Knee Infection* Reality Check

Greybiker

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Hi Everyone. I’ve done a lot of reading here and have learned a lot. I’d like to share my situation and ask for your thoughts on my progress. Hopefully this isn’t too long.

I had a RTKR done in 2014. The surgery was uneventful but I ended up with pain in the knee and learned to accept that as my new norm. X-rays showed that all was well until I had a recheck done in November 2022. They found a bone ‘spur’ had grown onto the side of my patella. My surgeon referred me to a colleague who does arthroscopic surgery with the goal of fixing this as least invasive as possible.

I had the arthroscopic surgery done in December. The ossification and much scar tissue was removed. The arthroscopy resulted in an incision about 3” long. The wound drained significantly from day one and continued to do so for about a week. At 10 days when I had my post-op visit the drainage had stopped and I was cleared to resume normal activity. That evening I walked around the block and got home with my foot wet from drainage. I reported this to my doctor and he advised rest and bandage changes daily.

The draining continued and I was finally able to get in to be seen. My doctor said the incision was almost healed and applied steri-strips. The drainage continued requiring daily dressing changes. Meanwhile my pain was increasing and the knee felt warm to the touch. I was seen in another office visit and was told it looked good. The PA refused to do an aspiration,without a CBC. The CBC that evening showed highly elevated WBC’s. The next day they finally did an aspiration and found an active infection. This is at 5 weeks post op.

The arthroscopy surgeon consulted with my original orthopedic surgeon. That night my OS called and scheduled emergency surgery for the following morning. He felt my infection could still be classified as early onset and recommended a 1 step approach with debridement and liner replacement. Infectious disease concurred so we agreed and had the surgery the next morning.

He found an active infection and a hole in my joint capsule. The culture identified staph epi. I was hospitalized for 6 days receiving vancomycin and rifampin. The sensitivities confirmed this drug combination was effective and I was discharged. At home I did twice daily infusions of vancomycin and rifampin orally. This went on for 2 weeks and I was moved to ciprofloxacin and rifampin. Both are oral meds so my picc line was removed. My labs are now almost normal with an elevated CRP but coming down and WBC’s normal.

I am now at 4 1/2 weeks post op and will start outpatient PT tomorrow. I’ve been walking some with and without my walking stick. Pain is varied between 4-8 and is managed with Tylenol and Tramadol occasionally. My therapist is the same one I worked with 8 years ago and he is conservative and highly skilled.

Does this sound like I’m progressing well given the history. Any words of wisdom are appreciated and welcome.
 
Hello Greybiker and Welcome to BoneSmart. Thanks for joining us.
I am sorry for all you've been through. Thankfully you're on the mend.

In an effort to create a signature for you that reflects your procedures and how far removed you are from each, we ask that you provide exact dates for the arthroscopic surgery in December and the month and date for the latest, debridement and liner replacement. This info will be helpful for those stopping by to read and comment.

It does seem you're progressing well given the circumstances and I certainly hope Physical Therapy doesn't change that for you, stalling your recovery. Please go very slow taking great care not to engage in anything painful or do anything you're uncomfortable with.

Best Wishes for complete healing without complication. Please stay in touch and share your progress with us. We'd love to support you along the way.
@Greybiker
 
Hello @Greybiker. Welcome to Bonesmart. Please tell us the date of your infection surgery and I'll add it to your signature for you.

It's good it hear that your infection has been cleared up. It sounds like you are doing well for 4 1/2 weeks out. Ice and elevation is your best friend for a while. They two together can bring you good pain relief.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

KNEE RECOVERY 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

6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital

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.

Try out our great new opportunity to improve your gait. It's OneStep. It's free and you will find it to be a huge help to you. Click here: OneStep
 
Thank you both for the encouragement. I forgot to mention that my knee is still warm to the touch. My OS tells me this is inflammation from the clean out. It must have been quite a procedure. In his op-notes he talks about cleaning the back of the knee. They changed all instruments and gloves plus irrigating with 9 liters. Hopefully this eliminated all biofilm.

My exact surgery dates are:

December 5, 2022 - arthroscopy for ossification and scar tissue
January 13, 2023 - debridement and liner exchange
 
Thank you for the information, Greybiker. I added the dates to your signature.
I have read of warmth weeks out from surgery, you're not the first.
We've also followed many success stories here after infection was discovered. My wish is that you join the ranks of all that successfully battled this complication and move forward with perfect healing.
I hope you have a nice week!
@Greybiker
 
I had my first round of PT yesterday and it went well. He measured ROM at 125 and 8 degrees and was pleased. I got a new set of exercises for home and rode the stationary bike without resistance. The ice and stim at the end sure felt good. The current plan is once a week for 6 weeks but I question if that is enough. It maybe an insurance restriction?
 
The current plan is once a week for 6 weeks but I question if that is enough.
Yes, it is enough.

Regaining our ROM does not require forceful bending or painful exercises.
Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 
Hi Greybiker :wave:
It's been two months since your procedure and about a month since we last heard from you.
How are you doing? Hopefully all is well and your looking forward to a great Spring / Summer 2023.
Take good care!
@Greybiker
 
Hi Layla,

I just noticed your message and yes I’m doing better. I’m now at 10 weeks post-op. Yesterday at PT my ROM measured 140/3. I’ve been working on strengthening with the stationary bike, leg presses and curls. Walking is now up to about 1 mile with lots of hills where I live. Our house has several flights of stairs too.

My schedule with working out has been one day on and one day off. This is to manage pain as I only use Tylenol. I’m doing labs every 4 weeks and the one last week showed normal WBC levels as well as the CRP.

I fully attribute my success and progress to working towards a healthy outcome and not waiting for it to happen on it’s own. I’ve read some real horror stories hear with cries of desperation and wanted to post something positive. I hope it will inspire others.

Cheers!
 
You are doing really well and it's great to read of a good outcome!
 
I’m doing labs every 4 weeks and the one last week showed normal WBC levels as well as the CRP
You sound like you are doing great. Your ROM is great too.
The CRP is very sensitive to inflammation and infection. I had septicaemia a few weeks back and mine went up to 250 but is back under one now. Its a really good marker that all is well if it is normal.
 
I’ve read some real horror stories hear with cries of desperation and wanted to post something positive. I hope it will inspire others.
I hope you continue to enjoy steady progress. Thanks for sharing inspirational news.
Four months to date since your procedure. Happy Anniversary!
 

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