Knee Infection* Persistent Infection<

[iggyw1]

Had a total revision on my right knee on Sept 24. Original knee replacement was on Jan. 28, 2018. Did not last long. Tore a tendon and knee prosthetic was misaligned, so went for a revision. Went very well and was doing great for two weeks, then BAM! Infection of the knee and quad muscles. Was in the hospital 10 days, and now doing I.V. treatments at home three times per day.These infusions are scheduled to end on Nov.15 "If the infection is gone" then, antibiotic pills for life thereafter. Real pain, but starting to feel a bit of recovery after one week. Therapist and nurse come to my house three times per week. Hope I improve quickly.
IGGY

 

[Cementless]

@iggyw1, do they know the cause of your infection post revision? Did they use antibiotics during and after surgery prophylacticly?

 

[SusieShoes]

Hi @iggyw1 and to BoneSmart. You’ve certainly had a bumpy trip so far. It sounds like you are in good hands and receiving good care for your infection. Just sorry you have to deal with something like this!

I’ll tag @KarriB to help advise you. She’s dealt with a TKR infection.

Here’s some reading to guide you while in recovery. The links lead to short articles filled with good advice and helpful tips. And of course we are here to help however we can, so feel free to ask questions or share concerns.

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
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

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

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.

 

[KarriB]

An infection is a real pain! Mine came on a little later than yours, at 4 weeks with a high fever and seeping. A revision specialist did a washout/spacer exchange and I spent 11 days in the hospital, so I totally understand. PICC line went in for the antibiotics, but I also took oral rifampin. My OS didn’t want me bending my knee at all for 2 weeks to allow the soft tissue time to heal because he said it was “very compromised”. Two weeks grew into 4 because the seeping started again after the staples came out.

But, 6 weeks after infection surgery I had non-aggressive PT and 8 weeks post op I was able to get a full rotation on a bike. There is life after an infection! Recovery might take a little longer and later I found walking was the best way to build strength in my leg, but even with lifetime antibiotics (me too) I’m loving life!

Please tell us the dates of your TKR, revision and washout so we can add to your signature. What type of therapy are you doing?

 

[iggyw1]

I was in the hospital for 10 days as well when they discovered my infection. I do not know the cause of the infection, and even my doctor is at a loss for why I contacted this thing, however, it is there.

I had a immobilizer on too for two weeks now (10 days in hospital and a week at home) to keep my leg perfectly straight. What a relief it was to get that thing removed today, 10-16-18. Dr. also placed a wound vac on my incision. It was still draining this morning, but quite a bit less than the past two days. The vac filter is good for a week then he will replace the filter OR remove the wound vac completely, of course dependent on the wound condition at the time. He will also be removing the staples a week from today.

Tonight I am sliding my foot back and forth slowly on the floor to bend the knee slightly then straighten it back out. Dr told me to do this but not to over do it, just a few reps at a time and not to bend it too much. My in home therapist comes in on Mon, Wed., and Fri so we will start on more bending exercises tomorrow.

Dr told me that if it starts to hurt, to tell the therapist to back off a little. He does not want me to try to get well overnight. He said to take it slow and easy.

The nurse comes just to take my vitals and change my dressing. But with the wound vac, she does not need to change that. Dr will do that next Tuesday. She still has to change my PICC line and connections and such every week. I am scheduled to come off the home IV treatments on November 15. Hope I am ready to do so at that time.

Feeling MUCH better tonight by just getting that darn brace off my leg and able to bend the knee a bit. Looks like about a 45 degree bend I am doing and I have an ice cooler that circulates the ice water around my knee and that is a great help! Could not use it with the brace on the past two weeks.

 

[sistersinhim]

Hello @iggyw1. Welcome to Bonesmart. I can relate to being immobilized for 6-8 weeks and unable to bend my knees at all. It certainly wasn't fun. Thank God that thing is off of you now! The ice water circulator is wonderful! The first month or so I kept my on my knee the whole time I was sitting or laying down. I even slept with it on all night. I'd have to 're-ice' it in the middle of the night, but I would put it right back on. As long as the water was really cold, I had low pain. Once the ice ran out, I'd start to hurt. Ice is a wonderful pain killer!

 

[Josephine]

I do not know the cause of the infection, and even my doctor is at a loss for why I contacted this thing

To be perfectly frank, iggy, NOBODY knows why these infections occur. There are lots of theories but nobody knows for sure. The one thing we do know is that it's not 'caught' like a cold or flu! Read these to learn more
Peri-prosthetic infection - also known as late onset infection

Peri-prosthetic infection: study by the Mayo Clinic concerning prophylactic antibiotics (Scientific Articles)
Periprosthetic infection: Mayo Clinic study shows that dental procedures are not a risk factor (Scientific Articles)
Periprosthetic infection (Scientific Articles)
Peri-prosthetic infection: study by the Mayo Clinic concerning prophylactic antibiotics (Scientific Articles)

 

[MathProf]

It sounds like you have a doctor who agrees with the BoneSmart way of PT. My 3rd PT was very good at not forcing things and I think I had a much better recovery after the revision than I did after the initial TKR of my left knee. As to the antibiotics, I have been on them since June (first vancomycin, then daptomycin, and now doxycycline). I am taking the Florastor brand probiotic (2 per day - sort of pricey) and eating a yogurt everyday. This has helped my tummy a lot, so if you start to have issues I would recommend that. I spoke with a nurse (from my insurance company) yesterday, who was surprised I had been on an antibiotic for 6 months (this was a first-time conversation) and she was worried about C-diff, and that is something to be aware of.

 

[arizonaone]

I agree with math prof. I too took florestor ( yes pricey) but that is the one my ID recommended and I think that’s because you can take it with antibiotics. And from what I understand not every probiotic can be. I also ate at least a yogurt a day. The only yogurt I could stomach is Siggy’s vanilla. It Skyr style and is high in protein and low in sugar. So it’s not sweet at all. Thought I would mention that in case, like me, you’re not a yogurt eater.

A couple of weeks into my IV antibiotics they thought I had c-diff. Tested me and thankfully I did not. But it is a real concern.

My dr had also told me they have no idea where my infection cane from. And as Josephine says no one knows why either.

Hang in there. I know it’s not fun but you will get through it. We all have

 

[iggyw1]

Hello,

Long story short I hope. I had a TKR on my right knee in Jan. of 2018. In Sept., I had a total revision of the same knee. Late Sept., I contacted a serious infection in the right knee. Spent 10 days in a hospital, had anti-biotic beads put into leg, and had I.V. anti-biotic treatments at home, and I am still on these I.V. treatments at home as of this date 11-10-18. (Every 8 hrs.)

I have two holes in my incision area that just will not heal up. They are still oozing some drainage, but not much at all. A regular bandaide will hold up for 12 hours. Every twelve hours, I am taking a Q-tip with peroxide on it to "clean out" the two holes per my Drs. orders. ( a separate clean Q-tip in each hole) I am getting no blood on the Q-tip, but some yellowish fluid, but again, not much at all.

My ortho doctor wants to see me on Tuesday of next week, and he will determine if he needs to go back in and "wash" the infection out again. This would be my fourth surgery on this knee this year. Has anyone else here gone thru this scenario or even worse with your TKR? I am going to ask my doctor if a stronger anti-biotic would work, or maybe an oral one with the I.V. treatment may work before I need to go under the knife again.

 

[Pumpkin]

@iggyw1
You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.

 

[Pumpkin]

@KarriB had a similar situation, she posted to you earlier in post #4. I have tagged her, she will be around when she sees the tag.
Do you have an infection doctor (ID) in charge of your antibiotics? If not get one on board ASAP.

 

[KarriB]

As Pumpkln asked, is there an Infectious Disease Dr treating you? Have they said the type of infection you have? While my revision OS performed my washout surgery, my ID diagnosed the type of infection and prescribed the correct antibiotic by analyzing the tissue samples taken during the surgery.

I was on 2 antibiotics after the washout surgery, one oral and one IV. It still took a month for the seeping to stop, however it seeped through a closed incision. My OS was going to to go back in if the seeping hadn’t stopped after a month.

 

[iggyw1]

Hi all,

Thanks for all of your input ad encouragement to me. I started a new thread because i am almost computer illiterate and could not find my original thread. Yes, I do have an ID on board working along with my OS. She agrees with him that he might have to go back in again.

I will know more after my visit with OS on this coming Tuesday, 11-13-18. Now a new question: I am having a very difficult time standing up out of a chair after sitting even a short time. My knee that I had replaced this year hurts mo soooooo bad. After I get up standing, the pain subsides and I am able to walk with hardly any pain at all, but it is extremely painful while rising out of a chair. Could this be due to a pocket of infection in the area that hurts so bad ( Top of knee cap)??

 

[Pumpkin]

Iggyw1,
Hard to say exactly what is causing your pain. Having an infection is enough to cause pain with the swelling and inflammation that go along with an infection.
Glad to hear you have an ID on board, and they are in agreement with your OS.
Keep us posted on your Tuesday appointment.

 

[KarriB]

I had pain on standing for quite a while. It may just be lack of use since you’ve been laid up with the infection since September and once you’re using it regularly the pain might subside.

 

[iggyw1]

Thanks. Currently, I am cleaning two holes in my knee with a Q-tip and peroxide as my OS advised me to do. I am actually getting little pieces of what looks like pus (not soft but more of a consistency of what comes out of a white head when squeezed. (sorry about the gross discription, but that is what I see). It is just little tiny pieces of this matter, but I do not think this is suppose to be in there. Is it possible this matter is from the antibiotic beads the OS put in during my last washout? That was about 5 weeks ago and I would think that stuff is gone by now. The two holes are just big enough for the Q-tip to fit into, and the Q-tip goes in past the cotton swab at the end, maybe 3/8 of an inch or a bit less??

I cannot wait until I see my OS on Tuesday, even though I am fearing that he will put me back into the operating room, but I want this over! I will post when I can after I see my OS on Tuesday. The last time he sent me to the O.R. was directly from his office and I would not have been able to reply or comment for 11 days. I am really hoping that I do not need the immobilizer again this time.

 

[Jockette]

I’m sorry you’re dealing with this. You’re in all our thoughts!

 

[KarriB]

I totally understand the feeling of being sent to the hospital/OR directly from the dr office. Do you think he might aspirate and send the fluid for analysis? The dr who was in the office when I went in due to the seeping (like a stream) was planning on aspirating until he actually saw my knee seeping.

 

[iggyw1]

I saw my OS today, and I will be going in for surgery tomorrow morning. I have been on anti-biotics I.V. Treatment for 5 weeks now. Numbers were looking good then all of a sudden went bad on the white cells. Doctor said he needs to open leg up, put anti infection beads in leg, then back on the I.V. for several more weeks.

He also said that he is going to do his best to save the prosthetic that is currently in place in my leg (this is the second one that was put in) and he said it may turn out that if this proceedure does not work, he may have to remove my knee entirely for two or three months and put a spacer in its place with bone cement, and wash and clean it out periodically until the infection is gone completely and then replace the knee at a later date.

Has anyone ever heard of this/ (removing the entire knee and do not replace it for a few months??)