I just had a friend who had a stiff knee go through a replacement with a Smith and Nephew knee. When they tested the old prosthesis, they did a 14 day culture on it instead of a 7 day. They discovered that she had had an infection for five years. After treatment for that infection, ( six weeks of vancimycin) and with the new Oxinimimum knee she now has a rom of 120---her former rom was 65.Here is info on that infection:
Biomed Res Int. 2013;2013:804391. doi: 10.1155/2013/804391. Epub 2013 Nov 6.
Propionibacterium acnes: an underestimated pathogen in implant-associated infections.
Portillo ME1,
Corvec S,
Borens O,
Trampuz A.
Author information
Abstract
The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is also responsible for infections involving implants. Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures increase the detection rate. In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as prosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants. The management of severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device). Intravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives, and amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment. Sonication of explanted prosthetic material improves the diagnosis of implant-associated infections. Molecular methods may further increase the sensitivity of P. acnes detection. Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby reduce the risk of biofilm formation during severe infections. Our understanding of the role of P. acnes in human diseases will likely continue to increase as new associations and pathogenic mechanisms are discovered.
PMID:
24308006
[PubMed - indexed for MEDLINE]
PMCID:
PMC3838805
I also have a list of docs who are specialists in arthrofibrosis: one of them, Dr. Gill works at Mass General in Boston. If he is too far, perhaps he can recommend someone. I try to keep the list updated, os if you find a new doc be sure to let me know and I will add it to the list. Kelly
Dr. Colin Eakin, Palo Alto Medical Foundation, California
Dr. Steadman, Steadman-Hawkins Clinic, Vail, Colorado
Dr. Peter Millet, Steadman Hawkins, Vail (as of 10/1/05)
Dr. Lonnie Paulos, Salt Lake City
Dr. Frank Noyes, Cincinnati Sports Clinic, Ohio
Dr. Wojitys, Ann Arbor, Michigan
Dr. Jason Folk Steadman-Hawkins Clinic of the Carolinas Greenville, SC
Dr. Shelbourne, Indianapolis, IN
Dr. Flandry, Hughston Clinic, Georgia, Alabama
Dr. Gill Boston Mass. General Hosptial and An asst. Prof at harvard
Dr. Tomas Sculo HSS
Dr. Answorth Allen HSS
Dr. Henry A Finn Weiss Memorial Hospital Chicago
Dr. Charles Bush-Joseph---Rush University Med Center.
Dr. Michael A. Terry Northwestern U Feinberg School of Medicine
Dr. Juan J. Rodrigo Baylor Schott and White Hilcrest Medical Center Waco, TX
Dr. Thomas N Lindenfeld Cincinnati Sportsmedicine and Orthopaedic Center
Dr. Friedrich Boettner HSS New York and the United Kingdom
Dr. Ajai Cadambi Texas Hip and Knee Center Forth Worth, TX
Dr. (Mr) Glyn Evans London Orthopedic clinic
Dr. Simon Tan St. Vincent's Sprotsmed Darlinghurst, Australia
Dr. Philipp Traut Bad Oeynhausen, Germany
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If you google Frank Noyes, he has a series of articles on Adhesions. (scar tissue) . Also Peter Millet is one of the men who does not think you should have an open Lysis of adhesions. Steadman treats arthrofibrosis, but they will not treat it after a TKR
Also Dirk Kokmeyer, Pt wrote tutorials on Arthrofibrosis Rehab that I found really useful