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Revision TKR Infection resolved! New knee 1/26/15. This one is going to be great!

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News finally from Duke. None of my cultures are positive.
My case was presented at their high risk conference and all think I need a 2 stage revision. I am seeing Infectious Disease in 3 weeks to see what type of antibiotics will go in the spacer. They will be guessing as my cultures are negative.

My synovial fluid WBC count and neutrophil percentages are so high they think I must have an infection. My knee is hot to touch at times. I have the option of living with this or going through 6 months of awful stuff. I can't do anything I want to do - so seems one option. I can't be seen by ID for 3 weeks.

I'm just afraid they still will not fix this. I also see no other options and knew this would be the recommendation. Once things start going wrong they seem for many to continue- and as things are iffy with the cultures I am worried.

I also would vote the same way the committee did - but I hope I can go through this. I'm not good with initial pain and have always suffer greatly for the first 12-24 hours. The pain meds wear of quickly for me. After the initial post op period I use minimal pain med after. I hate the side effects.

Enough whining. I just found out for $16 per month Harris a Teeter will pick put your food for you to pick up. Also for another 10 will bring it to your house. Maybe an option every few weeks or so. Hope you are all hanging in there! Old Texan has really had a time and I'm thinking about her especially.


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Hi, I'm late to this party but wanted to add my reassurance that you are in good hands at Duke. One of my dearest friends, her husband, and their daughter-in-law are nurses there (although not in Ortho dept.)

Fwiw, when my husband (Mr Jeano aka the Ice Sherpa) had to have his mitral valve replaced, he spiked a terrible fever etc. and a lurking infection was suspected. All cultures were negative and they slugged him with every antibiotic and antifungal and for all I know antifreeze before shrugging their shoulders and getting on with the heart surgery, which was delayed for 10 agonizing days by all the tests. I am a RN myself and was nearly having kittens at the thought of him being on a vent and so vulnerable to a hospital-acquired infection for such a long period. They never did find a cause for the symptoms, other than that his body possibly was responding to the valve failing the only way it could.

Long story short, you just don't always know what needs dealt with until you get in there and have a look-see. Be sure to advocate for yourself as regards pain management BEFOREHAND, and hang in there. We've got your back.
 
Ask lots of questions, express your concerns, and advocate for yourself. I think jeano is right, they just have to throw everything at it till they get something to work. Busylizzie had the spacer for a really long time. Take care, and good luck. Remember to take things one day at a time, and to put your health first. Sending good wishes your way. BTW, whine all you want. This is the forum for it!
 
I'm sorry to hear you must go through this. But it certainly sounds like you have a very competent medical team on your side. That's more than half the battle!! You ARE strong. Look what you've successfully dealt with so far. When these things happen you just take it one day at a time, be an active participant in your care and go for the best option. You're doing that and that's good.

Please stay in touch here and we'll do what we can to help get you through the challenges. Keep in mind that these folks are skilled in this whole process and we've had lots of BoneSmarties with successful revisions. Hang in there!!!
 
Thank you for the encouragement. I sometimes feel like The "Meg Rhyan" of patients in that scene from When Sally met Harry and she is ordering her salad with all of the specifics. I'm not usually a Diva - but have had enough surgery and problems that I end up sounding crazy I'm sure when I relay my concerns. I do it anyway.

I will need a pic line and home antibiotics. How awful is it to have one placed?
Thanks!
 
The pic line is a breeze. Don't worry about it a bit. You will be able to give yourself your IV antibiotics. A nurse will teach you how to do this and to flush your lines.
 
Margueritte said:
I will need a pic line and home antibiotics. How awful is it to have one placed?
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Hi Margueritte - I am so sorry to hear that you might have an infection :(

Like you, I've been through the mill with an infection and am now am in the 'no antibiotics' stage wondering if the bug will return or if it's been licked.

I had a PICC line put in for my IV antibiotics and it was over in seconds. I didn't know what to expect but they took me down to the radiological department and, while hooked up to an ultrasound (I think), the doctor came in and slipped the PICC line into my upper arm, all the way into my body. Didn't feel a thing and it was over in literally seconds.

They discharged me from hospital after 6 weeks but I had a nurse coming to our house every day for 2 weeks to give me my IV course. When my blood doctor told me I didn't need to continue the IV, the nurse removed my PICC line. Again, it was a piece of cake. No pain, no discomfort.

I'm sure you'll have the same experience with your line and having all those antibiotics pumping into your system, your bugs will be knocked for six :yes!:

Please don't hesitate to ask me any questions about my experience if you want to.

Good luck and I'm sure it won't be long before you're laughing about this particular stage in your life :fingersx:
 
Old Texan said:
You will be able to give yourself your IV antibiotics. A nurse will teach you how to do this and to flush your lines.
Click to expand...
Wow! That's amazing! No way we could do that here in Oz. They require a registered nurse to do that :thumb:
 
Oh, wow! I guess private for profit insurance? I do my antibiotics, flush both lumen (pigtails) on my picc line daily. The nurse draws blood and changes the picc line dressing weekly.
 
I had a bone infection near my 2 yr old TKR in June. I went to the ER with 104 temp and a red patch below my knee. I spent a week in the hospital with cellulitis, superficial thrombosis and possible bone infection. Doctor said if I would get a PICC line installed and have home health come every three days I could continue my treatment at home. I had six weeks of IV antibiotic and a nuclear scan that showed no infection in August. I am thrilled to say the infection did not require surgery. I had the picc line installed on my 70th birthday and now I think it was a great gift. I hope you will respond quickly to treatments and wish good health for you.
 
pjw said:
I had a bone infection near my 2 yr old TKR in June. I went to the ER with 104 temp and a red patch below my knee. I spent a week in the hospital with cellulitis, superficial thrombosis and possible bone infection. Doctor said if I would get a PICC line installed and have home health come every three days I could continue my treatment at home. I had six weeks of IV antibiotic and a nuclear scan that showed no infection in August. I am thrilled to say the infection did not require surgery. I had the picc line installed on my 70th birthday and now I think it was a great gift. I hope you will respond quickly to treatments and wish good health for you.
Click to expand...
@pjw I am so sorry to hear about your trials and tribulation and am very glad that you're over the infection! It was so good that you didn't need more surgery! :yay:

Thanks so much for your good wishes! I very much appreciate them :D

~Nona
 
Went to Duke yesterday for my preop discussion. Surgeon had called to say although all of my cultures are negative he still thinks I have an infection. He and I decided the 2 stage procedure was the best option.

When I got to a Duke my surgeon sent in his Fellow to talk with me. He proceeded to tell me my case at conference was met with great controversy and it was a hard decision what to do. He told me the procedure had potential for high morbidity. Another option is to wait 3 months and reculture. He personally would not be operated on at this time. I said" it's not your knee" I was angry.

My surgeon came in and agreed it would be a big hit to have this done but it's the only operation he will agree to and it has to be my choice. He thinks things will be the same in 3 months if we don't do anything. I told him my knee is a problem but he should be responsible for guiding me.

I have a friend in infectious dx who thinks I have an infection as well.

I finally said- I want the surgery. On the way out of the room the fellow said" you are brave- I'd never do this." Really ??

So - I prefer more direction! I'm going to take the info back to the original surgeon who referred me and see what he thinks. I had thought I'd get this done in 2 weeks but the first avail appt is in 6. I also found out my knee would not be replaced for at least 12 weeks and not 6.

I'm scared, have been to the best people and now they are making me decide- ultimately it is always the patients decision - but the last visit - especially with the Fellow was not appropriate.
Thanks for listening!






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I wish there was a good answer. Listen to everyone, but you do have to make the decision. I've had infections, surgery after surgery to drain, lab tests, haven't been able to work and had to draw money out of retirement funds. Now that I am feeling better, there is a new place that is draining. I am on super oral and I V antibiotics. I do not want to go back to hospital or have more surgery. This is crazy frustrating. Listen to your gut. Good luck. Sending good thoughts your way!
 
Please try not to be too angry at your surgeon. No doctor will ever tell you that you must have elective surgery....and that's what category all joint replacements fall into. The best he will do is just what he did for you....give you his opinion as to what will happen if you DO have surgery and what his opinion will be the situation if you DON'T have the surgery. Then the choice is yours as an informed patient.

That said....I get that you need to maybe talk over the surgical option with someone. The second opinion you're going to get is good. You can also get input here from your BoneSmart friends that get what you're feeling. Or you can talk with friends or family. But, in the end, it is really your decision.

However....the PA's comments were way out of line and, if it was me, I think I'd mention that to the surgeon at some point. That PA needs to learn better bedside manners. He was unprofessional.
 
Thanks so much. I am not sure what the Fellow was trying to do except perhaps show off his knowledge to his attending which untimely backfired. I will certainly talk to my surgeon about this - that a good idea. A lot of medical care has to do with a caring physician who listens and helps you decide about your options. My surgeon has been this for me until faced with this Fellows comments. My bet is he has been talked to.
I know nothing is guaranteed. I need to do this so I'm going forward. I appreciate your response!
 
@Old Texan
You have really had a prolonged post op with this and I'm impressed with your ability to continue the course.
I also appreciate your insight. I think if you are feeling better that is a good sign. I'm hoping that the infection clears really soon and will be thinking about you. You are really supportive in writing to me. I think your experience is invaluable in this forum.
 
Scheduled for surgery Oct 20th for removal of implant with spacer. I'm ok with this as it is the most careful thing to do. I am anxious about the recovery. I'm usually very active and will be home a lot - with fortunately Emily - my dog. My husband is a great help but works. I'll be ok as long as medically things go well.

Will let you know how things go. I have been very tired lately which is new to me. Fatigue could be due to anything but wonder if some of this is due to the knee.

I've read a lot of other posts from all of you. I hope you know what a wonderful job you do in giving support I'm so impressed.
I'm ok for now and will send update as soon as I have surgery!
Thanks for being there for me.


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@Margueritte

I can relate to your anxiety, Margueritte, having just spent almost 8 weeks with two spacers in my knee, so I had to clump around with a Richards splint and both crutches.

My shoulders ached, my back felt really painful and the first time I went out to the Pathology office, it took me forever to walk to the front door from the car park. This would normally be a minute's walk but it took me close to 7 minutes :( :boohoo:

My husband went and rented a wheelchair for me for when we go out and that helped a lot! You might want to think about renting one for yourself?!

I also have a black stool (a bit like a hairdresser's stool) which I used to sit on when dishing out pills for the week for my husband and for myself. It's quite a zippy little stool so I used to sit on it and move around our house, saving me sore shoulders :old:

At first I thought the days with the spacers would drag terribly but it wasn't too bad and now I have my knee put back in!

The doctors have been very cautious after my operation on Wed as they were nervous about the bug coming back in but - touch wood - so far so good, so I'm sure the same will apply to you and you'll be dancing in no time :happyfeet:

Please feel free to get in touch with me if you want any further information, as I would be more than happy to help in any way I can!

~Nona
 
@grannyweasel
Thank you for all of your support and great ideas! I'm so glad you have your new knee!

I think the stool and wheelchair will be really helpful.

The pain and swelling in my knee will come and go and is related a lot to activity. Did that happen to you? It seems better this week but exercise still causes swelling. I guess I can always have them check more fluid to see if the white count has dropped. You can tell I'm hoping " poof" it will cure itself. I think that is doubtful though.

I bet you will be dancing soon! What a long road you have had!
 
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