Revision TKR Lovetocookandsew’s long road to recovery

[lovetocookandsew]

Finally spoke at length to my OS today-it was supposed to be last week but got moved to today. He answered all my questions (and I had a ton! poor guy-it took a long time) and explained thoroughly exactly what's going to happen. He'll be doing a synovectomy, a washout with soap and then antibiotics plus a spacer exchange. He'll also be doing tissue and fluid cultures. Tissue samples will also be sent to pathology.

He plans to start IV antibiotics right away when I'm in the hospital, while the cultures grow and pathology reports back; depending on how they grow or don't grow in the 3, 4 or 5 days I'm in the hospital (due to all the problems I always have and had last time, I'll be there longer than usual), he'll either continue the IV antibiotics for 8 weeks, or send me home on oral antibiotics while the tissues, etc, continue to culture for 3 weeks. If something grows, we'll either continue the oral antibiotics if they're the right ones, or put me back on IV antibiotics if indicated, for 8 weeks, then go from there. I know his preference if I do have an infection is a two-stage revision right away, and I told him I'd probably go with what he thinks best at that point. I didn't ask today as he answered previously, but at some point we add the ID doc to the mixture. He's going to culture for all the usual possibilities, plus a whole bunch of unusual stuff, including the terrible bug I had a few years back that spread throughout my whole body, put me in the hospital for a week and just about killed me, on the small chance it's hiding in there and causing all the problems.

If I have no infection (and I again got the impression he thinks it's more likely I do have a low grade one of some type), then we see if the whole process fixes the problem. If not, then we assume it's a reaction to the metal causing all this and I'm stuck with the dreaded revision-albeit it's a one stage which isn't as bad as the other one. There is a very teeny, tiny chance he gets in there and sees that the implant has loosened, or has some other problem and needs to go; at that point he'll either do a one stage revision then and there, or if he sees signs of an obvious infection to boot, then he'll begin a two-stage right away.

I'll have to use a walker for a while, and since I'm also having a carpal tunnel release at the same time on my other hand, I'll have to use the platform walker that I hate. We spoke for quite a while, so I now know what he's doing and why, what he expects, etc, etc. While I'm not happy about the whole thing, I am happy that maybe it'll finally get fixed and I can get my life back, and I'm also happy to finally know and understand all the minute details which helps me prepare.

 

[newlybionic]

It's a good that you and your OS have been able to talk at length you you understand exactly what the plans on depending upon what he finds. I hope any infection that you might have can be quickly cured and you can finally have your knee without pain.

 

[lovetocookandsew]

 

[lovetocookandsew]

I don't know what TKR knees should look like at 2 years, but my knee is not only quite swollen, I think it's pretty ugly too. The keloids are actually a darker pink than they look in the photo. I had both my knees lying on the bed-my TKR knee is a lot larger than my left knee due to the swelling, but it's hard to show that in the picture. You can also see the pockets of fluid in my knee in the picture of my right knee by itself.

 

[KarriB]

The synovectomy is the procedure I had Thanksgiving Eve 2013. The tissue cultures were immediately given over to the ID group, in fact the day after surgery the head ID was the first doc I saw, then I saw one if them every day girl the week and half I was in hospital/transition care. The ID is so important as they know and will study which antibiotics work on what infections. I don't think an OS always knows and it's not their specialty. They did start me in one antibiotic, then after the cultures grew changed to a different IV and added an oral. I continue to see my ID twice a year now as I'm still on an antibiotic, but I LOVED that she told me she had conferred with her mentor who is at another hospital in a different group. It told me she cared enough to seek other opinions. God certainly blessed me with good doctors.

 

[lovetocookandsew]

@KarriB I'm so glad you got your knee taken care of and by great doctors. As you can see by the pictures, my knee isn't acute or obviously infected. One thing my OS said the other day was that my knee is hard to figure out; if it was easy they would have already gotten it done. Because all my tests so far are in the normal range, it makes it even more difficult to figure out. But it's obviously swollen, the pain has continued to get worse, I limp more now and have fallen a couple of times, so they know something's wrong. I don't know who the ID doc will be as he'll get one involved only if the cultures show an infection, otherwise I guess we assume it's the metal allergy.

 

[KarriB]

So when will they know if it's a metal allergy? Will they know once they open up the knee?

 

[lovetocookandsew]

I don't know how that works exactly. I had the LTT metal allergy test which was positive for nickel. But that doesn't necessarily mean the problems in my knee are from that. He did say if I don't have an infection, and the procedure that he's going to do doesn't work, then it's likely a reaction to the nickel. He also said if that turns out to be the problem, that my reaction to the nickel can keep getting worse as time goes on. I asked him, if he needs to do a revision at any point, if he'll use a nickel free joint replacement, just to be safe, and he said that he would. (he did mention that he believes all of them have nickel in them, but some have less nickel. Plus we know some of them wrap the nickel in layers, etc)

 

[lovetocookandsew]

@Josephine I was looking at your pictures of knees, and trying to decide if my knee swelling was huge, moderate or slight according to those pictures, but couldn't decide where my knee fit. I attached a couple of pictures of my 2 year old TKR in a post above; what's your opinion? Thanks.

 

[Josephine]

In my opinion, it's huge.

 

[lovetocookandsew]

Thanks, @Josephine I was wondering, but all I knew was it seemed like way too much swelling. This picture really shows the difference in my knees. We shall soon find out (hopefully) what's causing the swelling and pain.

 

[lovetocookandsew]

Good news/bad news...... I got an email this evening from my OS, (this poor guy works too much!) and he's going to have the Aesculap gold knee on hand for me just in case he needs it. Good that he has a knee replacement for nickel allergies on hand if he needs it, bad news because he might need it. Ugh!

 

[Pumpkin]

Your OS works too much! Glad he is looking out for you, even if it is a good news/bad news situation.

 

[Josephine]

They all do! It's part of their character. Never yet met a lazy orthopod! They're all driven, that's what makes them good!

This is what an Aesculap gold knee looks like - thought you'd like to know!

 

[lovetocookandsew]

Thanks, @Josephine ! While I'm hoping he doesn't need to use it, it's nice to know it'll be there just in case.

 

[lovetocookandsew]

For those who've had infections, metal allergies or revisions for other reasons after the original TKR, did you have pain going down the front of your leg inside your shin bone (tibia)? Along with all the other pain I have, I've been having pain in that area for a while now and am wondering if it's part of whatever's going on in there or something else.

 

[turtle68]

Along with the knee pain, I have had the shin pain down the front of my leg. It started when my knee buckled and it felt like something was ripping down the front of my leg. My guess, for what it is worth, that it does have something to do with what's going on in there. My OS mentioned cement that had come loose.

 

[lovetocookandsew]

@turtle68 Since it's a different pain, different area and relatively new, I was wondering if it was possibly related. I'm thinking it probably is related, I just wonder what's causing it and why.

 

[newlybionic]

I had that pain with original TKR and I attributed it to the stem from the new knee being placed there. I have it now also going further down my leg. My knee has never buckled either with he original TKR or now. I'm not sure if my original was loose at all. I plan to ask about the pain when I have my first postop visit tomorrow.

 

[lovetocookandsew]

@newlybionic Please let me know what the OS says. Thanks.