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Knee Infection* Right TKR revision from staph infection<

TimeBuster

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I have a question to the administrator, moderators or bonesmarties.

What are your thoughts or is there any information in the archive library pertaining to smoking before or after surgery with infection in early TKR or TKR revision.

I understand that smoking is linked to worse outcome in joint replacement but I'm trying to wrap my head around how smoking can cause you to develop a staph infection and the early stages of a TKR.

Thanks in advance.

Right TKR revision March 26, 2019. (Depuy Attune Revision Cementless)
Right staph infection (Cement antibiotic spacer with 2 rods 6 weeks of antibiotic via PICC line) December 18, 2018.
Right TKR April 2012.
 

sistersinhim

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I have never heard of such a thing. I'll ask the other staff members.
 

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Hello @TimeBuster

I'm sorry your knee replacement has been accompanied by problems. I hope everything goes more smoothly from now on.

Unfortunately, there does seem to be some increased risk of developing infection if you're a smoker.
We have these two articles about it in our Library.

Smokers at increased risk infection after TJR
Smoking and joint replacements

It's a couple of months now since you had the replacement hardware put back in, but I'll give you our post-op reading anyway. There will still be some articles that are helpful 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
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 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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TimeBuster

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Thank you for the replies and information.

My reason for concern about infection I was doing so well on my recovery for 7 1/2 weeks that was until this past Wednesday when I got up to get a cup of coffee when I stood up and put bear weight on my surgical leg to intense pain. Prior to Wednesday, I had no issue putting bear weight on my leg. In fact, a couple of weeks ago I graduated from a walker to my cane and was getting around very nicely and so proud of how far I have come with my new knee especially with my history of my botched TKR in 2012.

My first thought was I must have aggravated my knee somehow with some Tylenol, ice and rest I should be fine in a couple of days. No such luck as the days have gone by it hasn't gotten any better. Now I'm back getting around with my walker because I can't put any weight on my leg without my knee being in excruciating pain.

I started doing some research on the Internet and came across several articles on staph infection on knee revision and one that caught my attention was about X smokers like myself quit in 2014 and the high risk and percentage of a reoccurring knee infection. I'm not jumping to any conclusions as of yet but the thought is there since I had complications with a staph infection in the past.

Prior to my revision, I was taking a daily antibiotic orally and both the infectious control Dr. and my surgeon agreed that I should continue taking an oral antibiotic on a daily basis for at least a year. Mind you I had a follow-up appointment with my orthopedic surgeon two weeks ago I was in no pain x-rays were taken and my surgeon was extremely happy and so was I with the x-rays and how far I have come in six weeks.

Tomorrow I'll be calling the OS office to make an appointment I just hate the thought of going through more blood work and another knee aspirations especially when I was doing so good and I thought I was behind having any complications with my new knee.
 

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Have you increased your activity and/or PT in the last week?
 
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@Jockette Nothing out of the norm that I haven't done since surgery. Prior to this past Wednesday, I would do my 2 to 3 light exercises per day ice and elevate on the days I wasn't going to PT. I stop going to outpatient physical therapy two weeks ago copayments was too expensive but even at PT, the exercise was a breeze.

I can honestly say at this point I am totally baffled why all of a sudden when I was doing so good and I had no signs of distress on my knee I took this turn for the worse. I am so aggravated right now after two surgeries in less than three months the last thing I need to hear, we have to open you up again.
 

Jockette

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I am going to tag @Josephine
our forum administrator and nurse director to address new pain.

Two knee surgeries in 3 months that also involve an infection is a lot of trauma for your knee. Give it what some of us call a “knee-cation” (vacation) and let it have some quiet time to heal.
 
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Josephine

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I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
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a aknee3.png

The image above is my old TKR. As you can see from the red arrow the bottom plate is loose from the tibia. The extension stem on the bottom plate in the red circle is literally pushing out through the tibia. If you look closely to the right of the bottom plate you can see where the bone has deteriorated from Osteoarthritis and the staph infection. Because of the deterioration over time, the bottom stem started shifting to one side and I can tell you, folks, anytime I would put weight on my leg I would scream for mercy.

When I had my first TKR surgery in 2012, the surgeon fractured my tibia and had to be graft that's the reason they had to put in a stem extension. From day one anytime I put weight on my leg I was in excruciating pain.

So as you can see from the x-ray above my current orthopedic surgeon had her work cut out to repair years of neglect and damage to my knee.

She was very concerned about the deterioration of my tibia and that's why she chose to use this particular prosthetic. Just hoping this current pain I've been having is temporary and not a serious problem where I have to go back under the knife again.
a aknee5.png
 

Josephine

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Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
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1. 1 sitting down - 7 when I stand up and put bear weight on my surgical leg.
Note: prior to last Wednesday I had no issue with pain when putting bear weight on my surgical leg.

2. 2 Advil every four hours.
Note: prior to last Wednesday I had no issue with pain when putting bear weight on my surgical leg so there was no need for pain medication.

3. Slight.

4. 100/0

5. 4 to 6 times a day for 60 minutes.

6. Every time I lay down or sit I elevate my leg.

7. No housework - Minimal cooking. No cleaning. Shopping once a week. When I go shopping I use a battery powered scooter to get around.

8. I stopped all the exercises two weeks ago.

Prior to quitting exercise two weeks ago.
Glute tightening 30 reps 1x day
Quad tightening 30 reps 1x day
Heel slides 20 reps 1x day

Stop going to physical therapy two weeks ago copayments too expensive. Did not have pain issue when going to physical therapy.
 
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TimeBuster

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I would like to add, May 3 was my birthday and I took a video of myself walking unassisted when I went food shopping to share it with family. I was so proud of that moment that I literally cried. It was the first time in seven years I was actually walking without any assistance or pain.
 

Josephine

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1. 1 sitting down - 7 when I stand up and put bear weight on my surgical leg. Prior to last Wednesday I had no issue with pain when putting bear weight on my surgical leg.
And what happened last Wednesday?
2. 2 Advil every four hours. Prior to last Wednesday I had no issue with pain when putting bear weight on my surgical leg so there was no need for pain medication.
I would suggest you rather used Tylenol 1,000mg 4 times a day at 6hrly intervals. It's a much better pain med than Advil.

I know the FDA has ruled that 3,000mg acetaminophen is a safe maximum but that would be assuming that the patient is taking another medication that also contained it and thereby inadvertently take an overdose. Assuming that this is not the case, the maximum safe dosage per 24hrs 4,000mgs.

As for the ibuprofen, read these
Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study
3. Slight.
Not bad!
That's excellent!
5. 4 to 6 times a day for 60 minutes.
Very good!
6. Every time I lay down or sit I elevate my leg.
Excellent

7. No housework - Minimal cooking. No cleaning. Shopping once a week. When I go shopping I use a battery powered scooter to get around.
also excellent
8. I stopped all the exercises two weeks ago.

Prior to quitting exercise two weeks ago.
Glute tightening 30 reps 1x day
Quad tightening 30 reps 1x day
Heel slides 20 reps 1x day

Stop going to physical therapy two weeks ago copayments too expensive. Did not have pain issue when going to physical therapy.
Okay, got all that.

I think if you changed your meds, that would do the trick
 
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TimeBuster

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And what happened last Wednesday?
I was doing so well on my recovery for 7½ weeks that was until this past Wednesday. That morning I got out of bed walked to the kitchen made coffee I sat down in front of the computer and I was fine, no issues putting weight on my leg. A couple of hours later I got up to make another cup of coffee when I got up off the chair and I put weight on my surgical leg to my surprise I was in intense pain.

Now prior to Wednesday, I had no issue putting weight on my leg. In fact, a couple of weeks ago, after my six weeks check up with my OS and with her blessing, I graduated from a walker to my cane and was getting around very nicely heel to toe without any discomfort or pain.

What is baffling to me, I can sleep all night or sit down all day and I have absolutely no discomfort or pain, knee feels fine. I can take my good leg and push back my surgical leg as far as the flex lets me, no problem. I can even get in and out of the car without any discomfort or pain. But when I put actual weight on my surgical leg I'm in intense pain. I have gone back to using my walker and favoring my surgical leg and my good leg is not happy about that.

I'm not the type of person that waits around for things to get better, I mean it's been five days of medicating, icing and elevating and my knee is not getting any better. If I learned anything from my first TKR in 2012, the sooner I can get to the bottom of my current issue with my knee, the better I'm going to be in the long run.

I made three appointments yesterday, one with my GP, I can get my blood work done in his office. Second with my orthopedic surgeon, and third with the infectious control Dr, in that order. My blood work should be ready when I see my OS. I will have xrays done at the OS office to make sure no loose components and if the blood work does shows signs of infection the infectious control Dr will give me a referral to have my knee aspirated. And I will go from there.

I spent seven years hopping around in pain on one leg. I got a taste although brief of walking around unassisted and with no pain before this past week and I want that feeling back again, dammit.
 

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@TimeBuster glad you are being proactive. Hopefully it is not the joint. My first knee I suddenly couldn’t bear weight at 7 weeks and it was my IT band, (Josephine told me I “pranged” it) It took several weeks to settle down including going back to using crutches. I have no idea what did it I just was walking in my house and suddenly hit.
Thinking of you hopefully you will get answers soon. Praying for quick resolution
 

sistersinhim

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when I got up off the chair and I put bear weight on my surgical leg to my surprise I was in intense pain.
I bet when you got up you twisted without realizing it and upset some soft tissues. Rest, ice and elevate as much as you can until it settles back down. Unfortunately, these setbacks aren't anything unusual. We can be doing so well, then something happens, who knows what!, and we are back to a couple of weeks or so. Remember that this is a rollercoaster recovery.
 

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@TimeBuster An excellent description of your problem. However, at no time did you actually mention the site of this pain. Can you do that now using this chart, please? I've left both charts just in case!

aa hip-references-horz.jpg
aa knee-references-horz.jpg
 
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TimeBuster

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@TimeBuster glad you are being proactive. Hopefully it is not the joint. My first knee I suddenly couldn’t bear weight at 7 weeks and it was my IT band, (Josephine told me I “pranged” it) It took several weeks to settle down including going back to using crutches. I have no idea what did it I just was walking in my house and suddenly hit. Thinking of you hopefully you will get answers soon. Praying for quick resolution
Thank you I definitely will bring that up with my OS in my next appointment.

I bet when you got up you twisted without realizing it and upset some soft tissues. Rest, ice and elevate as much as you can until it settles back down. Unfortunately, these setbacks aren't anything unusual. We can be doing so well, then something happens, who knows what!, and we are back to a couple of weeks or so. Remember that this is a rollercoaster recovery.
You're absolutely correct, this is a rollercoaster recovery and I can't wait for this ride to be over:tiredwheel: Oh how I wish you were right, but I would have realized instantly if I twisted my knee when I got up off the chair. As far as icing and elevating I've been doing that for less six days with no improvement. Still can't put any bear weight on my knees and it's frustrating, to say the least.

@TimeBuster An excellent description of your problem. However, at no time did you actually mention the site of this pain. Can you do that now using this chart, please? I've left both charts just in case!
On both the medial and lateral side behind the patella and the entire back of my knee is my source of pain. Like I said in my prior post, I can lay in bed all night or sit down for hours, flex my leg back and forth and not be in any pain or discomfort, but as soon as I stand up and put bear weight on my knee I'm in excruciating pain.

a achart.png
 

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