Knee Infection* Permanent spacer?

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archie

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After another blood test and aspirates from both knees to compare to the original stats, it was determined that in all likelihood, I had an indolent knee infection in both knees. In other words, low grade, under-the-radar infection. Bilateral knee revision surgery was recommended.

I have been home now for almost 2 weeks and am recovering well. My first revision was done on May 30th and the second was done on June 9th. Because I was considered an emergency, I was put on a ‘walking wounded’ emergency list and was strongly encouraged to take the first available surgeon. Unfortunately, all my research and subsequent appointments with my preferred surgeon went out the window.

However, the first surgeon seemed very knowledgeable and competent and my knee is recovering well, and for my second surgery, I did luck out and actually did have the surgeon I had hoped for. He happened to be able to fit me in. So 2 weeks in hospital, 2 knees revised, and I am home.

I am managing surprisingly well for the most part. Lots of support. Today, however, I awoke with tear-inducing pain in the lateral part of my 2nd surgery knee. Almost feels like a cramp/spasm. Can’t really put too much weight on it so have returned to bed to massage and apply some heat. Hoping this is normal?

My surgeries are considered a sort of 2 stages in one surgery, in that both knees have been replaced with a spacer that is totally functional. I am unsure what differentiates it from a normal prosthesis. However, both knee prostheses were implanted with antibiotic cement and I have been told they are to be considered permanent. I couldn’t get a time frame as to what permanent might mean in terms of longevity. However, they are to move and function as a normal revision.

I am on a course of IV antibiotics for 6 weeks with a follow-up with the infectious disease team to determine whether or not to stay on oral antibiotics for a time or for my lifetime. I have yet to read up on the pros and cons of these treatments. I am wondering if anyone else has dealt with this choice?
The surgeons didn’t find much damage, thankfully, to my bones due to the infection. They were also unable to grow any sort of bacterial culture from samples taken during surgery.

While waiting for my second surgery, my unrevised knee responded well to the antibiotics, reducing swelling and pain to almost normal, and this further pointed to infection as the likely cause of my trouble.
So that’s my update. Please be vocal and persistent at your follow-up appointments if you feel something isn’t right.
 

sistersinhim

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Today, however, I awoke with tear-inducing pain in the lateral part of my 2nd surgery knee. Almost feels like a cramp/spasm. Can’t really put too much weight on it so have returned to bed to massage and apply some heat.
More than likely you moved in a way your knee didn't like in your sleep. It's not unusual to wake up with a new pain somewhere that you can't account for. But don't use heat on a newly operated on knee. It will increase the swelling. Ice would be so much better, and don't forget to elevate your knee above your heart.
 

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Bilateral knee revision surgery was recommended.

I have been home now for almost 2 weeks and am recovering well.
Did they revise your Patellofemoral to a new Patellofemoral or do you now have a TKR in each knee?

Also, which knee goes with which date? We just want your signature to be accurate.

I do hope this fixes things for you, I know you’ve been through a lot!
 
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archie

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Both Patellofemorals were revised to TKRs.
Right knee was May 30, ‘22
Left knee was June 9, ‘22
 
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archie

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Today, however, I awoke with tear-inducing pain in the lateral part of my 2nd surgery knee. Almost feels like a cramp/spasm. Can’t really put too much weight on it so have returned to bed to massage and apply some heat.
More than likely you moved in a way your knee didn't like in your sleep. It's not unusual to wake up with a new pain somewhere that you can't account for. But don't use heat on a newly operated on knee. It will increase the swelling. Ice would be so much better, and don't forget to elevate your knee above your heart.
Thank you for your advice. It is very much appreciated.
 

Jockette

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I’d like to suggest a different title: “Patellofemoral revised to TKR” :flwrysmile:
 
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archie

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I’d like to suggest a different title: “Patellofemoral revised to TKR” :flwrysmile:
Of course. This reflects more accurately what has taken place. Do you change the title, or me?
 

Jockette

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I can do it. I agree, it’s good for others to know.

I‘m still tolerating my patellofemoral, it was 5 years in March, but it doesn’t feel good. I’m just not ready to look into it any further than I already have.

I do hope this is your answer and you’ll heal well and be back to (a new) normal! :flwrysmile:
 
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archie

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I can do it. I agree, it’s good for others to know.

I‘m still tolerating my patellofemoral, it was 5 years in March, but it doesn’t feel good. I’m just not ready to look into it any further than I already have.

I do hope this is your answer and you’ll heal well and be back to (a new) normal! :flwrysmile:
Thanks so much, Jockette.
 
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archie

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Hard to believe that I am 41/2 months from my bilateral TKR revisions due to infection. I am feeling SO much better! I am going on 2 km walks every other day and although tired at the end of the walk, I have little to no pain. Occasionally, I have a sore left hip when I start on my walk, but I feel this is a tight IT band and if I massage it while walking it loosens up and the pain disappears.
I still occasionally take Tylenol if I have been on my feet for longer than 3 hours as my knees start ‘talking’ to me.
Stairs and chairs are improving. I practice sit to stands every other day and am about halfway to a normal height chair. I use folded towels to elevate the seat level to a point where I can complete the exercises. I can now stand from my raised toilet seat without grabbing onto the counter and hope to get rid of the seat within the month.

On the stairs, I can climb up step over step with a little help from the railings, sometimes just floating my hands over the railings in case I need them. Going downstairs, however, requires a firm grip on the railing while I descend using a ‘normal’ step pattern.

I can sleep now without any pain meds and I use a very small, flat pillow between my knees. Within a very short time, I won’t need the pillow.

My right leg has healed up extremely well and causes me very little discomfort. However, my left knee isn’t as good. It is substantially weaker. I do notice improvements in strength, though. I just have to be patient and work on my strengthening exercises for my quads and I feel confident I can improve. It’s just slow going at this point.

Follow-up appointments with the Infectious Disease doctor have been very promising. After 6 weeks on IV antibiotics, followed by 6 weeks of oral antibiotics I recently had blood work that indicated all normal levels. This has brought me a great sense of relief. No repeated tests have been ordered and the ID doctor says that none will be necessary unless I start having negative symptoms. I certainly know what to look for now.
So all in all, I have been blessed with a very good outcome. Whew!
 

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It's been a long road but it sounds like you are on the right track now.
 
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archie

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Has anyone received an articulating spacer as part of a permanent TKR revision done due to infection.
Because I was infected bilaterally and received revisions from 2 surgeons in the span of 10 days, I had 2 different surgical approaches. I have had great success with one knee and less so with the other. Still, both are tremendously improved as compared to pre surgery.
One knee received an articulating Prostelac spacer, that is being left in place as a permanent replacement. This is the knee that isn’t as functional as the other.
It is my understanding, that in years past, these spacers were only left in for 6-12 weeks and then replaced with a new prosthesis. My surgeon ( very highly regarded)said that patients are having success leaving these in permanently. Not sure I agree and am curious if anyone else has had this approach?
 

Jaycey

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@archie I'm sure you trust your surgeon. But I would go back to him and ask why the spacer is permanent. This is rarely done. In cases where the infection is difficult to treat, a spacer may be left in place for many months. But I can't think if a case here on BoneSmart where a spacer was left in permanently.

I've changed your thread title so that any members with experience can come and give you input.
 

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