TKR Spacer

MikeG

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I have had 14 knee surgeries since on my right knee since 2014. Started with a TKR followed by an infection. I've had three total knee replacements with several clean outs and antibiotic spacers. Each TKR was followed by infection and the last spacer was implanted in August 2021. I have been advised to forego any future surgeries and live with the spacer due to lack of tissue and the high probability of reinfection. I can't bend my knee and can't imagine living like this the rest of my life. Any ideas would be appreciated
 

sistersinhim

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@MikeG, will you please list your surgeries and when they were done? Knowing these will help us to better advise you.

Has the same doctor done all these surgeries? If so, I'd run from him. You need a revision specialist that has experience with problem knees, someone far away from your current doctor. Fresh eyes will be much better for your knee.

I see we are from the same area. Who was your doctor?
 

Jamie

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Hi, @MikeG.....wow, I'm so sorry to hear all you've been through. I understand your frustration with being told to "just live with it." Let's see if we can help you find someone who may have a different viewpoint. First, I'll need to know a bit more details about what you've been through so far. If you could respond to these questions, it will help.

1. Have you had the same surgeon for all the surgeries?
2. Can you provide names of the surgeons you've used?
3. Was an infectious disease doctor brought into your case at any point? If so, can you provide that doctor's name?

And the big question, I see you live in a rather small community in the middle of Virginia. Would you be willing to travel to see a revision specialist?
 
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MikeG

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@Jamie Thank you for responding. I have had four different surgeons throughout this nightmare that has basically ruined my life. I started with Dr. Paul Kiritsis at Saint Francis Hospital in Midlothian, Va. This doctor is the main cause of all my problems as he turned his back on me when the thought of infection presented itself. It was very obvious after the surgery that something was wrong as the wound was leaking fluid. The awesome nurses also could tell something was wrong, but this doctor was very intimidating and kept insisting all was well. He left for a three-day conference and instructed the stall to bombard me with antibiotics and while he was gone the nurse informed me I was scheduled for a clean out. Upon his return he informed me the drugs had done their job and cancelled the surgery and I was released. Of course, now I know it doesn't work that way and in order to protect his flawless record he dismissed me.

Of course, this came back to bite me in the butt 9 months later when I went to the ER with a badly infected knee and had revision surgery. Doctor Glenn Kerr performed the revision that included removing the implant and inserting a spacer followed later by a new implant.

I moved to Atlanta and three years later the infection returned so I was rushed to Southside Hospital with a 106 temperature. I had the implant removed and another spacer implanted only to have a clean out 3 weeks later. I spent a month in the hospital and returned to Virginia to see Dr Kerr as I discovered the surgeon in Atlanta was not a joint specialist and had additional surgeries performed by Dr Kerr only to be referred to VCU Hospital as they had a better infection control department. The surgeon was Jibanananda Satpathy who performed the revision surgery by inserting another spacer. After the usual 6 weeks antibiotics it became infected again and another spacer was inserted which cured the infection and that's where we are today. That was August 2021 and when I saw him in December 2021, he advised me to forego any future surgeries. It's been almost a year and I feel the spacer is breaking down. I can barely walk and feel totally hopeless. I so much appreciate any assistance you can provide. In Atlanta I also had neck surgery as the infection had entered the C5 vertebrae and had to be surgically removed.

Surgeries​


Knee replacement Right 11/2014 (St Francis, Midlothian, Va)
Spacer inserted right knee 12/15 (St Francis, Midlothian, Va)
Knee replacement Right 02/8/16 (St Francis, Midlothian, Va)
Spacer inserted right knee 5/17 20 (Southside hospital. Atlanta, Ga)
Clean-out 6/20 (Southside hospital. Atlanta, Ga)
Neck surgery 6/20 (Southside hospital. Atlanta, Ga)
Clean-out 8/16/20 (Southside hospital. Atlanta, Ga)
Clean-out 10/2/20 (St Francis, Midlothian, Va)
Knee replacement Right 11/2014 (St Francis, Midlothian, Va)
Spacer inserted right knee 12/15 (St Francis, Midlothian, Va)
Knee replacement Right 12/8/20 (St Francis, Midlothian, Va
Clean-out 12/18/20 (St Francis, Midlothian, Va
Spacer inserted right knee 6/16/21 VCU Hospital, Richmond, Va
Clean-out 8/19/21 right knee 8/19/21 VCU Hospital, Richmond, Va
 

WFD

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If I understand correctly, you have been advised to leave the antibiotic spacer in there? I didn’t think those were intended as permanent solutions.

If lack of tissue were the only problem then you might consider a hinged knee - that’s what they are designed for - but getting infections after every TKR is concerning. Has anyone ever determined why that happens? Is there an underlying problem that can be addressed? Getting infections after every surgery is not normal.
 

sistersinhim

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Have you been tested for a metal allergy? Just throwing that in there. We've had a few members that continuely had problems and it ended up being a severe metal allergy.

For anyone who would like to get a full metal allergy test prior to any joint replacement surgery, you can get the test done in the USA by ordering the test kit from https://www.orthopedicanalysis.com/testing/order-testing-panel . You want the Orthopedic Panel Test 2. Once you get the test kit, your GP (or any lab) can do the blood draw and send it in for testing. You will have to have a doctor's order for the lab to run it.
 

Jamie

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@MikeG Did you have an infectious disease specialist involved with any of these procedures? If so, which ones, please. This makes a difference in how I might guide you.

I've condensed your list of procedures down a bit to create a signature for you. It's quite a list and very troubling that the infection has been so persistent. But I'll need information about the involvement of an infection specialist before providing any recommendations.
 
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Jamie

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If I understand correctly, you have been advised to leave the antibiotic spacer in there? I didn’t think those were intended as permanent solutions.
Actually, there are cases where the ceramic spacers are left in place for extended periods of time and they can function that way.
 

LaJudes

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I just had a hinged knee replacement put in June 28 , after a reoccurring infection , hardware removal , antibiotic spacer and 6 weeks IV antibiotic treatment . The hinged knee was placed because the lengthy infection ( 1 year) caused a lot of damage . My original orthopedic Dr also said all along that the reoccurring infection was not in the knee hardware , but more surface and kept treating me with antibiotics , until the infection surfaced as a big bubble just below my knee . He then referred me to a revision specialist , who admitted me the same day and did the hardware removal surgery the next day . That surgeon said the infection was all over the knee joint ! The whole thing is so long term , and I spent 3 months with a knee brace on, besides the surgeries and antibiotics. I have yet to have any PT , but will be seeing one next wee just to go over the difference between the regular TKR hardware and the hinged hardware .Pain with this new hinged knee has been minimal , and I have a good bend already 90% , with no rehab .
 

Jamie

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Thanks for your post, @LaJudes. It’s always helpful to hear from someone who has been there. Your unfortunate infection situation highlights the need to get an infectious disease specialist involved if an infection goes on for an extended period of time. Best of luck to you with this new knee. Things sound good so far.
 
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MikeG

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Sorry for not responding earlier but I took a bad fall and broke a bone in my foot and broke a rib as well. When you can't bend your knee you can't break your fall. My infectious disease doctor was... Mark A Gentz, DO,
Primary Care, Infectious Diseases
 
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sistersinhim

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Oh no, @MikeG! What a terrible fall you had. I pray for your quick healing. You have been through enough!

When did you have your fall and which foot was it? I can relate. I've had 2 broken bones in my tkr foot and ankle and 2 cracked ribs. I can't imagine how painful a broken rib would be! My cracks were very painful. Are you non-weight bearing?
 

Jockette

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So sorry you had such a bad fall. :sad:
 

Jamie

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@MikeG.....oh my, how awful that you took such a bad fall. I am glad to hear you have had an infectious disease doctor on your case. Has he offered the same advice as your orthopedic surgeon.....not to have any invasive procedures?

I understand there is a risk of infection returning for someone who has been through everything you have experienced. But there is also a quality of life factor that you must balance with that risk. In order to make decisions, you're going to need all the input from your medical team you can get.

Once you feel better from your recent fall, I would schedule a consultation with your infection specialist. If he believes the infection is truly gone, you could talk with a couple of other revision surgeons who are not connected with your doctors in any way.

One good option would be to gather all your records and submit them to a special team at the Hospital for Special Surgery in New York City. They will do some consultations via telehealth as they review your case. A surgeon I am familiar with there is Dr. Della Valle. Here is some information for you in case you decide to go this route. Please let us know if you have any questions and what you decide to do. I'm so sorry this has happened to you and we'll be here to support you in any way possible.

New York City
Hospital for Special Surgery (HSS)


Stavros Niarchos Foundation Complex Joint Reconstruction Center is a special program created with a $10M grant that deals with diagnosing and treating the most challenging knee and hip replacement problems. As part of the diagnosis, a committee of surgeons meets to discuss your case. There is a $500 fee for your case review. This center is headed up by Dr.Thomas Sculco.

Hospital for Special Surgery (HHS) surgeons for knee revisions:

Dr. Bostrom*
Dr DeFelice
Dr. Della Valle*
Dr. Jerebek
Dr. Westrich

* These are the two surgeons I have some knowledge of and would definitely recommend.
 
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MikeG

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Thank you so much for all your advice and encouragement
 

campcol1

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Dr. Della Valle-hss. He is a great doc. Robotic assisted. He did both my knees and hips. Goo d luck!
 

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