Knee Infection* Next step???

[Hopefordad]

Hi all! I am writing to see if anyone has gone through what my dad has for the past 13 months with his TKR. A little history... when all this began my father was a very active 77-year-old man who does have Parkinson's Disease. I am trying to research and get answers to help him get his life back!

On 3/8/22 my father went in for TKR. Everything seemed fine until 4/13/22 when he began running a fever and his leg was very red. Admitted to the hospital with MERSA/SEPSIS also found out a suture was left in was put on IV Vanco for 8 weeks. Dr. also did an I & D (incision and drainage). Left the hospital and went to rehab, we thought all was going well. On 7/13/22 another infection. Dr performed another I & D and sent home the same day.

Still showing signs of infection knee is very discolored. The general doctor requested an indium scan. Results showed infection all over the prosthesis. On 8/9/22 prosthesis was removed, a spacer was put in, and cultures showed signs of MRSA again. Put on Vanco. On 8/30/22 he develops cdiff. Scheduled an appointment with infectious dis. 9/27 going in for a second revision. The doctor left the wound opened. C-Diff again....10/12/22 finally request to be transferred to a different hospital as the care in the one he was in was a nightmare.

10/24/22 transferred to another hospital, Drs. here worked as a team, they took the implant out once again, and did a flap, skin graph, and cement spacer with rods. 11/11/22 moved to a rehab facility. 12/23/22 discharged to home!!! 2/15/23 signs of infection again!! 6 weeks Vanco again! 3/13/23 back home. 4/7/23 became sepsis went to ER discharged the next day. OS said he will see him this week! The doctor called and said the options are to put another spacer in and see if they can get rid of the infection or possibly amputation.

We have such mixed feelings and do not know which route to go! We just want dad to get a life back, somewhat!

 

[trinket]

My goodness. How terrible for your father. I hope you find some answers.

 

[sistersinhim]

What a horrible experience you and your father have been through. I pray you can find a successful cure for your dad.

 

[Jamie]

This is a terrible situation and I share your anxiety about your father. Let me do a little checking into your situation and see if I can make a recommendation that will help you. Don't agree to amputation until you have exhausted all other options!

In the meantime, can you tell me the names of the surgeons you have seen or been working with at all steps of this? That will help me in my search of who may be available to help you.

 

[Jamie]

Depending on who your father has been working with (doctors and hospitals), I may be able to help get you to someone new who may have different options for you. But it is critical that I know who he's seen so far. As soon as you provide that, I'll get back with you. I'm so sorry for you both. This is definitely not a common thing to happen. On the surface reading your dad's history, it does seem like he was hurried through the revisions. Normally when an infection occurs, the implant is removed pretty quickly and replaced with an antibiotic spacer. This is left in place until the infectious disease doctor and surgeon are assured (by frequent testing) that there is no longer any danger of reinfection. It doesn't seem like that occurred from what you wrote.

I hope you can respond soon and we can offer some references for you. The good news is your location in New York. There are a number of options there who may be able to help.

 

[Jamie]

One other question regarding the C-diff infection....has anyone recommended that your father start on some really good pro-biotics?

 

[Hopefordad]

3/8/22 RTKR performed by Dr. Billings in the Villages, Florida
4/13/22 - removal of undissolved suture Dr. Billings
4/16/22- Dr. Billings I & D
7/13/22- I & D #2 Dr. Billings
8/9/22 Removal of Right Knee Replacement with articulating cement spacer- Dr. Billings
9/27/22- Revision Dr. Biilings
10/13/22- Transferred to Shands Hospital, Gainseville, Florida, under the care of Dr. Deen OS, Dr Ritter Infectious Disease
10/31/22- Dr. Deen removal of second Right knee replacement with static spacer. Dr Chim performed plastic surgery with flap and graft.

He is currently under the care of Dr. Deen.

And with the C-diff yes, he has been on probiotics since the onset also was 6 weeks of iv vanco and oral vanco.

 

[sistersinhim]

I'm glad you have an infectious disease doctor on your dad's case now. This should have been recommended by Dr. Billings right from the start. I pray your dad sees improvement soon.

 

[Greybiker]

I’m surprised that they are treating the infection with only vancomycin. MRSA bacteria put down biofilms to protect themselves from antiobiotics.

My infectious disease doctors at UCSF used Rifampin in conjunction with Vancomycin. Rifampin breaks down biofilms. Knock wood - this treatment protocol worked for me.

Role of Rifampin against Staphylococcal Biofilm Infections In Vitro, in Animal Models, and in Orthopedic-Device-Related Infections - PubMed

Rifampin has been used as an agent in combination therapy in orthopedic device-related infections (ODRI) for almost three decades. The aim of this review is to provide data regarding the role of rifampin against biofilm infection <i>in vitro</i>, in animal models, and in clinical ODRI. Available...

pubmed.ncbi.nlm.nih.gov

 

[Flashlight]

I feel so bad about what happened to your Dad. I know it must be difficult and frustrating for you not living close by. Is your Mom with your Dad? My daughter when she was in college got MRSA on her face close to her eye. They think it was from an exercise mat at the gym. I know this wasn't as serious as what is happening to your Dad. The antibiotics and Flagyl side effects were terrible. Her MRSA bacteria did lie dormant for about 6-months then reappeared on another part of her body, but it wasn't as bad, so she was able to take bactrim. With the probiotic I gave her yogurt with each meal. I learned that probiotics should be started a couple days before antibiotics but there wasn't any time to do this. I hope your Dad's c-diff has resolved so he can get stronger, and I know Jamie will help you find a doctor to put the correct spacer in. Best wishes to you and your Dad.

 

[Hopefordad]

Thank you all for the information thoughts and prayers!! I am looking into everything you have suggested and making a list of notes for the Doctors!!

 

[Greybiker]

Thank you all for the information thoughts and prayers!! I am looking into everything you have suggested and making a list of notes for the Doctors!!

When you see the doctors maybe a printed copy of the Rifampin study would help.

Best of luck to you and your dad.

 

[HaylingIslander]

So sorry to hear of your Dad's troubles. I cannot add anything professional here. Just that my Mum's neighbour's twin brother went through this. I belive it took about 18months,there was talk about amputation at one point, but all persevered, MRSA was eventually cleared and all is good now.

Wishing you and Dad all the very best.