TKR Right TKR is done

[RMasano]

I am so sorry you are going through this. I know you are in Wisconsin. My neighbor. I there anyway your insurance will cover your costs to go to Rush in Chicago. I know it is well worth it.

 

[sistersinhim]

I agree with the others that you need to see a specialist for this new opening. Somethings just not right.

 

[Josephine]

Yard work will be nasty as well as lots of other things

Then you'd best not do yard work and 'other things' for a while.

Wish I had something to offer but I don't. Any more, it seems, than your surgeon does!

 

[zzevi]

Don't know a lot about what you have going on, I would think someone out there in the medical profession could help come up with a way to get that healed shut.
I saw a wound specialist and they were very knowledgeable about knowing what types of medication to use in the wounds to help your body with the healing process.
Make sure your getting enough protein in your diet, when my wound was being treated, they recommended that I drink Ensure, or boost not for the calories just for the extra protein. ( that may help your body product a scab.)
One thing I do know is the longer you have a area open and exposed the more chance you risk an infection, my knee was open a while, but better I finally got decent treatment I developed an infection.

 

[GingerP]

Thank you all for your thoughts and advice. Yesterday I emailed my os. I plan to follow up with a phone call on Monday to his office and ask that I be referred to the wound clinic or to a fellow general surgeon who has dealt with an issue such as mine. He has to know that I'm not happy with where I am. In my opinion this kind of thing is beyond his expertise and he is just doing what seems 'logical' or whatever you may call it.
I also am going to call a local os to see if I can get an appt with him and discuss what I have and the possibility of having my right knee surgery done by him. I realize that my knee surgery was ok with my os, but having two openings on the incision following has tainted my confidence in him. I guess I am just looking into different options right now. Knowing that the opening has to heal before I can have my right knee done gives me time to further review options available to me.
As an observation of the drainage, it seems to be more on the yellowish color and still watery. I am gently massaging my leg a couple times a day to get extra fluid out that doesn't come out on its own. It doesn't seem to be a lot, but in my reading on the Internet it mentions that the cells were damaged and I don't have much of a perspective of how long it will take to repair them.
I appreciate the note to be sure to get more protein in my diet and I had purchased some protein drinks to use in anticipation of having surgery soon, so I will get to having them now!
My faith in my current os has been shaken, so it has given me the reminder that 'I' have to advocate for myself. It's not easy for me to be demanding or pushy, but I don't feel that I'm getting good care at the present time.
Again many thanks for your words of encouragement. One day at a time.

 

[SusieShoes]

You are doing the right thing to see a wound specialist. I had a wound issue with my last surgery (abdominal, not a knee replacement), where I had an infection, then a second surgery to fix it, after which the wound would not heal. My surgeon sent me to a wound specialist. Long story short, I'm fine now, wound healed and no problems. These wound specialists know a lot of tricks (as my guy said himself) and they treat each wound and patient uniquely. Wishing you all the best with getting this issue taken care of.

 

[KarriB]

I think it's wise to look for a second opinion, but I'm not sure asking your current OS will give you an adequate answer. Take today to do some research on orthos within your insurance group. I had a surgeon who did my TKR, but a revision specialist took care of my infection surgery. That doesn't mean you need a revision, just that these docs know how to deal with complications when they arise. Check out the the OS bios on their websites and it should say revision or 2nd TKR surgeries. You can take a look at the Find a Clinic tab at the top of the forum to start your search if you like.

 

[sistersinhim]

I agree with KarriB. You should go to a wound specialist who's completely out of your surgeon's group. They need to have no ties with each other. Another OS isn't specialized enough for you now unless it's someone who knows wound care.

 

[zzevi]

Sorry re-reading my post I meant to say, that my knee wound stayed open to long and prior to getting decent treatment from the wound care clinic, I developed an infection. Again I think any time you have some open to long, it becomes more and more an invitation for infection. Even if you careful.

 

[GingerP]

I called the surgeons office this morning to be certain they saw my email. They let me speak to my surgeon' s nurse and she read the email and would talk with my Dr and she was certain that he would refer me to the wound clinic. That is comforting. She didn't seem to be very surprised or concerned because she knows that this shouldn't be happening in her heart of hearts and especially when I am so in need of having my second knee surgery.
My mom has an appointment at the wound clinic tomorrow morning so I can visit with them tomorrow and get an appointment as soon as possible.
Drainage overnight was minimal, but that is to be expected when my leg is still in bed. Still thin fluid, and more light yellow.
Feeling better that I can see someone that may have seen something like this and have an approach to heal me up. I know with my mom's sore they have done different things when they see there wasn't the expected progress, and not just letting 'time' heal. I'm hoping today changes things.
One day at a time......

 

[GingerP]

Turns out I hit a spot with the dr and he personally called me to talk about everything. I told him I thought it best for both of us to get some fresh eyes looking at my incision. Then he pulled the 'I took a chance on you' because my bmi is 48 and most surgeons around here won't do surgery on some one with a bmi over 40. Sure, go ahead and tell me now that I weigh too much. Hit me where it hurts. I've been overweight my whole life. My knee surgery went well and I told him I was very happy to have a new knee and pain free. I just wasn't happy that my incision had an opening occur twice. He goes on to say that he has referred people to the local wound clinic in the past and that he has also had others that have developed openings such as mine and resolved them.....but not once when I had my first opening show up or now with this one last week, did he say anything like that to assure me he had dealt with these kinds of things. That may have helped me feel more confident. He has agreed that the wound clinic may be able to come up with an approach to resolve this and will send a referral.
So, on top of being upset that my knee surgery for my right knee is being put off, and I have a second opening on the incision, I feel terrible because I'm overweight. Don't know how someone that hurts so bad to even walk can go about losing a lot of weight. It's not all about me eating too much, exercise plays a part too. Geez.......

 

[Pumpkin]

Sad the OS felt the need to blind side you. At least he has referred you to a wound clinic.
If he is not comfortable working with persons whose BMI is high, he should have referred you to anther OS who has more experience. I agree with KarriB, you need a second opinion, with a surgeon who specializes in revisions, they have the education and experience to advise you properly. They should have no relationship with your present surgeon, not even golf buddies.

 

[Pumpkin]

If another culture is done, be sure they keep it for two weeks There are many slow growing pathogens need time to be detectable.

 

[GingerP]

Thanks for the advice on cultures. I have been on keflex since miD February up until last Friday when he put me on doxycycline. I just don't know how long my body should be put on antibiotics.
I got a call from the wound clinic and my appointment is on Thursday afternoon. I'm very happy to be able to have another person look at me and my situation. Maybe I'm too hopeful, but without hope there is only despair so I have to think that way yet today.
When I first saw my surgeon I had some problems with edema in my calves and at that time he told me that he would do surgery on me if my bmi was under 50 and if I got the edema resolved. I lost over 30 pounds, went to a clinic to get my edema resolved and wear compression stockings and when I saw him in September he said I met his requirements for surgery and we could schedule it. He said that many of the younger surgeons will not do surgery on anyone over 40 bmi. I am very happy with the knee replacement. That has worked well. It is in the incision closing that I have that is disturbing, so I don't know 'who' does that - the surgeon or assistant staff, but since I carry more fat on my thighs I don't know if my bmi is all about that, maybe. Personally I think it's about understanding the skin and tissues about that anatomy. Oh well. I will continue to work on weight loss but doubt if losing weight will close up my second hole.

 

[Celle]

I'm sorry your surgeon felt the need to mention your weight. That wasn't kind. He was probably feeling defensive himself and doubtless he's forgotten how much weight you lost, in order to meet his requirements for surgery. Try not to let it upset you.

At least he has referred you to the wound clinic and you have an appointment. Do let us know how you get on with Thursday's appointment.

.

 

[KarriB]

I'm confused about the antibiotics. Why did he put you in Keflex if you didn't have an infection? Had you been on Keflex before the cultures were taken?

I have been on doxycycline for three years now. When my incision began to seep and I had the washout/spacer exchange the same incision was used, but longer. An infectious disease dr grew the cultures and decided what antibiotics I needed (oral rafapim & another IV antibiotic) for the first 6 weeks. Then followed with doxycycline. She does labs twice a year to make sure my body is handling the doxycycline and I take a very good probiotic. But the point is my ID decided which antibiotics I needed to fight the infection. Did your OS say why you were taking the antibiotics?

 

[newlybionic]

That OS was trying to deflect his inability in closing your wound properly by blaming you for being too heavy. Personally I would not have anything to do with him or his office in the future. I'm glad you have an appointment with the wound care center on Thursday. They will know how to handle your wound. Usually they have an infectious disease doctor associated with them who can prescribe what if any antibiotics you need to take. Let us know how it goes.

 

[KarriB]

I didn't know a wound care clinic had an ID on staff. That's good to know, Marian! I didn't deal with a wound care doctor/clinic as my incision closed but still seeped through.

Ginger, I am overweight with heavy legs also. Even when I lose weight, my legs are still heavy. It was something my original OS warned me about before surgery. He did say that people with heavy legs or a lot of fatty tissue in their legs can be prone to infection, but he never offered it as an excuse when the infection came along. He was kind and understanding, very pleased with my revision specialist. I think my heavy legs were part if not the whole reason why it took so long for the infection to clear up.

 

[RMasano]

Unbelievable!!! Sorry about your whole situation. Just wondering-Do you think the surgery was even necessary? You seemed to be pretty good and the opening was very small?

 

[Celle]

I don't think it does any good to wonder that, @RMasano. What's done is done. The surgeon opened the first seroma and it apparently healed well. He has not opened up the second one, so both approaches have been tried.
Seromas can heal themselves, but care should be taken, to try an prevent the introduction of infection.

It's good that a wound care specialist will be advising now.