Knee Infection* Permanent spacer?

[zdclimber]

Also, since PT isn’t helping, maybe consider stopping that. Sometimes the more PT we do, the more we maintain upset tissues. Maybe yours need to time to calm down.

I'd echo this. I also have a Patellofemoral PKR and my recovery has been quite good so far. However, every time I started doing some strengthening exercise (because I though it'd help me recover faster), I ended up upsetting my surgical knee and was forced to stop doing it a few days later. For me, just walking and biking worked really well.

 

[archie]

@archie So sorry you are still having issues with your knees so long after recovery, the stabbing pain sounds like Zingers, these I still get on my knee that was operated on in 2019, healing of the nerves is still ongoing. However your level of pain doesn't sound good at all, would you not think of getting a second opinion from a completely different doctor, one that isn't familiar with you, a new set of eyes to give their expert opinion and see why you are still having this level of discomfort.

Thanks so much for your advice. I am in Canada and our health system is such that I would have to remove myself from being a patient of my present OS and be put on a waiting list for another (either someone I request or a random available surgeon). This is a big decision (certainly one I am considering) as once I leave my present surgeon it will be a LONG wait, especially during Covid, before I see another. I think your advice is sound’ though, and after 2 unsuccessful results, I think I must. Any idea what they might suggest options if indeed it is nerve pain?

 

[archie]

@archie I have to agree with Sara61 , it really does sound like nerve pain, extremely sharp and sudden pain that comes and goes quickly- it can be very debilitating. Can you go to your GP and discuss this issue with them or possibly go to a different OS for a second opinion?
I am currently suffering with nerve pain just over 3 months after LTKR, in my case it is causing buckling, increased all round in pain levels and of course those zingers. I got a lot more help from my GP than from my OS and was prescribed medication to help with this.

Thanks so much for your advice. I think another surgeon might be wise. Also will discuss with my GO.

 

[archie]

I think a second opinion is a very good idea. Zingers are one thing, not being able to walk well due to pain is another. I also have a Patellofemoral. It’s been 4 years and I’m not happy with it at all. I will admit, though, 2 second opinions have not found a cause for my discomfort, so I am just making the best of it.

Also, since PT isn’t helping, maybe consider stopping that. Sometimes the more PT we do, the more we maintain upset tissues. Maybe yours need to time to calm down.

I appreciate your sound advice and have booked a visit with my GP. I will discuss getting on another OS waiting list.

 

[Jockette]

I hope you find an answer and help. It is so disappointing when we don’t get the outcome we were expecting. Let us know how things go.

 

[archie]

Saw my OS last week. No x-rays, just a discussion. Didn’t watch me walk nor touch my knee. Offered me an anthroscopy to see if maybe bits of meniscus or other tissue floating about and causing my pain in both knees. I requested a second opinion and just heard back this week. I have an appointment for April 7th with a new OS from a different hospital. He was recommended by a friend who was pleased with his TKR results. Also have requested through my GP, another opinion with an OS that I researched. So hopefully something positive will come from these . Having more pain now, with walking becoming extremely difficult unless taking regular pain meds. Thinking PKR was really not the way to go and anticipating 2 more surgeries for revisions. Time will tell and I am focusing on trying to be optimistic. It’s been rough but I have lots of support from family and friends so am very fortunate.

 

[Jockette]

I’m surprised your OS didn’t take any X-rays, mine did at every post op appointment.

I’m glad you do have an appointment with a new OS, but I’m sure April seems so far away, but I guess a 2 month wait is fairly common. It’s good that you will also have another one coming up, so you can compare the two opinions. I do hope you get some good information. Please continue to keep us posted.

 

[archie]

I was actually surprised I got an appointment so soon given the major backlogs from Covid. I , too, was surprised no x-rays. I did have some taken in June 2021, so I guess she just went with those. Don’t know. Anyhow, looking forward to some other opinions. Thank you for your comments and wise advice. I will be sure to update after my appointment. BTW, do you know of many people who have had success using prolotherapy after a knee replacement? I was thinking of giving it a go. Depends on what I hear at my next appointment with new OS.

 

[Jaycey]

BTW, do you know of many people who have had success using prolotherapy after a knee replacement?

Who suggested this treatment for you? I'm afraid it would not be something I would consider post PKR.

 

[Sara61]

Prolotherapy - I would be cautious with these injections, as they can cause severe interior swelling and if not performed by a physician whom is wholly trained in the procedure, can do more harm than good, I think if I'm not mistaken, they are more for joint injuries, as opposed to replacements.

 

[Jamie]

I also would be hesitant to use prolotherapy after a knee replacement. I don't know about Canada, but here in the US the procedure is not regulated and that would be a red flag for me. You don't want to be doing injections into a knee with metal hardware in it due to the increased risk of infection.

I would question your original surgeon's casual assessment that there might be some bits of tissue or meniscus floating around in both knees causing pain. That's an odd thing to say to me, as it would indicate he didn't do a very good job with his surgery on two knees. I think you're much better off to go with another surgeon and I'm glad you've been able get some appointments for other opinions.

PKRs are actually a very tricky surgery and many times they aren't successful. If that's the case and your surgeons recommend conversion to a full TKR, please don't be afraid to do that. Just be sure that whichever surgeon you pick does a significant number of this type of revision surgery with good success rates.

 

[archie]

I also would be hesitant to use prolotherapy after a knee replacement. I don't know about Canada, but here in the US the procedure is not regulated and that would be a red flag for me. You don't want to be doing injections into a knee with metal hardware in it due to the increased risk of infection.

I would question your original surgeon's casual assessment that there might be some bits of tissue or meniscus floating around in both knees causing pain. That's an odd thing to say to me, as it would indicate he didn't do a very good job with his surgery on two knees. I think you're much better off to go with another surgeon and I'm glad you've been able get some appointments for other opinions.

PKRs are actually a very tricky surgery and many times they aren't successful. If that's the case and your surgeons recommend conversion to a full TKR, please don't be afraid to do that. Just be sure that whichever surgeon you pick does a significant number of this type of revision surgery with good success rates.

Thank you very much for your advice. I really appreciate it and will report back after my second opinion. Cheers!

 

[archie]

Prolotherapy - I would be cautious with these injections, as they can cause severe interior swelling and if not performed by a physician whom is wholly trained in the procedure, can do more harm than good, I think if I'm not mistaken, they are more for joint injuries, as opposed to replacements.

Thanks very much for your comment. I will discuss prolotherapy with my GP but have a feeling he will recommend a pass. Seems too dangerous given what my knees have been through already.

 

[archie]

BTW, do you know of many people who have had success using prolotherapy after a knee replacement?

Who suggested this treatment for you? I'm afraid it would not be something I would consider post PKR.

No one suggested it. I have just been rather desperate to get some improvement and looked into options on my own. I think, however, that I will not proceed as it just seems too risky. Don’t want to cause more harm then good. My sincere ‘thanks’ for your reply.

 

[archie]

Was fortunate and got in to see another OS sooner than expected. He has an amazing reputation and is a revision specialist. I did my homework and asked specifically for a referral to him. He noted my disabled state, offered cortisone shots for both knees, sent me for blood work to rule out infection, remarked on progression ( although not severe) of osteoarthritis as seen in the x-rays he ordered, also commented on the high revision rate for patellofemoral replacements stating this is why he doesn’t do them. I am signed up for revision to TKR for both knees at 3 month intervals. Due to Covid, I will have a wait time of anywhere between 6 months to 2 years before first surgery. I am getting my head around more surgery and am started to feel grateful and optimistic that I may finally return to my ‘normal’ self. I know I won’t be 100%, but I am hopeful that I will be much improved.
Original surgeon, wasn’t too concerned with my ongoing discussions of pain, the fact that I felt I was losing ground and that I had trouble walking. On my final appointment with her, to sign off on my last surgery, she didn’t take x-rays, no blood work, wouldn’t consider cortisone shots because she felt infection was too risky a possibility, never touched my knee nor even look at it, and continued to stress that physio was what was needed to improve my function. This was after 2 1/2 years of physio which began 4 months before first surgery. So, not the best doctor upon reflection.
Oh well, live and learn. Onward and upward!

 

[Jockette]

also commented on the high revision rate for patellofemoral replacements stating this is why he doesn’t do them.

This is interesting. I asked my second second opinion surgeon if he does Patellofemoral replacements and he said no. He said surgeons are on the fence about it.

I sure wish my surgeon had been honest and open about the success rate for this surgery and how many he had done, I now suspect he hasn’t done very many.

I hope your revision goes really well for you!

 

[archie]

Thanks, Jockette. Had another appointment today to discuss my blood work taken last week. Seems I have a few markers that could indicate infection. Sigh. Doctor tried to aspirate fluid from both knees, in order to grow a culture, but knees were dry, probably due to cortisone received last week. When that wears off, he will try again. If infection is present, then surgery is moved up to deal with it. No point in worrying until results are obtained. Furious with first surgeon who didn’t test for infection after all my complaints of increasing pain. Hoping the elevated markers are a result of returning osteoarthritis, but who knows. In the meantime, I feel well and will just enjoy that.

 

[Jockette]

I hope it’s not infection, but if it is, they can take care of it, it’s just a longer haul. My second second opinion did order blood work for me and that came out fine, and I was almost 2 years post op at the time.

I bet it was painful trying to get fluid from your knee with no fluid to get.

 

[archie]

Just a wee update. Doctors were able to aspirate knee fluid, from left knee only, on March 30th and it was sent for culture growth. I see the surgeon on May 4th to discuss results and next steps. Walking is extremely difficult these days, but I am able to do floor exercises quite well and will continue these with hopes of keeping legs as strong as possible. Really hoping this is just osteoarthritis progression. Fingers are crossed!

 

[Jockette]

I’m glad they finally got a culture, I hope it’s not infected.