg muscles to get them in good shape for the coming recovery and I think that was very helpful. Going into further surgery after the six weeks of relative inactivity I have just been through is a concern. Its good to know there are lights at the ends of these tunnels, so thank you.

 

[newlybionic]

I had a washout of my knee and 6 weeks of IV antibiotics followed by 4 months of oral antibiotics. My infection was found only weeks after my original replacement. So far the infection has not come back. I hope that whatever your OS suggests you will finally wind up with a working knee.

 

[Jamie]

@Crowwood, so sorry to hear of your infection. I know when you have surgery like this and get a ways out from the operation, you don't expect to have something like this happen. But it does sometimes. Fortunately there are options to deal with it and get things back on the right track.

It sounds like you have a good surgeon you're working with. He's trying the most conservative approach first - the washout. It can work and is always worth it rather than rushing to a revision.

But if he does feel it's not getting the job done, his approach to moving on to a two-stage revision is a good next step. Try not to fear this treatment, as it is usually very effective. As mentioned in the posts above, you'll need to be sure he puts an infectious disease specialist on your case as well. This ensures you have both a surgical expert and an infection expert on your side. I suggest in your chat with your surgeon that you ask how many of these types of revisions he's dealt with. You do want someone who is experienced at both dealing with infections and revising a primary joint replacement.

I hope you also spend some time reading the recovery threads of other BoneSmarties who have gone through infections and revisions. Although it is not a quick process, people come out on the other end with no infection and a functioning knee.

All the best on Monday. There may be some challenges ahead for you, but we'll be right here to help and support you.

 

[LolaBee]

@Crowwood, I am entering my 8th week after 2nd stage. Like you, I was several years out from initial tkr. Mine was staphylococcus Caprae. Very virulent staph, and did a lot of damage to my bones, along with lots of tissue damage. My Infectious Disease doctor likened it to MRSA, but treatable.

2 stage revision is a difficult journey, but there there are many on here who have successfully navigated it. I will find out at the end of this month if I continue to be infection free. My inflammatory marker was 84 when I started treatment. I was on IV antibiotics 10 weeks after stage 1. I had lots of complications and setbacks, but mainly due to other reasons. You can check out my journey.

Hoping your doctors have a good game plan going forward. Best wishes.

 

[Crowwood]

My visit today was more positive than I had anticipated. The CR-P marker had gone up but the bloods taken yesterday showed it returning to a better trajectory and at 33. The conclusion of the review was to extend the daily Teicoplanin antibiotic for another two/three weeks, subject to confirmation with the microbiologist and then review again. I am getting very good service from our NHS. My local hospital has this year set up a Hospital At Home service so a nurse calls in every day and gives the antibiotics via a midline in my arm and takes bloods for tests as and when needed.
Thank you to everyone who has replied and given me support

 

[Jaycey]

@Crowwood Very positive report - well done! Thank goodness for our NHS! Sounds like you are really getting great care.

Please keep us updated!

 

[Jamie]

@Crowwood ... how are things going for you? As of Monday, it sounded like you were on a positive path.

 

[Crowwood]

Well I am feeling a lot better and thank you for asking. The bloods taken last sunday (20/10/19) showed that my CR-P score has dropped to 14 from 32 the week before so that looks very positive and the haematologist reported that in most other areas things are looking good. My white blood count is a little below what it should be as is my haemoglobin, which might account for why it get so very tired very quickly. My next review with the Ortho. consultant is on the 28th. and I will continue with the daily intravenous Teicoplanin until then and see what he has to say.
I had a physio session last week at the hospital and my ROM for the knee is around 105 degrees and I can now start to use an exercise bike (very gently !). The knee is still a little swollen, seems weak and gets sore pretty quickly so I am taking things slowly re exercise etc. The nurse told me this morning that usually the consultant will arrange for an MRI scan at the end of the treatment in case the infection has caused any damage to the knee or implant. Its the first I had heard of this possibility. In your experience how big a risk is this ?

 

[Kurt_H]

@Crowwood thats an excellent drop in CRP score, mine is 17.9, hope to get it under 10 or even better 5!

My infection caused loosening of the prothsesis which was easily picked up in an x-ray. I have to have a new one. That being said they must have seen possible loosening by now or will MRI determine that?

 

[Crowwood]

The knee gets stiff and sore still after little activity which might mean it needs attention or just inflammation still present. Yes, I am hoping to get my CR-P down further but am told its a pretty excitable indicator .....its just I am a bit target driven !......under 5 would be good too !! next bloods on sunday......
Best wishes.

 

[Celle]

You're doing well, but treating a knee joint infection is a long haul. You'll need every trick you can find that can help you with patience.

 

[Crowwood]

Saw the Consultant this morning. My CR-P has gone from 14 last week to 12 yesterday, a small decline. Consultant is proposing a further two weeks of Teicoplanin to see if it will get below 7 and then a further review in two weeks time. Its slow process.......

 

[sistersinhim]

It's going in the correct path!

 

[newlybionic]

You’re moving in the right direction. I hope the numbers continue to decline.

 

[Crowwood]

The latest blood test results from Sunday shows CR-P remaining at 12. Knee still swollen and giving off heat which suggest to me that infection may still be present, even after 7 weeks of Teicoplanin. I see the Consultant in a weeks time for review so hoping things will be clearer then !