Knee Infection* Infection?

[Freebird88]

Hi everyone. I am 3 months post op on right knee TKR. Lots of pain which is gradually getting Better. Such a slow recovery! Not what I expected. Is there a way to tell if you have infection in the joint? The skin over my knee is red and slightly swollen, hot to the touch. But I have never had a fever-do have chills- and blood work showed no white cells. Doctor says if joint was infected I would not be able to walk. Pt is gradual and mostly done by me at home on stationary bike after PT pushed me too hard at facility. I Do not take pain meds as hard to get any refills anymore due to opioid situation In US. So I am hoarding the last I have when I really need it. Does any of this sound norma? Very discouraged as I know people who have not had it this hard. thanks for any input.

 

[Tykey]

Hi, yes not all have it this hard, but that might be because we continued with non opioid pain killers. You should take them for as long as you need them.
The same goes for elevating and icing

 

[Jockette]

Hi and Welcome!

This is a much longer recovery than what most of us expected, a full year, on average, so it is not unusual to have pain at 3 months.

A warm knee is par for the course in this healing process.

I took Tylenol and ibuprofen alternately, for several months after I stopped the prescriptions, and that helped me.

Another way to lower your pain level is to be careful of your activity level, especially with PT, and never allow a PT to push your knee to pain.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jockette]

Please tell us the date of your surgery and which knee it is and we’ll make a signature for you.

 

[graveday]

So how is your knee doing?

 

[Freebird88]

I am now at 10 months and doctors thinks it’s infected- probably bacteria on the implant. Yet I have still never run a fever or had chills. No white cells in bloodwork, but elevated neutrphils in aspiration. Had intravenous antibiotics and oral afterward, which I cannot tolerate due to side effects. Encouraged by second opinion surgeon to have the horrific 2-stage surgery where old implant is removed, temporary put in while antibiotics clear infection, then new implant put in. Yet I have minimal pain, swelling and redness as time goes on. So confused. When I read the forum, I feel like I’m just healing slower than some and should hang in without surgery. Looks like no way to prove infection is actually on the hardware. Big decision. Asking for prayers.

 

[Freebird88]

Just an additional comment- I do not have minimal pain, just lessening pain. Better than 6 months ago but certainly not minimal. Swelling and redness are lessening also. It freaking me out to think I may have infection on implant, but what if all this is just normal slow healing? Thanks for any comments

 

[Freebird88]

Has Anybody on this site been through this and had the surgery? Did you have definitive proof that you had an infected implant? Thanks for any and all input.

 

[Freebird88]

Moderator- in answer to your original question, my initial surgery on right knee was October 6, 2020.

 

[SkiBikeHikeDude]

Hi, I'm sorry you are going through this. My knee swelled and developed hot red spots around 7 weeks post op. I went to PT and my PT immediately sent me to the surgeon as he was concerned it was infected. The surgeon drained fluid from the knee and sent it in to the lab to see if it would grow a culture to see if it was infected. It turned out the culture didn't grow and it was decided there was no infection. I have continued to heal since then, but slower than I hoped.

Has the doctor drained the knee and sent the fluid it to a lab for a culture? I am not a doctor and not an expert, but I wouldn't agree to more surgery without running more tests to really see if it is infected first.

Good luck to you! I hope it all works out well.

 

[Celle]

Has the doctor drained the knee and sent the fluid it to a lab for a culture? I am not a doctor and not an expert, but I wouldn't agree to more surgery without running more tests to really see if it is infected first.

I agree with this advice.

If you do have an infection, it will be important to have had an aspiration of the fluid from your knee, to identify the infecting bacterium and what antibiotics it is sensitive to.

 

[Freebird88]

Has anyone been diagnosed with infection ON THE HARDWARE? I had TKR right knee in October 2020. Still in pain when bending the knee, shooting pain sometimes at night. Only mild pain when walking. Tests were all negative except elevated neutrophils and c-protein reactive, but these were not off the charts and could be related to inflammation. OS and ID doctor both think hardware is infected. I may decide to live with this and be on antibiotics forever as my ID doc suggests. Or proceed with 2 stage surgery to replace implant. But I am 76 and have a propensity for blood clots. Any opinions would be greatly appreciated. I have never heard from anyone with infection on hardware. Thanks

 

[Jockette]

@Freebird88
I’m sorry you are having issues with infection. I will discuss this with other staff members.

I moved this post to your own thread so that you would have a journal of this issue, and replies, in one place.

 

[Claire56]

Has a nickel sensitivity been ruled out? I had never been diagnosed but occasionally when my ear piercings got irritated, they would get puffy & weepy if I wore cheap earrings. Based on that I was given a nickel free prosthetic.

 

[GiantFinnegan]

Did the tests you mention include actually taking fluid from the knee and culturing it to look for infection?

 

[Jamie]

Has anyone been diagnosed with infection ON THE HARDWARE?

@freebird88 .... IF you have an infected knee, here is most likely what is going on:

Periprosthetic joint infections occur in many cases because of bacteria encased in a biofilm (a slimy, sticky coating) that is created on the implant. The implant itself obviously cannot be infected, but it can serve as a platform to host bacterial colonies. Once attached and protected by the biofilm, the bacteria go through a growth and maturation phase.

This process is not completely understood. Some colonies manage to mature and cause damage to the tissue surrounding the implant, resulting in loosening of the prosthesis. But for whatever reason, sometimes the colonies just remain on the implant and either are not activated at all or do so over an extended period of time.

The protective biofilm offers the bacteria the ability to ward off some or all of any antibiotics that are used to combat the presence of an active infection. In some cases, like what you are describing, doctors will try to keep the bacteria at bay or managed by long term antibiotic use. It can work. But, if the infection continues to worsen or the implant becomes loose, a revision can become the better treatment method. If your implant isn't loose, it's a normal treatment response to try the antibiotics rather than additional surgery.

 

[Gingerbread]

I'm so sorry you're going through this. Praying for a swift sure resolution for you and a pain free recovery! God bless you.

 

[Mrs. Ciz]

Has anyone been diagnosed with infection ON THE HARDWARE?

@freebird88 .... IF you have an infected knee, here is most likely what is going on:

Periprosthetic joint infections occur in many cases because of bacteria encased in a biofilm (a slimy, sticky coating) that is created on the implant. The implant itself obviously cannot be infected, but it can serve as a platform to host bacterial colonies. Once attached and protected by the biofilm, the bacteria go through a growth and maturation phase.

This process is not completely understood. Some colonies manage to mature and cause damage to the tissue surrounding the implant, resulting in loosening of the prosthesis. But for whatever reason, sometimes the colonies just remain on the implant and either are not activated at all or do so over an extended period of time.

The protective biofilm offers the bacteria the ability to ward off some or all of any antibiotics that are used to combat the presence of an active infection. In some cases, like what you are describing, doctors will try to keep the bacteria at bay or managed by long term antibiotic use. It can work. But, if the infection continues to worsen or the implant becomes loose, a revision can become the better treatment method. If your implant isn't loose, it's a normal treatment response to try the antibiotics rather than additional surgery.

Excellent explanation!!! This is exactly how my surgeon described what happened to me. The bacteria on the implant eventually moved into the hole drilled in my tibia for the implant stem. It turned the bone to mush and the implant loosened. The whole thing had to come out. That was the only way to get rid of the infection and the biofilm.

 

[jessicarogers36]

Wow I hope your doing OK. My thoughts are with you.

 

[Freebird88]

Did the tests you mention include actually taking fluid from the knee and culturing it to look for infection?

Yes- aspiration showed nothing growing on culture, but ID doc says that’s why she thinks it’s on hardware. So confused