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Knee Infection* Repeated infections!

Sienna

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I am a week out, and will need to change optifoam bandage. This knee has now been opened up four times because of past infections. I am supposed to change bandage tomorrow. I can see there is some blood beneath, and wanting know what to clean it with before putting on new optifoam on.
 

Jaycey

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@Sienna Welcome to BoneSmart! Since you have a history of infection in that knee I would recommend you see your family doctor or the nurse at that office to have them change this dressing. You are right to be concerned with keeping everything very clean in the area.

Can you give us the dates of your surgeries and which knee? We will make a signature for you.

Meanwhile here is some reading for you:
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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this Activity progression for TKRs

6. Access these pages on the website

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.
 
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Sienna

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I thought of that too, but we had a snowstorm here and I will need to do it at home. Just wanted to know what to clean the wound and stitches with before putting on new optifoam, but I think I will call the nurse at my surgeons office to see what she suggests. Thank you.
Date of surgery was 11-5-10, 2nd part of two phase tkr
 

LolaBee

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My surgeon instructed daily dressing changes. First using peroxide, then rubbing alchohol, and lastly betadine, all liberally and allowing to dry between each.

Are you on antibiotics?
 

Celle

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@Sienna, I recommend leaving the dressing alone. Phone and speak to the nurse. I'm sure it wont hurt to leave the dressing on for q few more days, and then have her change it.

I don't approve of telling people to change their own dressings, unless they've been shown the proper technique, which obviously you haven't.

Every time a dressing is changed, there is a risk of introducing infection.

@LolaBee , in spite of what your surgeon said, it's not a good idea to use all those antiseptic lotions, either. Over-use of these lotions has bred bacteria that have become resistant to them.

Most hospitals nowadays are using sterile saline solution to cleanse wounds.
 

sistersinhim

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@LolaBee , in spite of what your surgeon said, it's not a good idea to use all those antiseptic lotions, either. Over-use of these lotions has bred bacteria that have become resistant to them.
What is the best thing to use is what's up on our rotating banner at the top of the page:

1579402304230.png


I have personally used this many times and it works great! I will always use this on my wounds.
 
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efawest

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My first two week after bilateral knee replacement was spent at a skilled nursing facility. My bandages were changed daily by their wound specialist. He applied some kind of antiseptic solution. My wounds recovered ok, but if there had been any sign of an infection, they would have immediately shipped me off to the hospital ER to have it tended to.
 
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Sienna

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I have had 4 surgeries on one knee ( right) since July 2018. I don't understand why but it keeps getting infected. Latest surgery was Nov 5, 2019. Was doing great til 6 weeks post op, now all of a sudden can't wals, or put any weight at all on that leg. Thought I may have gotten out of car strange and injured myself. Had blood work done 12-23-19, surgeon called to say my crp is elevated, to come in on 12-26-19 to have fluid drawn and sent to lab. I see another surgery in my future! My question is how? How does it keep getting infected? Or Am I one of those susceptible people? Once surgery (washout and debridement this time, and again from before) he will want be to be on low dose antibiotics for the life of this prosthetic. That sounds scary to me. Any thoughts or opinions please? Sue
 
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Jaycey

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@Sienna So sorry you are struggling with infection. It's not uncommon for an infection to take awhile to leave - or indeed to have it return.

Are you working with someone in Infection Control?

If you go to our Knee Recovery forum and find a thread with a red subtitle
Screen Shot 2019-12-24 at 18.59.10.png
- click on that subtitle and you will get a list of all the threads of our members dealing with the same issues.

Meanwhile can you give me the exact dates of your surgeries. I will put the information in your signature for you.
 

Celle

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@Sienna ,
We need more details from you before we can help.
  • Please tell us the full dates of all the surgeries you had on your knee, and what was done each time.
  • When did you have your first TKR?
  • When was infection discovered?
  • What treatment did you have, and when?
  • When was the first TKR hardware removed?
  • Did you have an antibiotic spacer? For how long?
  • Did you have intravenous antibiotics? Through a PICC line? For how long?
  • Are you taking oral antibiotics?
  • Is an Infectious Diseases (ID) doctor involved in your care?
 

Celle

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By the way, I've merged your two threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this one thread. Don't worry that we won't see your new questions as, between us, the staff read all new posts every day.

If you would like a new thread title, just post what you would like it to be and we'll change it for you
 
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Sienna

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1st surgery- July 31, 2018
Aug 31, 2018-stitches removed, surgeon said everything looked ok.
Nov 4, 2018- back to work

2nd surgery-Jan 6, 2019- infection found, did washout, debridement, and new antibiotic loaded spacers. Sent home on oral antibiotics, Rifampin, and IV antibiotics for 6 weeks, Cefazolin.
Feb 6, 2019- bad virus, fever, uncontrollable shaking, could not get warm
Saw primary doctor, she sent me to Univ of Mich emergency, from there, I was sent to St. Joe 10th floor, which is a floor that both U of M doctors and St. Joe doctors can see patients. Was taken by ambulance. They at first thought I had some kind of infection with the PICC line, or was septic or had MRSA. It was none of these, but it scared the hell outta me! I was on too many antibiotics, apparently. So in the hospital, I was put on IV Daptocin, got me better, sent me home on 2-12-19, finished my 2 weeks of iv antibiotic, Cefazolin, and picc removed on 2-19-19.
Started oral Keflex on 2-20-19, stopped on 7-2-19, started Keflex again on 7-5-19.

3rd surgery 2 stage-7-15-19 - removed knee prosthetic, put temp knee in. Sent home with PICC line again, to do 6 weeks IV antibiotics, Cefazolin, no oral this time. PICC removed 8-26-19. Did bloodworm, was infection free. Put new prosthetic knee in on Nov 15, 2019. That was surgery #4.
Was doing okay, had stitches out late November, 2019. Went for one month follow up, not walking well, actually hurt to walk. Drew out some fluid, it was infected again. That was Dec 23, 2019.

Surgery 5- 12-27-19. Did another washout and debridement, new antibiotic loaded spacers. Sent home with IV antibiotics for third time. Was told after this 6 weeks of IV antibiotics, I will need to be on oral antibiotics for the life of the prosthetic! Scary! I don't feel safe being on antibiotics for years at a time! Read about some new infection intervention at Massachusetts General hospital, but still in testing phase. Another study is where they find a way to remove the biofilm that causes the infection. Something I might need to ride my prosthetic of infection for good!
 
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Sienna

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A year and a half of this, and being in constant pain, and being under anesthesia for each surgery, 5 times in a year and a half, can't be good for me. I am really hoping for a
CURE for this!!
 

Jockette

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. I am really hoping for a
CURE for this!!
I sure hope they find the right medication to cure these infections for good. I’m sorry you’ve been through so much. :console2:
 
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Sienna

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Shouldn't the pain be lessening after 3 weeks? I am using a walker in the house and when I go out, but I think I should be getting to a point where it would start to feel better. Not taking oxycodone, it does weird stuff to
Me.
 

Celle

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@Sienna , thank you for your surgical history. I've done the best I can with your signature, but some things have me puzzled.

The usual course of action with an infected knee replacement joint is to sometimes try a washout and debridement and, if that doesn't work, to remove the metal hardware and insert an antibiotic spacer. That's a solid spacer that is impregnated with antibiotics.
At the same time, IV antibiotics are given via a PICC line, for at least 6 weeks. Oral antibiotics are also given.

After several months, provided that blood tests and knee aspirations indicate that the infection has gone, a second stage revision is done, whereby a new set of metal hardware is inserted. It's very common for oral antibiotics to be continued for a long period, sometimes for life.

What puzzles me is that, from what you say, an antibiotic spacer was inserted into your knee while the original metal hardware was still in place. Is that correct, or was it antibiotic beads that were inserted?

Similarly, you said that you have had the hardware re-inserted, but you now also have an antibiotic spacer. Usually, that just doesn't happen. Have I misunderstood?

I've made a signature for you, using the details you gave me. Please let me know if parts of it need to be corrected. Thank you.

By the way, has an Infectious Disease Control doctor been advising on your progress? It is a good idea to have one on your team.
 
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Jamie

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Sienna, I share your concerns about all that you and your knee have been through. I'll be looking for your responses to Celle's latest questions. Have you been working with the same surgeon through all this? If so, I think it's time you see someone different to get a new set of eyes on your knee. Infection can be a very complex situation and it's easier to get on top of it if you have both an experienced surgeon who has dealt successfully with this type of situation frequently and who works hand in hand with an infectious disease specialist.

If you find you need help getting to a different doctor, please let me know and I can try to assist you. To tag me (so I'll see your responses faster), type the "at" sign (@) followed by my username with no space in between.....like this.... @Jamie
 

Celle

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@Sienna ,
Please help us to help you, by answering these questions I asked you:

What puzzles me is that, from what you say, an antibiotic spacer was inserted into your knee while the original metal hardware was still in place. Is that correct, or was it antibiotic beads that were inserted?

Similarly, you said that you have had the hardware re-inserted, but you now also have an antibiotic spacer. Usually, that just doesn't happen. Have I misunderstood?
 
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Sienna

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Maybe I am misunderstanding what a spacer is. 1st surgery went okay. Then got infected. 2nd surgery, prosthetic debridement and washout done, on IV antibiotics. 3ed surgery, prosthetic removed, and plastic and cement temp knee put in, on IV antibiotics again to clear infection. 4th surgery new prosthetic put in with antibiotic beads. 5th surgery was another washout and debridement and IV antibiotics for 3rd time. So I have been through the one stage and two stage, the back to one stage again
 

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