Knee Infection* Multiple Revisions; What's Next?

[BigBadKnee]

I had a TKR at age 60 and all was fine until age 70 when I somehow broke the pin on the poly, causing dislocations, so I had a revision to replace the plastic. Following the revision, the surgeon thought there was excessive, unexplained bleeding in the wound so a month later he opened it for debridement and placed it in a knee immobilizer to curb the bleeding. A month after that, I could not bend the knee and it was still very red and swollen, so he did another debridement, a lateral release, and quad extension.

He still suspected excessive bleeding so I had three of the four main blood vessels restricted by a vein specialist. It didn't help, and the knee was now huge, red and not healing. I saw another knee surgeon two months after the third revision who did a fourth, complete revision, replacing the femur implant, removing the patella button, and replacing the tibia component with a plastic, antibiotic impregnated implant followed by six weeks of IV antibiotics and lifetime (?) oral antibiotics. He said if I liked the plastic implant, I could keep it instead of doing the full two stage replacement.

It's been a year since then and while I'm not happy with my huge, painful knee, I'm at least walking short distances without a cane and can do all my essential things. There's no sign of infection now, but the oral antibiotics may cause false negatives on the tests. I get no recommendations from the doctors regarding what's next. They just turn it around on me; asking what I want to do; put in the rest of the knee or leave it alone. Has anyone else (I hope not) gone through similar and did you keep the plastic implant or proceed with full replacement; and if so, what were your results?

 

[DSJ]

You should ask to be refered to an infectious disease specialist.
For me, the procedure was 6 weeks of iv followed by 6 months of oral antibiotics, then a period of an antibiotic "holiday" before drawing synovial fluid for testing.
I'm having weekly blood tests done to measure evaluate several things, including how well Im tolerating the antibiotics.

 

[BigBadKnee]

Thanks for your input. I abbreviated my story. I am seeing an infectious disease doctor. Have been since the last surgery. The IV antibiotics attacked my platelets and put me in the hospital for a week for transfusions, etc. He's been working closely with me and insists I stay on oral antibiotics. Should I ever have an indication that I'm not responding to them, he said he would change them, but not remove them. Best of luck in your full recovery.

 

[Pumpkin]

@BigBadKnee
Welcome to BoneSmart, glad you joined us!

Sorry you have been through so much with your knee. Are you seeing surgeons who specialize in knee revisions or complex joint reconstruction to address your huge painful knee?

Ultimately the decision is up to you if you undergo further surgery or are content to live with your knee as it is today.
IMO, if you decide to pursue further surgery, a full 2 state revision will give you the best chance for a successful recovery.
Find a surgeon with whom you have complete confidence, that does complex joint reconstruction, and has experience with infections.

Please post your surgery dates as you can best remember, a moderator will add them to your signature for you. Having the dates will help us properly advise you. Thanks!

 

[DSJ]

Thanks for your input. I abbreviated my story. I am seeing an infectious disease doctor. Have been since the last surgery. The IV antibiotics attacked my platelets and put me in the hospital for a week for transfusions, etc. He's been working closely with me and insists I stay on oral antibiotics. Should I ever have an indication that I'm not responding to them, he said he would change them, but not remove them. Best of luck in your full recovery.

That's interesting. During my first round of IV antibiotics in March2019, I landed in the hospital when my bp rose to 230/130 after 4 weeks on iv vancomycin plus an oral ab. He switched me to a combination of oral antibiotics for six months after that, but my bp stayed stubbornly high for the duration.

My current treatment was cefalexin iv for 6 weeks and i'm currently on oral cefadroxyl for 6 months.
I've been told that antibiotics for life is a possibility, but there's still quite a bit that would need to go sideways before that happens.

 

[BigBadKnee]

Surgery dates, per moderator request:

1/2/2009​

TKR right

2/11/2019​	Rt knee revision-poly replacement
3/11/2019​	Rt knee revision debridement
5/30/2019​	Rt knee revision-debridement, quad extension, lateral release
9/13/2019​	Rt knee embolization
10/23/2019​	Rt knee total revision-infected

 

[Pumpkin]

Thanks for letting us know your surgery dates!

 

[PegGar16]

Has anyone else (I hope not) gone through similar and did you keep the plastic implant or proceed with full replacement; and if so, what were your results?

Hi! I also went through a number of surgeries and had the spacer (2 different spacers) in for almost a year. After putting in the new implant I have not had any major issues and am very happy with the results.

 

[BigBadKnee]

Thanks, Peggy. I'm pleased to hear all is going well for you after all that.

 

[PegGar16]

I hope you also have a good outcome. I see that the choice is yours and it sounds like you are doing good research. You have been through a lot and I hope you have an Infect dz doc and revision specialist that you are comfortable with.