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[KNEE INFECTION] Revision with infection

LolaBee

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I am scheduled for a Right TKR 2 stage revision in a few days.

..Right TKR Sept 26, 2013.
..Arthroscopic synthetic cartilage plugs on femur June 24, 2010.
..broken patella 1972

TKR was tolerable, and I had relatively easy recovery. No trouble until now.

About ten days ago my TKR had slight pain but I just thought I must have over done it. Next day stairs were difficult and a little more painful. 3rd day, pain was excruciating, lots of swelling, fiery red and angry. Could not tolerate any weight on it.

Went to Ortho Dr, not my OS, as I had moved. Immediately ordered xrays, labs, and bone scan. Also tick borne panel, as I have a bite (?) on that same knee.

Labs thus far are inconclusive, but further time to culture ordered.

50cc of very bright yellow fluid taken and sent to lab.

Bone scan findings:
TECHNIQUE: Three phase bone scan of the knees was performed in standard fashion utilizing 25.0 millicuries of technetium 99M MDP.
FINDINGS: Hyperemia about the right knee and abnormal blood pool and delayed phase activity about the right knee. This is about the tibial and femoral components, greater involving the tibial components, nonspecific but could represent aseptic loosening or periprosthetic infection.

IMPRESSION:
Abnormal three-phase activity about the right knee arthroplasty, may represent peri-prosthetic infection.

Fever 99°-101°. Taking Tylenol PM at night. Pain is a constant 9, even with Tylenol.

Have always had near perfect BP, but at pre-op, it was sky high. Now I have to go to my GP and get medical release to have surgery. (You think the horrible pain and fear might have something to do with it, lol?)

Revision plan:
#1 Old TKR removal, infected tissues removal, flush, and an antibiotic reticulating spacer will be inserted. 4-5 days in hospital, then 4 weeks of IV antibiotics. Still waiting on insurance to decide if I can do that at home or nursing facility.

#2 infection recheck and new TKR installed if all ok.

My OS has been very honest about the long road ahead.
I am terrified!
 

Jockette

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Welcome to Bonesmart, we’re glad you joined us.
My OS has been very honest about the long road ahead.
I am terrified!
I’m sure I’d be terrified, too. We’ll be here for you every step of the way.

I’ll ask @KarriB to come talk with you, she had surgery for an infection.
 

Celle

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Hello @LolaBee - and :welome:

I'm sorry you have to have this revision and I understand how concerned you are.
To give you some reassurance, the two-stage revision way of treating a knee infection is very successful. As your surgeon said, it is a long road - but with a cure at the end of it.

Please will you tell us the full date of the first stage surgery (removal of hardware)? Then we will be able to make an up-to-date signature for you.

Thank you.:flwrysmile:
 
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LolaBee

LolaBee

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Thank you, Cells.

My removal surgery is May 30th.
Got medical clearance from my GO today, so ready to go on Thursday.
 
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LolaBee

LolaBee

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Sheesh! Celle. Dang auto correct. :umm:
 

Celle

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Thank you for your surgery date. I've added it to your signature.
I'm going to move your thread to the Knee Replacement Recovery Area, since your surgery is imminent. Best wishes for that surgery.
 

Izabel

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Just want to send you best wishes for tomorrow @LolaBee for your 1st Stage Revision. I have had a 2 Stage Revision on my hip. Fear not, have faith ... all will go well. :fingersx:
 

TimeBuster

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From someone who recently had a two-stage TKR revision, I wanna wish you the best of luck tomorrow.
 
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LolaBee

LolaBee

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Thank you everyone. I'm trying to put on my brave face and get through this.

I'm very concerned about the lengthy IV antibiotic regime being very hard on my body. Did any of you have serious side effects? What did your doctors do to prevent or alleviate them?
 

Izabel

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I was on antibiotics for 5 months (IV then tablets) between stages and I wasn't ill with any of them ... and I only weighed 112lbs at the time, a weakling! :heehee: Others may have different stories. Please do not fret about what may or may not happen. Take a deep breath and relax.
 

TimeBuster

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I'm very concerned about the lengthy IV antibiotic regime being very hard on my body.
Other than the IV line being a nuisance I had no issues with IV antibiotics. Was on them for six weeks. I had a nurse come every week to my home to change the dressing and draw blood. Just make sure the PICC line stays dry and be careful when handling things that the line doesn't get caught on it you'll be fine.

Good luck tomorrow, see you on the other side:) :-) (:
 

TimeBuster

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Also, I wanted to add one more thing if you get home delivery of your antibiotics, what I did is save the ice packs that came in the box with the antibiotics and I recycle them. I have 16 ice packs comfortably stored in the freezer so I'm never out of ice.:ice:
 

KarriB

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I did not have removal of my TKR, but I did have a surgical washout and spacer exchange. My infection occurred a month after TKR came with a high fever and seeping from a closed incision. Like you, I had 4 days in a hospital, but then I was moved to their rehab-transition unit for a week so my docs could keep a better eye on me. A PICC line was inserted for antibiotics and I also took an oral antibiotic as well, both for 6 weeks. A home health nurse came to my house to teach me how to administer the IV antibiotics. It wasn’t difficult, but it was awkward because the PICC line was in my right upper arm and I’m right handed. A nurse came weekly to clean and change the dressing on the PICC line, draw blood for cultures and check my incision also.

If you are able to go home I suggest someone be with you when they’re teaching you how to administer to antibiotics. It was a little much all on the same day as I came home so I was glad my sisters were there.

Please feel free to ask any questions and we’ll all do what we can to help.
 

Celle

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I'm very concerned about the lengthy IV antibiotic regime being very hard on my body.
That is a concern, but really it's the lesser of two evils. Think how much harder on your body it would be if you were left with an incompletely cured infection, or one that kept on recurring.
 

KarriB

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The antibiotics did bother my body, I’ll be honest. I was on two different antibiotics for 6 weeks (think I mentioned that above) and I tried to always have a bathroom nearby. There was also a problem with my body not producing white cells which hastened the end of my antibiotics. It took about 2 weeks without antibiotics for my body to kick back into white cell production. But as Celle said above, it is the lesser of the evils and the infection has to be dealt with. Your Infectious Disease Dr should perform regular blood labs to insure your body is dealing with the medication.
 
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LolaBee

LolaBee

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I had stage 1 revision surgery Thur morning now it's early Sunday. I've lost track of Fri and Saturday. After 12 hours in my hospital room, I was moved to ICU, where I'll stay a few days.
Was having trouble getting my pain under control, severe headache (possibly from epi or the morphine), and vomiting for 36 hours straight.

I'm still a hot mess, but managed to get 3 hours of sleep, and headache is much better. Only med I'm being given now is Tylenol ES with Dilaudid rotation. I'm keeping crackers down, so maybe the vomiting is over.

I am able to get out of bed to portable commode with help. I have to have leg brace on when out of bed.

Surgeon unceremoniously removed drain tube yesterday. Whew! Was not prepared for that fun! :scaredycat:
 

TimeBuster

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From one two stage TKR revision to another, wishing you a quick recovery.
 

Jockette

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Surgeon unceremoniously removed drain tube yesterday. Whew! Was not prepared for that fun! :scaredycat:
I don’t understand how doctors can be so uncaring at times. I’m sorry you had to go through that. :console2:

I’m sorry you’ve had such a difficult start to this recovery. I hope your nurses are caring and watching after you well.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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
5. At week 4 and after you should follow this
6. Access to 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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

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