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Knee Infection* My Knee Revision Journey (2 stage)

LDB63

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Hi All,

My desperation has caused me to turn to you. LOL my Doctor offers no answers! So at 9 weeks I was the poster child of a successful knee replacement ... I'm walking trail, feeling great! then I went on a short walk only 8 blocks or so and went right to PT after (I had forgotten all about it! would not have intentionally done both!) My physical therapy was an aggressive one but I did great! Until... 6 hours later. I had my very first MASSIVE swell event. All the sudden while making dinner I feel my knee begin to swell... ok... 30 minutes later I can't move it ...for the rest of the night! I iced and finally went to bed to thankfully wake up being able to walk.

Since that first swell event I have been plagued by these random swellings - The worst one had me hysterical about a week ago... and two days ago soon after waking up... that event lasted all day till 4!!! I had to use my walker again... haven't pulled that out since week 3!

I was scheduled to go back to work today... I lasted half a day... just sitting at the desk it began it's swelling... had my cane with me... and was able to get to the car. It's crazy!

I've been home for 3 hours now. I have my ice machine going... leg elevated and still significantly swollen. But not as bad a some previous swell events where I couldn't move the limb at all!

all this since week 9! No longer feeling like a rock star!

anyone else with this weird extreme form of swelling???
I Ice
take Meloxicam 15 mg
Tylenol Arthritis 8 hr
Tumeric
and stopped eating carbs!!!
 
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LDB63

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I just read Meloxicam can cause swelling... I was off it for about a week at 4 weeks... and I was much more swollen than the norm then without it... so maybe not.
 
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Jockette

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Hi and Welcome to Bonesmart!

Please give us the exact date of your surgery and we’ll put it in a signature for you.

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.

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: 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
5. Here is a week-by-week guide for

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.
 

sistersinhim

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I'm walking trail, feeling great! then I went on a short walk only 8 blocks or so and went right to PT after (I had forgotten all about it! would not have intentionally done both!) My physical therapy was an aggressive one but I did great! Until... 6 hours later. I had my very first MASSIVE swell event. All the sudden while making dinner I feel my knee begin to swell... ok... 30 minutes later I can't move it ...for the rest of the night! I iced and finally went to bed to thankfully wake up being able to walk
Oh my goodness. This was way too much for a 9 week old knee! It is now very inflamed, angry, and you've had a set back in your recovery.

Do nothing but your ADL, (activities of daily living) until your swelling is under control. The more you try and bend it the more it's going to swell. Right night all it needs is TLC. Your knee is still a very young baby.



While members may create as many threads as they like in a 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 history before providing advice.
 
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LDB63

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My Surgery was Nov 6th 2018... I'm beginning to think it was the clam shell exercises I was told to do... It really hurt me the first time at the PT appointment that started all this mess. He also had me standing on the balance ball... it was fun but way too unstable for my knee... and the wobble board! looking back I really should have kept with the basics... walking and leg slides! When I swell I feel like I'm back at week 2 and the good times are maybe week 5 or 6 only. a real set back.

Thank you for your response I look forward to the info and yes no more working it...
 

Jockette

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looking back I really should have kept with the basics
Your “therapist” should have known those other things were not appropriate for you. This is exactly why I will not be going to PT next time.
 

Dizzy

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Over and over in this forum we have read that people, who are trying to push themselves with the PT or just too much exercising, are finding that it causes setbacks in their recovery. I guess it's the attitude "that's not gonna happen to me" but time and time again we have read how over exercising too soon after surgery just creates more problems. I found, after my revision, that the PT caused more issues so discontinued it after two sessions and just let nature take its course. A long recovery...absolutely....but I am happy with the results so far.
 

Celle

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Oh dear, @LDB63 - Your poor knee! And poor you!
Although you only did what you were told, you were told wrong. Your poor knee was wounded, not lazy or unfit.
It didn't need aggressive exercise and lots of activity.

You've had one of the most major surgeries possible and both you and your knee needed rest and gentle treatment, so you could both heal. Just a little, gentle exercise would have been sufficient.

Your problem with the pain and swelling is a classic example of "too much, too soon".
We always advise people this:
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.

Your knee was sending you messages when it swelled. It was telling you to back off the activities that were upsetting it. Pain and swelling were the message.
But you were probably told something stupid, like "Push through the pain", or "No pain, no gain". So you carried on doing those activities. You were given bad advice.
Myth busting: no pain, no gain

All isn't lost, but you have some lost ground to make up. Start doing that by being kind to your knee. Give it lots of rest, ice and elevation, and restrict your activities drastically.

Your knee is irritated and upset now. All its soft tissues are angry and inflamed. It may take a month or so for all that to settle down, if you treat it gently now. If you don't, you could end up with a knee that is chronically inflamed and painful.

Since complete recovery from a knee replacement takes as long as a full year, you are only a quarter of the way there. Your knee is like a whiny toddler that is saying, "Mum, I'm tired and sore. I need a rest." It's no good arguing with that toddler - that just makes things worse and brings on a tantrum. You just have to give that cranky child the rest it so badly needs. Do the same for your knee. Listen to its messages and do all you can, to keep it happy.

I'm beginning to think it was the clam shell exercises I was told to do... It really hurt me the first time at the PT appointment that started all this mess. He also had me standing on the balance ball... it was fun but way too unstable for my knee... and the wobble board! looking back I really should have kept with the basics... walking and leg slides! When I swell I feel like I'm back at week 2 and the good times are maybe week 5 or 6 only. a real set back.
That PT therapist was the wrong person for someone with a brand new knee. Everything he had you do was too much for your knee at that early stage of its recovery.

I bet he told you that hoary old myth about there being a "window of opportunity" to get good ROM (Range of Motion) as well. It wasn't true, although he probably believed it..
There's no need to rush to get ROM because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

And, finally, it's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

Given time, your knee should settle down and become happier again. Try to look on this as just a temporary setback. It may take a while longer, but you could still do well in the end. :console2:
 

Dolly Girl

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It'll settle back down, it's so discouraging to go backwards, but if you got there once, you can get there again! Hang in there. ☺
 

SusieShoes

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In the first weeks (indeed, first three months or so) following a TKR, healing is still brand-new and easy to disrupt. A knee that’s healing nicely, as it sounds yours was, can feel a lot more “healed” than it really is, so it’s easy to over-exercise it. I had many a disagreement with my PT about whether or not I should do things like the wobble board or leg presses. I refused leg presses altogether (and am glad I did) but I did try the wobble board.

My knees hurt and swelled for three days after. I never did the wobble board again.

Your swelling with subside again, and your knee will get back to healing nicely. It knows how to heal — our bodies are wonderful that way — so what it needs from you is opportunity. Create a healing environment for your knee: rest, elevate (reduces swelling), ice (reduces swelling and pain), and just do gentle stretches. The only exercise your knee and you need are your daily activities. You need to attend to staying alive, clean, and mobile. Getting up and about, and doing some gentle walking perhaps, are exercise enough for now. You have all the time in the world to get back to hiking and making your knee strong. Right now you’re aiming for functional and pain-free. If your PT won’t work on just that, take some time off from PT and go back later for the strength work.

From what you wrote, it sounds like you’re actually doing really well!
 

Josephine

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I'm walking trail, feeling great! then I went on a short walk only 8 blocks or so and went right to PT after (I had forgotten all about it! would not have intentionally done both!) My physical therapy was an aggressive one but I did great! Until... 6 hours later.
Didn't you think these were all connected?


I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
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LDB63

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Thank you so much everyone! Yes, I'm convinced I need to take it easy! I love the analogy of it being my new baby or a toddler... That fully resonated with me... (I had 4 children)

I just started work... made it through a half day the first day and all day yesterday and today I've have been doing some light house work and it's doing much better! My knee has definitely settled down from my last exercise session and I'm not doing any more! Just heel slides and walking for now! I hope my overuse is the simple answer... I feel it is. I've hit 130 degrees on the bend so I don't feel I have to push anything!

I wish I found this site earlier! … You've all offered the advice I really needed. Advice my Doctor wouldn't even give... they're just the mechanics. How you drive that knee is your business! ugh!

So thank you everyone! Big hugs!
 

Larryhg3

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@LDB63 welcome to BoneSmart. You are not the first person to find us because you joined the over did it club (ODIC). It sounds like your knee got very angry probably not from any one activity but a combination of a few, which you acknowledged in your very first post. When that happens the only thing you can do is stop everything until it calms down and then slowly add things. We often talk about listening to our knees as we get better...it “talks” to us by swelling, stiffening, aching. When it does that we need to rest ice elevate. At 10 weeks you will find many things that set it off adding things in slowly and backing off if they aggravate your knee is a good approach. Good luck in your journey.
 

maryo52

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I learned from my TKR in 2010 to err on the "go slow" side. I've read many accounts here of people who were "stupid" one day and having lots of backlash. Swelling to me is a cry for lots of icing and elevating until things go back to normal. Hang in there.
 
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LDB63

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****11 MONTH TKR UPDATE*****

1. My swelling was caused by a failed TKR - the swelling is the direct result of the unit moving about inside the bone. My surgeon did not fit my knee correctly.
2. first sign of a problem. I could NEVER do a "clam shell". At 9 weeks my physical therapist had me attempt to do one of these. I couldn't do. Not at all. Trying at home... I simply could not do and it triggered a swell event each time I tried to do just one. I remember my therapist being stumped as to why I couldn't do.
3. My knee continued to fail. I was on a cane 90% - and 3-4 major swell events a month when I accidentally walked on an uneven surface, over worked, or just slept wrong. My swell events lasted for 8 hours and Ice did not take down the swelling...maybe another sign...

I just had a Total Knee Revision and a week out from that surgery i can easily do a clam shell. (I tried only one... that exercise will be for later) It's a beautiful surgery... no bruising. My first surgery looked like something out of a horror story... bruising all over... staples red and angry... a real mess.
I had great confidence in my new surgeon. My knee feels and looks great....

The most unfortunate has happened with my beautiful knee revision that already feels so different and better... Bacteria was introduced to my joint during surgery- I have two different forms of staff bacteria. I have a pic line and administer antibiotics three times a day as well as a have to take oral antibiotics. It's a big deal. I won't say more... It's a lightning struck twice...

My advice... if you can't do a clam shell - you may have a loose prosthetic - Big Swell Events - it may be caused by a loose prosthetic.
and if it is... It needs to be fixed... and I have no idea how to advise so you don't get bacteria
in that joint. That's on the hospital's end. Be vigilant... be knowledgeable of what can happen.
and good luck.

I'm starting a new thread to post updates from this Bacteria thing.
 
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LDB63

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Hi Kurt,

OK... we are going through the exact same thing. I had a bad TKR last November that steadily failed.

I also had tested for bacteria and none was found.

Just had my revision surgery 9 days ago. I was in the hospital for 1 night. The second night (first night home) I received the call... 2 of the 5 samples taken before my knee was closed up tested positive for bacteria.
In the morning I went back to the hospital for 4 more days until the cultures could mature and they could determine which bacteria got me.

I have both Pasteri and Epidermidis staphlococculus

Since they felt the infection was new - drugs can keep it at bay. I want a 2 stage replacement and
get it cleaned up. The doctor for the CDC said he felt a drug therapy will work here... I don't know.
I am on the IV antibiotic for 6 weeks and another oral antibiotic which I may have to take for the rest of the life of this knee...until it get's cleaned up.

upon reading opinions of the outcome of the antibiotic therapy like you and I are doing-since we are both younger - we will see a time where our knee will need to be replaced again.
at that time they would do the 2 stage option...clean it all up and start again.

This is daunting I know. It's a real disappointment. We Must keep our bodies healthy, take probiotic pills, Keep our minds from going to that dark place, and just be as positive as we can be. It's a big one for sure.

Big hugs... to us both. We'll get through this. :)
 

Jockette

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According to this article from our Recovery Guidelines, Clam shells are not recommended for a new, healing knee, so I’m not surprised you had trouble doing them, even if your implant hadn’t been loose.


I’m glad the revision feels better, but so sorry about the infection. Here’s a list of other members who have had infections:
 

Kurt_H

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Hi LDB,

Yes looks like we are in the same boat. I was also hoping it was just a straightforward revision, but fortunately they have got this test which can be performed in theatre to determine whether a bug is present. So they went in with both options.

It's gonna be a long six weeks but I'm just taking it day by day I guess. Trying to keep my mind busy!! Not sure what bug it is but they are busy growing the cultures to see. If it's not that dangerous then I can possibly go home and take antibiotics orally else it's this three step approach to really flush it out.

Frankly can't wait for my new knee, cant do much with this temporary one. My physio freaks out if I attempt too much.

Yeah I am relatively young, but I'll cross the new revision bridge when I get there. Let's get better now!! Hey maybe in 20 years they are able to grow or 3D print a knee from your own cells

Big hugs, stay well on this journey and I'll keep you posted of progress!!
 
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LDB63

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Kurt,

you don't have your knee? Wow... so they are going to do a 2 stage revision... they kept my knew knee in. They're just treating the infection... I would have felt better with a new one on order. Do the 2 stage revision to clean out all infection... I still may insist. That seems to be the best prognosis.

My surgeon went on vacation the day after my surgery. UGH. My next appointment is on
Tuesday... I want to have an opportunity to really hash out my options. I'm not so settled
with the antibiotic only option....

OK... good to hear your story... That I'm not alone! lol...
 

bland9

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since I had my knee done late April this year- my leg is continuously swollen no respite and continuous pain and still using crutches and waiting for a second opinion- must admit I am concerned about another surgery because my surgeon said I may lose my knee,
 

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