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Knee Infection* Need advice - knee infection

barefoot14

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First, my 77 year old husband has been thru hell the past 2.5 years, starting with aortic valve replacement, then last year abdominal aortic aneurysm surgery, and two months ago 11" incisional hernia surgery from the AAA surgery. Also had lower inguinal surgery in October which has failed and now pain in colon.

Last week his 15 year old knee replacement swelled up, was red and painful. He had been hospitalized in February with staph infection in fluid buildup in abdomen from that surgery.

Evidently the staph traveled to his knee. He couldn't walk. Was in ER twice last week before they finally woke up and figured out what the problem was.

He has been in local small hospital on IV since Thursday. Now they are talking about transferring him to Jordan Young Institute in Norfolk to get the knee out.

Due to coronavirus, I am not allowed to see him. We are talking by phone and email.

He is scared to death. I need advice as to what life will be like after he has the implant removed and before he can get a new knee.

I have a really bad back and can't lift. We live in middle of nowhere with a few neighbors to help and no family. I am thinking about having our guest shower ripped out and have a wheelchair accessible shower with sloping drain. We have electric lift recliner, shower stool, bedside toilet, crutches (which he has no strength to use.) What else can I do????
 

Pumpkln

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@barefoot14,
:welome:
Welcome to BoneSmart, glad you joined us, so sorry to hear of the difficult position you and your husband are facing. :console2:

Here is a link in our Library for additional information Knee infection: what happens when a knee becomes infected?

He should have an infection doctor (ID) involved in his case, and a wound care specialist.
You will need to ask the following questions:
Will he be able to come home after the implant is removed?
What will I need at home, and what will the hospital/our health insurance provide.
Medicare usually will pay for supplies issued at the hospital. After you go home you have to pay. Get everything you can before discharge.
How will antibiotics be administered at home?
Who will administer the antibiotics, and can I be trained to administer the antibiotics?
Will he receive a PIC line?

What should happen, is the implant will be removed, a temporary spacer infused with antibiotics will be placed to maintain the joint space, and should allow some weight bearing. He should receive PT and OT in the hospital to work with mobility, bathing, toileting, dressing. Assume he is on Medicare, they will send him home with what ever assistive device he can use to maintain weight bearing. They will also be able to help with transfer in and out of what ever he will need to do at home.

All the best to you and your husband, keep us posted on how you are doing.
 
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Celle

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Hi @barefoot14 - I'm really sorry this has happened to you both. :console2:

As Pumpkln said, your husband needs an Infection Doctor and probably a wound care specialist on his team, as well as a surgeon who is skilled in doing knee revisions. In view of that, it would be best for him if he is moved to a larger hospital, where they have these people on staff.

Recovery from a knee infection can be a lengthy process but it is almost always successful.
Make sure you take care of yourself as well.

By the way, I've moved your thread to the Knee Surgery Recovery area, since your husband has had a knee replacement.

There are other people here who have had knee joint infections. If you feel like reading some of their stories, click on the red prefix that says "Knee Infection" and a list of threads will come up.
 

sistersinhim

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I am from your area and have heard of the Jordan Young institute. My SIL had two replacements there and is very happy with them. But, I'm afraid I have to agree with the others, that your husband will need much more specialized services than what they can provide there. Research and find an infection specialist and a revision specialist that deals with problem knees.

I pray you find what your husband needs.
 

Kenello

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My husband had a revision with an antibiotic-laced spacer in place for 3 months. He had a pic line, and we could manage administering antibiotics at home with the pic line. We would periodically go in to a clinic to be sure the pic line didn't move and to get more antibiotics. Although the spacer allowed him to bend his leg, and it was ok to put some weight on it, it sounds like your husband will need a wheelchair or scooter. His surgery for the knee after the spacer went well. No more infection, very functional knee, and its been 8 years. Get as much home health care from visiting nurses, and use them to get supplies, and figure out how to make everything work. It must be so difficult being apart right now! Best Wishes for a great outcome!
 
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barefoot14

barefoot14

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UPDATE: Jordan Young Institute refused to be involved because even though they had done Jim's shoulder surgery 5 years ago, they were not taking "new" patients. I escalated this and got nowhere. He is at Sentara Leigh Hospital in Norfolk and his orthopedic surgeon was "on call" with Atlantic Orthopedics, Dr. Balsamo, who per the internet has an excellent reputation. I have had no communication at all from the surgeon and I keep calling the nurse's station to get reports but they are minimal. Today I received a voicemail that he was in the recovery room, I didn't even know he was having surgery! The orthopedist decided to take a less invasive route, he replace the plastic around the metal after cleaning well, put in some antibiotic beads (this is according to my doped up husband) and he is on IV antibiotics and will come home with a PIC line and have a home health nurse occasionally. They had him up walking this afternoon and working with a physical therapist. In a Facebook group, I found a woman whose husband had this same procedure and a few months later ended up having his knee removed as the staph infection would not go away. Her husband has been waiting several months for a new knee. I am afraid that due to the Coronavirus, my ability to have communication with the professionals and get the proper care has been severely restricted. I have been getting everything ready for Jim's return home, and I have no idea when that will be. I ordered a shower bench, we have a wheelchair, bedside toilet, bedpan, crutches, shower chair, walker with wheels and seat and regular walker. I ordered plastic knee and arm shower protectors. We are in a remote isolated area but have plenty of food. Our local Food Lion has not had toilet paper, water or bread for weeks, but our well water is safe to drink and we have a stash of toilet paper from our Airbnb Cottage, which has no guests. Thanks to everyone for your advice, sorry I am unable to take some of it due to the world crisis. I only wish I could!
 

steverup

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I’m so sorry to hear all you and your husband are going through! I don’t have any advise but my wife and I will certainly pray for you and him. I wish I had more to offer. I’m sure others here will have suggestion.. this place is a goldmine of info.
 

Pumpkln

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@barefoot14
Sorry to hear of all you are going through due to the corona virus. I am sure the surgeon has done the best he can given current limitations, switching the spacer, cleaning out the joint, putting in antibiotic beads, and IV antibiotics. I am happy to hear your husband is already up and walking.

Sounds like you have done a great job preparing your home for when your husband is discharged.
You are doing the best you can to get through what is going on in your world and the wider world.
Wishing the both of you all the best, keep up posted on how you are doing.
 

Jamie

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@barefoot14 .... I am so very sorry to read your story. How sad that Jordan Young Institute would not help you, but I do understand that the coronavirus problem has changed everything about the way our hospitals can respond right now.

I agree with Pumpkln that you have done a sterling job of being an advocate for your husband and preparing to have him home with you for the time being. I know you will both be relieved to be able to see each other - sometimes that's the best medicine of all.

The washout, plastic spacer exchange and antibiotic beads should work to keep things leveled out until something more can be done. In the meantime, you'll need to start the search for an excellent revision surgeon and an infectious disease doctor so that once things open back up, you have a plan to proceed. We can help with the search for a revision surgeon if you need it. You may have to drive a bit to find the right team, but it sounds like you were willing to do that. Just let me know if you need assistance for your search.
 
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barefoot14

barefoot14

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March 26 UPDATE: The surgeon finally called. He performed an "open debridement and polyethylene exchange" with irrigation of knee, removed the lining, left implant in, replaced plastic and put in dissolving antibiotic beads. The type of staph aureus Jim has is a low virulent organism, not MRSA. An infectious disease doctor is involved with antibiotic therapy. No problems with bone, good chance won't need replacement of knee if they get infection under control. May be sent home with PICC IV for several weeks. Jim is using walker and was going to physical therapy this morning. Not sure when he will be released. Whew. With all that is going on in the world, now we just have to steer clear of the Covid-19 virus. I have a question: how do I get notices that some of you have commented? I checked everything in the preferences and settings but I have to sign in to see if anyone commented. Thanks!
 

Pumpkln

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@barefoot14
On a desk top or lap top: Click on your username top right, a drop down menu will appear, click on preferences.
Where it says Content Options, click on "And receive e mail notifications". You should start receiving e mails when someone comments on your thread.

Glad you finally spoke with the surgeon.
@KarriB had the same procedure and did well, hopefully she will see the tag and be along to comment about her procedure.
My mother in law had a similar procedure for her infected hip at age 90-91, she did well and lived to be 98 1/2.

With all that is going on in the world, now we just have to steer clear of the Covid-19 virus.
We all are trying to do our part, washing our hands, staying home, social distancing, covering our sneezes and coughs, and taking care as best we can.
 
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barefoot14

barefoot14

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Thanks for all the advice! He "might" come home in two days....they installed the picc line today from elbow to heart. We will have to learn how to handle the antibiotics. He has been flushing three drainage tubes from his abdominal hernia surgery since mid-January, so I think we can handle it! I should now be able to get notices of messages posted here and be faster at responding! And as soon as he is better, back to surgery to repair October's inguinal hernia surgery that failed and is pinching his colon. I was glad to hear that his hernia surgeon stopped by to check on him today.....
 

Pumpkln

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barefoot14,
With your husband going home soon, here is a copy of our recovery guidelines for you.
Hope he can go home soon, so you two can be together.

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

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

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. At week 4 and after you should follow this

6. Access these pages on the website


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 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.
 

Celle

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Hello, @barefoot14 - It sounds as if you're doing everything you can to help your husband during thsi difficult time.
Please can you help us a little, by giving us the full dates of all his knee surgeries and which knee it is, , so we can put them in a signature for him? That way, we'll be able to refer to them each time you post, and we'll know how far along he is in his journey.

From what you've told us, I've worked out this:
Revision TKR (Wound washout, spacer exchange, insertion of antibiotic beads, PICC line) March 26, 2020
Knee infection discovered March ??, 2020
TKR 2005

Please will you add further details and correct any mistakes I've made? Thank you. :flwrysmile:
 
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barefoot14

barefoot14

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For some reason I am still not getting email notifications of posts. He had TKR fifteen years ago of left knee, was on one of those machines that keep your knee moving for several weeks and fishing at the NC coast 30 days after surgery. In Oct 2017 had aortic valve replacement with lots of complications, thought I lost him twice. Several cardioversions plus they had to re-open his chest due to internal bleeding; Feb 2019 abdominal aortic aneurysm surgery (hereditary) with very long incision, worse surgery than the heart. Afterwards developed large incisional hernia and a few small lower ab hernias. Had surgery for a lower inguinal hernia in October, it has failed and needs to be re-done, he has pain in colon. Had 11" abdominal incisional hernia surgery Jan 10, 2020 followed by lots of fluid build up which got infected. Was in the hospital on antibiotics in February and had abdomen drained. Just two weeks ago today we were about to go camping in our RV and he developed a fever. Took him to local ER as he still had one abdominal drainage tube. His knee was killing him but they ignored it, did an ultrasound to make sure he didn't have a blood clot and said he had fluid on the knee and sent him home. He walked into the ER and I had to take him out in a wheelchair!!!! The next morning I had to call ambulance as fever was higher and pain in knee worse. Took him back to ER, they put him on antibiotic and sent him home. The third day (March 18, 2020) the small hospital's orthopedist had me get a different antibiotic and asked me to bring him in first thing the next day. As he could not walk, I had to get neighbors to help. Orthopedists said the staph auarea infection in abdomen had gone to his knee replacement and that it was bad. Cardiologist was concerned it might hit his heart. They rushed him back to ER to remove the abdominal drainage tube and admitted him to hospital. I didn't even get a chance to say I love you. He was in our small local hospital two nights and the internist called, he said the two orthopedists thought surgery would be too big a strain on his heart. (They had done an antibiotic flush procedure to his knee in the meantime). The internist and the cardiologist thought he could handle it. At this point, they were talking about removing the implant and having him go without a knee for several months until the infection was gone. I couldn't see him in the hospital due to Coronavirus and was going crazy. The internist said they were sending him across the Chesapeake Bay to Norfolk Sentara and that I should come to local hospital ASAP and they would grant a special exception. So I got to see him for half an hour. Then he went to Sentara and I had no communication from anyone (he emailed me from his ipad). Several days after he was admitted, I received a phone call from a nurse in recovery saying the "surgery went well." The surgery? What surgery? I picked him up two days later and still never heard from anyone about discharge instructions, etc. We needed a small home walker as the one we have is huge, has four wheels and a seat. It won't fit between the power recliner and the potty chair. I am still waiting to see if they can order one, but in the meantime neighbors have loaned us one. The nurse was here for 1 1/2 hours today helping us learn how to manage the picc line in his elbow that goes to his heart. We have to infuse it once per day with saline, antibiotic then heparin until first week of May, cost is $200 PER WEEK not covered by Medicare/Anthem. He cannot walk, I have a bad back and neck. This is a nightmare on top of the world's nightmare. We have no children just a loving, hugging standard poodle. No family nearby so we have neighbors we have never met before helping us out. The orthopedist removed the plastic around his metal knee, cleaned it really well and put in slow-dissolving antibiotic beads. We are supposed to go back in 2 weeks. Per my internet research there is an 80% chance this procedure will work. He said the staph was not MRSA and should respond to the picc antibiotic therapy. We have been through 2.5 years of health issues and Jim is very weary of it. All I can do is take one day at a time and hope we get through this.
 

Jockette

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I am so sorry for all you are going through, both physically and emotionally. I have no advice but wanted to send a virtual hug. :console2:

I know it would be very difficult for my husband to be in a hospital and not be able to have me visit, as well as for me, not being allowed to be there with him. These are times we need our spouse the most.

I’m so glad you have caring neighbors who are helping you. And a caring, huggable poodle is a special blessing.

Please keep us posted as to how things are going. We are here to help with whatever information we can give you, and we are great with caring support. Once a member of Bonesmart, you are not alone.:console2:
 

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