Knee Infection* Revision #3 Journey

[lovetocookandsew]

I'm sorry you're having to go through this after all you've already had to go through. Can you please tell me exactly what your doctor did during surgery?

I'm having a strut graft on Thursday, which, according to my OS, is the same, or similar, to the procedure for a broken femur. I know I'll have to use a walker for 4-6 weeks, but I can't remember if he said I'll be full weight-bearing, or not. My OS said some people who have this procedure have less pain than with a TKR as they don't cut into the bone, but some people still have quite a lot of pain.

Are your pain levels similar to your TKR, or less, or more, so far? I'd write down some very specific questions to ask your doctor such as what exactly is allowed and what is not, in the way of movement, showering, standing, PT, and any needed pain meds.

I'll be using an ice machine, but since I'm having two sites opened up for the graft, I may use two ice machines. I think using an ice machine, or ice packs, is a good idea to help with pain and swelling in either case.

With a TKR, they generally allow full weight bearing when walking, even with a walker, cane or crutches but that doesn't seem to be allowed in your case.

Did your surgeon give you any guidelines at all yet for recovery?

 

[sistersinhim]

Pets can be so comforting, but as you well know, they can be such a pain, too. I pray you have a successful healing.

 

[celynda]

@lovetocookandsew,
Re:Can you please tell me exactly what your doctor did during surgery?; I’ve yet seen the op note so don’t know exactly what does other than put the femur back together and everything back in place with plates, cables, and screws. The incision runs just below the knee to the top of my leg. The dozens of staples to be removed in about two weeks.

Until Thursday, pain management includes opioids, muscle relaxers, and morphine. Now the pain is under control with opioids.

other than toe-touch or no weight bearing, I’ve been given any restrictions. I still help transferring to/from the bed to a chair. I’ve not yet taken any steps.


Are your pain levels similar to your TKR, or less, or more, so far? I'd write down some very specific questions to ask your doctor such as what exactly is allowed and what is not, in the way of movement, showering, standing, PT, and any needed pain meds.

I'll be using an ice machine, but since I'm having two sites opened up for the graft, I may use two ice machines. I think using an ice machine, or ice packs, is a good idea to help with pain and swelling in either case.

no ice or elevation needed for pain control.


Did your surgeon give you any guidelines at all yet for recovery? 3-6 for full recovery.

 

[lovetocookandsew]

Looking at the picture you posted, your leg looks quite swolllen. If it were me, I'd be icing/elevating to help get the swelling down.

I'll have a very similar procedure with a graft and cables, but I don't think my incisions will be as long as yours, although they will be long.

3-6 for full recovery.

I'm assuming this means 3-6 months.

I still think writing down specific questions on post-op activities, etc, to ask your dotor is a good idea for you.

 

[celynda]

The rest of the details

By midnight on Sunday I was settled in my room with SX scheduled for Monday. The first night was pretty good they were very generous with pain meds.

monday
Got cleaned up and was able to wash my hair using a no rinse shampoo in a shower cap.
Surgery was pushed to Tuesday around noon so the primary tasks for the were notifying friends and family.

Tuesday

The medical staff started focusing on peeing/pooping as I hadn’t done either since admissionI finally peed right before being moved to the OR from pre-op.

When I signed the consents, three options were discussed. The first was an Open Reduction, internal fixation (ORIF) using plates, cables, and screws. I don’t remember the second and the third was the ORIF plus a knee revision. Fortunately, the OS was able to do the least complicated solution. Blood loss was less then 500 ML

I see the OS in 2 weeks to have the 80 million staples removed. I am toe-touch weight-bearing only for at least six weeks. I knew rehab would be in mix as I have no support system at home.

Wednesday
Pain level under control. Still no output so they started pushing Fluids and Flomax.

OT showed to try to xfr to a chair. I was non-compliant between the non weight bearing and the left leg weakness due to cerebral palsy. They said push off with L foot and I said “how? The L foot isn’t touching the floor” I wasn’t their favorite patient and stayed in the chair for just under two hours.

My hemoglobin started to be concerning as it dropped to 6.7 when 12.3 is normal. Over the next few days, 2 units of blood would pushed and the number stabilized.

pain control is good.

Thursday

More output support with good pain control. Today’s chair transfer was much smoother until I peed in the chair. Once the flomax kicked in, the muscles were so relaxed that time between urge and output was seconds. I think I peed 40 times from 6 p Thursday through noon Friday.

one down; one to go.

Friday
I’m now starting to check into SNF or short-term rehab. The OS checked in and removed the ace wrap. The incision is covered by something called dry tape which my skin didn’t like.

The Weekend

quiet with no PT/OT. Dr confirmed I wasn’t going anywhere until I pooped.Ramped up measures included: a suppository, an enema, and doses of lactolose.

Monday

success and settled into rehab by 6 pm

 

[Cococay]

This may be a dumb question and I apologize in advance—you said during surgery you lost minimal blood- and then a day later when your hemoglobin went down they gave you blood to get it back up- which worked. What was it that caused the need for blood?

 

[celynda]

it’s not a dumb question and I never got a good explanation. One reason was because they were pushing fluids, the blood volume got dilated

 

[celynda]

@lovetocookandsew, the swelling increased throughout the evening. The night nurse is clueless. She’s put in a message for the in-house doctor for tomorrow. I will also mention it to OT/PT in the morning.

 

[celynda]

11.17: first full day. Grade about B- day shift on the ball; night shift, not so much. I’m good about pushing for muscle relaxer or oxycodone on schedule. Haven’t had evening meds which should have happened three hours ago. I bugged nurse and she’s off to check in the “system”

 

[Jockette]

Haven’t had evening meds which should have happened three hours ago. I bugged nurse and she’s off to check in the “system”

I hope you don’t pay a big price for this lack of care.

 

[celynda]

The overnight nurse came on shift and all is good now.

 

[celynda]

11.18 Update: B
Facility doctor performed initial assessment. Agreed I have 54 staples and my OS is brilliant in the OR while bedside manner and communication suffers. There is stile quite a bit of edema and some oozing from the incision from from several seromas at the top of the incision. Not sure how long they they’ll take to clear.

today’s PT went well.I was able to xfr from bed to wheelchair for a couple of hours. It was so nice to get out of bed. Next step: getting from wheelchair to toilet. I’ll spend several hours each day in the chair working. The current plan is to stay in rehab until I’m weight bearing.

I’m allowed one visitor a week. This week it’s a courtyard with the puppy dogs and dog walker.

 

[celynda]

11/21 Update: been in SNF for almost a week and for the most part, things are good.

worked with PT/OT on a transfer protocol from bed to wheelchair. This is huge as it lets me sit a table they brought in so I can work. I can also get a daily shower and go to the bathroom during the day. At night, I stick with the brief as I don’t trust them to
me in time.

I had my first shower in two weeks today as part of therapy it was wonderful and now I am on the schedule for a daily shower.

I complained about the bed from day 1 and on Thursday, I got a brand new bed. It’s so much better. I ordered nicer sheets which should arrive on Monday.

I’m in COVID isolation until 30 November. My dog walker visited on Friday bringing the week’s worth of mail and the dogs. It was grand seeing them and sitting outside for a bit. Inside visits aren’t allowed until I’m out of isolation.
The food’s not bad and dietary has been flexible in working with my likes and dislikes.

For the most part, family and friends have supportive and encouraging. My brother, however, likes to offer advice and suggestions to push, do more so I can rehab faster. He has difficulty grasping that I am not in rehab so much as I’m healing a broken bone which cannot be rushed.

Thanks for listening

 

[Pumpkin]

Sounds like you are making slow but steady progress. You are right, bones heal at in their own good time, and cannot be rushed.

 

[Schaargi]

So glad you got to visit with the dogs. Dogs help everything.

 

[Cococay]

I bet that was great seeing your dogs!! I’m so sorry your having to go through all of this. And I hope your night nurses get it together- it’s so hard to have to wait for others for things you need like meds and help transferring to get up to use the bathroom.....
sending healing vibes your way.

 

[Jaycey]

My brother, however, likes to offer advice and suggestions to push, do more so I can rehab faster.

Not helpful! There is no pushing this recovery. The slow and steady approach works every time.

 

[Aplace2rest]

How is your recovery coming along? I too slipped on a puppies urine, but in my kitchen instead of living room. I broke my right patella into 5 pieces. I’m on month 2 of recovery with limited ROM. I hope you’re feeling better.

 

[celynda]

New Topic/Concern…

TL;DR:
Looking for guidance, suggestions, or advice on the following:
1. Should I take Osteoporosis treatment meds with a broken femur
2. Any idea what elevated C-Reactive Protein and Eos mean?
3. With loosening of the implant, fragmentation, osteoporosis, and elevated bloodwork, am I looking at another revision?

It’s been an interesting year. In April, I fell and landed on my knees. I didn’t give it much concern as I was psyched that I was able to get up without assistance. THAT doesn’t happen often. Since then, the right leg between the knee and mid -thigh has been painful. In the last three months, it’s gotten worse. It’s painful to walk, get up from a sitting position. Even sleeping is hard because, stretching hurts as does bending the knee. When I stand up, it takes several seconds to get moving. In fact, I’ve gone back to using a cane when outside my home. Good thing, I still work from home?

My PCP ordered X-rays before putting in a referral to a Sports Medicine doc. The XRay report said I had Osteopenia and there was sign of loosening of the implant and fragmentation on the distal medial side of the femur. SAY WHAT???

The next week, I had a previously scheduled DEXA scan which came back with Osteoporosis. The T score is -2.7 at the right femoral neck. I’m meeting with the GYN in two weeks to discuss options.

Last week, I saw the local OS (side note: I moved from Orlando to Lewisburg, WV in June. I’m loving the small town life. Medical Specialists are rare here.) He said he hadn’t seen anything this bad since his residency at Johns Hopkins. [I’ll post the X-Rays as soon as I can]. His primary concern is an infection so he ordered blood work. The Eos was .5 when it should be under .4. The C-Reactive Protein is 25 when it should be under 10.

The OS acknowledged my situation was above his pay grade so he’s referring me to a Dr Klein at the University of West Virginia’s Medical School who is supposed to be a pre-eminent joint replacement specialist.

Looking for guidance, suggestions, or advice on the following:
1. Should I take Osteoporosis treatment meds with a broken femur
2. Any idea what elevated C-Reactive Protein and Eos mean?
3. With loosening of the implant, fragmentation, osteoporosis, and elevated bloodwork, am I looking at another revision?

 

[Pumpkin]

@celynda
Sorry to hear you are having so many challenges after your fall.
Glad the Dr you saw has referred you to a specialist for your hip, have you made an appointment?

1. Should I take Osteoporosis treatment meds with a broken femur

That is a question your OBGYN should be able to answer.

2. Any idea what elevated C-Reactive Protein and Eos mean?

You have increased inflammation, most likely from your fracture. Your orthopedic doctor will run tests to rule out infection.

3. With loosening of the implant, fragmentation, osteoporosis, and elevated bloodwork, am I looking at another revision?

My best guess is most likely, the loose implant is not going to heal, and may cause further damage if it is allowed to move around possibly damaging your bones.
When you see the specialist they will be able to determine a plan for your hip.

All the best in your search for answers,
Chris