Knee Infection* Intermittent Pain

bockoman

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Wife is 60 significantly overweight 300lbs.
Sero neg RA Fibromyalgia.
3 level neck fusion and a brachioplexus injury at birth giving her limited use of her left arm.
Knee was completely bone on bone and excruciating limiting mobility in the extreme (on a good day we could go to a movie or a bit in a mall. She has been in constant pain from the RA fibro and osteo arthritis but the knees were the worst.

Had a TKR in one knee 6 months ago. Two weeks after the surgery her other knee gave out and she completely tore the rotator cuff on the other arm. This limited her recovery greatly and she still wasn't able to drive and needed some assistance leaving the house but that knee was not painful anymore.

The other one could not bend at all and was subluxed. She also had lymphedema in that leg
6 weeks ago that knee was done.
There was clear drainage that continued for weeks and increased significantly in the last week or two.
The knee was not painful at all and there was no fever.
She went to a wound center and they admitted her for emergency surgical debridement.

Plastic surgeon said that he cleaned everything out and there was significant pus. He did not see the joint but he was able to probe with his finger and says he could feel the metal.

At 6weeks post op there was no pain in either knee but because of all the other factors her balance is difficult and she still can not get up from a regular chair without assistance. He says the implant has to come out

The knee surgeon feels that it would not be best for her to remove the implant (I don't think she would survive it with any quality of life on the other side)

Has anyone heard of anything similar where they went with 6 weeks of IV antibiotics and then orals long-term????
 
Welcome to Bonesmart, we’re glad you found us. I am so sorry your wife has been through so much.

I am going to tag @Josephine
our forum director and nurse to address your concerns.
 
There have been members here who have done both- had the implant removed and then had an antibiotic spacer put in for two months or so and then a new implant. Some have not had the implant removed, but just had the antibiotic for six or more weeks. I think that you need to talk to her surgeon, express her concerns and find out why he formed the opinion that the implant has to come out. There is a Doctor in Houston, Dr. Maale, who believes in a single stage treatment for infections, perhaps you need another doctor's opinion to help you decide what to do for your wife.
 
Had a TKR in one knee 6 months ago
6 weeks ago that knee was done.
Would you kindly tell me the dates of her surgery and of the debridement, please?
There was clear drainage that continued for weeks
Drainage from where exactly?
they admitted her for emergency surgical debridement.
This was of the knee, presumably?
Plastic surgeon said that he cleaned everything out and there was significant pus. He did not see the joint but he was able to probe with his finger and says he could feel the metal. He says the implant has to come out
Why a plastic surgeon? I would have considered it more appropriate to let the knee surgeon deal with this.
The knee surgeon feels that it would not be best for her to remove the implant
With all her co-morbdities (other conditions) I would agree with her. But first you need to find out if this surgeon does a lot of revisions and infected knees? If she doesn't do more than about 40 per year then you need to find a revision specialist.
Has anyone heard of anything similar where they went with 6 weeks of IV antibiotics
Loads of them! If you go into the index page here, where all the thread titles are displayed, you will observe that every thread has a prefix. Like yours now has a prefix like this
infection knee.JPG
. If you click on any one of the red tabs/prefixes in the forum, you will get a search of all the existing threads in that topic. Though many of them might not be particular to your circumstaces,
thenorals chronically
Sorry I don't know what is meant by this. Can you explain please?
 
I think it's a typo and he means "then orals".
 
Anyone had the following symptoms:
Hx: Overweight, RA, Knee replacement led to multiple infections and muscle flap coverage. Last surgery put a constrained joint in just under a year ago after much convincing since they wanted to fuse it. On the only oral antibiotic that covers the last infection (MRSA)

Able to walk around the house and a bit outside with walker/cane. Recently taking a mis-step perhaps causes extreme pain in the inner thigh and sometime the lower leg. Barely can walk the rest of the day. Usually after meds and sleep it's mostly better or after a day or 2 back to the baseline.
 
@bockman
Welcome back to BoneSmart!
Sorry to hear your wife is having continuing problems with her knee.

Please post your Wifes surgery dates, a moderator will add it to your signature for you. Having the exact dates will help us properly advise you. Thanks!


You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:
  • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
  • Having only one thread will act as a diary of your progress that you can look back on.
So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.

Many members bookmark their thread in their computer browser, so they can find it when they log on.

thanks for understanding.
Chris
 
Last edited:
Thank you.
Surgery dates:
12/17 left TKA, 6/18 right TKA, 8/17 rt washout and debridement massive skin loss in front of leg (6x8 inches) infected with Stenotrophomonas maltophilia, enterococcus faecalis, Proteus mirables 12/18-end of month (dif hospital) removal of prosthesis fixed antibiotic spacer and IM nail temp fusion within the 40+ days gastoc muscle flap and skin graft, 2/19 Constrained joint rt implanted, 2/20 debridement and washout- MRSA inf--currently doxy 100mg BID indefinitely
 
Thank you for the dates,
Please review your signature and let us know if there are any corrections to the dates.

@PegGar16 had a similar experience with infections and skin grafts, she will be along to talk to you about her experience.
 
Wow! Your wife has had a lot going on. I have had some of what she has had done. I know it is quite the process.
 
Make the changes to my sig below, thanks
Infection Right TKR - February 20, 2020, Irrigation and Debridement
Revision Right TKR - February 19, 2019, Stage two,
Revision Right TKR - August 28, 2018, Stage one, Gastroc muscle flap, skin spacer, IM rod for temporary fusion

Peggy,
Yeah, you really learn to take things a day at a time. Thankful for every day she's not bedridden. She never was able to walk on the spacer.
 
I could walk with the first one but not the second. When they did my flap they had to switch out the spacer and put in the rods. From that point I was in a straight plastic brace (looked like a removable cast) and no weight. I felt so bad for my husband...that was a 10+ hour surgery. While he was stressing in the waiting room I was having the best sleep that I had in months.
 

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