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[KNEE INFECTION] Stage Two Revision Completed

arizonaone

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Hi all.

Im new here and apologize for the length of this post but I'm really upset - barely slept last night and I need advice/insight from anyone who has had an infection after a TKR . I am in another forum as well but there was only one person who had an infection and in looking for additional information/ perspectives

I have been in alot of pain (with swelling) since my TKR in May of last year and subsequent MUA in August. Even pain management has not been 100 % effective. While I have always felt the implant moving in my knee; for the last couple of months everytime I move it I feel/hear it "thudding" - the only way I can describe it. The pain has also increased and I also developed numbing in the lateral part of the knee and the toes on the outside of my foot. In addition for the past week or so I have had burning in the joint area and sometimes over my entire knee. My knee has become really stiff and sometimes gives out.

Given the above I made an appointment with a new ortho surgeon because I was not especially happy with my original one. After examining my knee he felt that the implant was loose but ordered blood work (sed rate and C reactive protein) and a MARS MRI to rule out infection and for a better picture of the implant prior to scheduling revision surgery. I was able to view my lab results online which indicated the below:

Sed rate 46 mm/h - high ( in range is <OR=30 mm/h

C-reactive protein 11.3 - high (in range is < 8.0 mg/L

So I called the dr. to make an appointment after June 1 and asked if it was ok to wait this long given the out of range lab results. I was told that he wanted to see me sooner rather than later. So I went to see him on May 24th.

At the time of the visit he told me that I had an infection which would require the two stage surgery - the first to implant a cement spacer with antibiotics followed by at least 6 weeks of IV antibiotics via a picc line and the second for the actual revision. He also told me that he would not aspirate at this time to determine the type of infection because he did not feel it prudent to do so and that this would be done at the time of the surgery at which point the type of infection would be identified and the proper antibiotic prescribed. He also said that I must have a really good immune system as he was surprised that the infection has not caused sepsis. I should mention that he had not yet received the results of the MARS MRI which I found really surprising given that I had had it a week and a half before my appointment and while he may not have had the CD of the images the hospital where I had it should have faxed the report. He did not seem too concerned that he did not have this report but did say he needed it prior to surgery.

He did not feel I should wait 6 months for the first surgery but also did not feel it urgent enough to get it done a.s.a.p. When the surgical coordinator came in to schedule my first surgery I got the first available date of 7/6. At that time she told me that if the doctor felt the infection was really serious he would have immediately sent me to the ER as he had done with other patients,

I was telling one of my friends about this and she got really angry telling me that the doctor was full of sh**. That while my labs were slightly elevated that this was not indicative of an infection and that if I really had one the results would be in the thousands. She was basing this on what her lab results were regarding a thyroid condition that while elevated she was told by her doctor that they would have had to have been in the hundreds to correlate to this particular condition. She also said that there was no way my immune system had anything to do with me becoming septic or not and that there was no danger of that because she went through it with her husband who had a brain aneurysm and after his last surgery developed it and subsequently died when he went into septic shock. She thought the doctor was using this as a scare tactic and that if he really felt that I had an infection he would not allow me to wait 6 weeks for surgery, She also does not trust what he is telling me at all .

She then said that while she thinks I do have a problem with the implant that she does not think I have an infection or I would be really sick and that the only reason he wanted to do the two stage revision was to make money not caring about what I would have to go through. And she did not believe that he did not have the MRI results She said I need to get a second opinion.

I think that she is projecting her experience with her husband onto my condition which is like comparing apples to oranges as her husband's issue was extremely dire from the start. I also think she has a general distrust for doctors which is further clouding her judgement based upon what she went through. I also want to add that she thinks that she knows everything about doctors, lab results etc based on what she went through

I know none of us are doctors but I was hoping someone could answer my below questions based upon their experience:

Did your doctor aspirate your joint to confirm that you actually had an infection before scheduling surgery?


If not were you placed on any type of antibiotic before surgery to try to eradicate the infection prior to having the surgery to insert the spacer with antibiotics?.

Did you have the above labs and do you recall how high your results were and whether the results would have been extremely high if in fact an infection was present.


After the first surgery were you mobile with just a spacer in your knee - could you get around with a walker or crutches?

Were you in alot of pain afterwards?

Do you think the infection can get worse by having to wait 6 weeks for the doctor's first availabile surgery slot? Or maybe the infection is not even bad enough to warrant the two stage surgery and I should just have a revision?

Anything else I should know about the first surgery and then the actual revision surgery?

Lastly, do you think there is ANY validity in what my friend is saying and should I listen to her? I thought I could trust my doctor but now having second thoughts .

Thank you so much for any input on this, I really appreciate it! And again apologize for the length of my first post .
 
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Celle

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Hello @arizonaone - and :welome:

Please will you tell us the full dates of your knee replacement and the MUA, so we can make a signature for you? Thank you.:flwrysmile:

I'm sorry to read that your surgeon thinks you have a joint infection. :console2:
I would be far more inclined to believe your surgeon than your friend. I think you're right and she is projecting her experience onto your situation. She had a terrible experience, so don't blame her for that.

Your surgeon is recommending the right two-stage treatment for a joint infection.

It does sometimes happen that an infection is not treated immediately, especially if your general condition is good. Doing that can allow the infected biofilm to mature on the implant, which can increase the chances of a successful cure.

Whether you have a full-blown infection or not, it sounds to me as if removing the current implant is necessary. It sounds as if it is loose. That in itself could be irritating your knee.

When the knee implants have been removed, you will have an antibiotic-impregnated cement spacer placed in your knee. Most people can get around with that in place, using crutches or a walker.
While the antibiotic spacer is in place, you will be given a course of intravenous antibiotics and you will take antibiotics orally as well.
The IV antibiotics will probably be given via a PICC line:
PICC Line
Knee infection: what happens when a knee becomes infected?

An Infectious Diseases doctor should be on your team, to advise about the most appropriate antibiotics and the length of treatment.

When your doctors are satisfied that all infection has gone, you will have the antibiotic spacer removed and new knee replacement hardware will be inserted.
 
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arizonaone

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TKR. 5/16/17

MUA . 8/15/17

Thank you so much for your reply! It makes me feel so much better! I don't blame my friend, I totally understand where she is coming from but while she really upset me I do know she has my best interests at heart.
 

Jockette

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Welcome to Bonesmart! This is a wonderful forum with lots of information and lots of comfort and support.

Best wishes as you move forward.
 

SusieShoes

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I have a family member who had an infection and two stage treatment for her TKR. She waited a few weeks, as I recall, before the surgery and had the antibiotic spacer for a few months. She could get around the house on crutches and used a wheelchair to go out and about. She’s doing really well now with the revised knee.

I’d say trust your surgeon. Your friend is well-meaning but she’s not an orthopedic surgeon. Above all, go with your own gut and instincts. Wishing you the very best!
 

MathProf

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My implant will be removed next Monday, so I am a little bit ahead of you in the process. I had my LTKR in May of 2014, and never felt like it was right. It was always stiff and swollen. My RTKR had been done in May of 2012 and was (and still is) perfect. In December of 2017, on a cruise, my entire left leg hurt, throbbed actually, and I decided I had to do something, so I went back to my OS who had done both replacement surgeries, and he finally did the blood tests that you had. He was shocked with the results, as my SED rate was 62 and C-reactive was 24.9. He was unable to get any fluid off the knee and ordered an indium III white blood scan. The scan couldn't be done as the technicians were unable to get enough blood out of me to run the scan (I am a VERY hard stick). So by the end of February I had a doctor who said he was more than 50% sure I had an infection, but would not go farther than that. All the advice I got from lay people was useless....this infection is not like any other infection.
Eventually we went back to our summer home and I got a second opinion, who was able to get fluid out of the knee (he was willing to torture me - but also knew how to use an ultrasound to assist in the process), and the infection was not only confirmed but eventually cultured and is staph. I am not and have not been on any antibiotics during this whole time. It is my understanding from what I have read, and what my surgeon has said, is that not only will antibiotics not help with the infection I have, but they can make it harder to diagnose what the infection is and maybe even harder to treat after the joint is removed. I also understand that cultures will be taken during the surgery from at least 5 locations and these will be used to make sure that the correct bacteria has been identified, so that the correct antibiotic is given.
We are back in Florida and I am having the original surgeon operate, in part because I trust him, and in part because our home here is all on one level!
The Florida doctor indicated back in February that I was unlikely to develop any sepsis, but if I started to run a fever of 102.5* or higher to go immediately to ER. The pain has slowly and steadily gotten worse, but other than being maybe more tired (which could be because the pain at night is worse) I really don't feel bad. I know what you mean about hearing a noise from the knee, as mine has gotten worse in the last 3 months in that way too.

While your friend is well-meaning, she really doesn't have a clue what she is talking about. I have had plenty of that as well, from friends who are nurses, physical therapists, and med school dropouts :heehee:. Waiting is up to you, based on your pain level and satisfaction with your surgeon. Good Luck, and I'll be following you and your journey. Let me know if you have any other questions.
 
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arizonaone

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Thank you Susie and mathprof for your insight. I have known for many months that something was not right . Like you mathprof, I am tired all the time but as you said that could be lack of sleep from the pain. At times I'm also nauseous and unable to eat but that is probably from the pain meds.

I did and do trust my OS - much more than the first one I unfortunately was unable to find any specific info on infections, the blood work results or how they are treated beyond the two stage surgery. I'm so happy and appreciative that you both have shared your stories. They have put my mind at ease and I know now I am getting the best of care from my doctor.

It's funny how when I had cancer many years ago none of my friends (including the one I spoke of ) or family ever second guessed or questioned my oncologist's treatment plan or care. But for a knee infection which is far less serious everyone is now a "doctor" .

So glad I found this forum .:)
 

KarriB

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Is there an infectious disease dr consulting on your case? My infection became apparent early on, about 4 weeks after TKR surgery. I experienced a high fever and seeping through a closed incision. An ortho in the office was going to aspirate until he saw the seeping, upon which I was sent directly to the hospital for surgery with a revision specialist I had never met. Going into the surgery I was told the Dr wasn’t sure of the outcome, he may need to remove the implant and put in an antibiotic spacer or he may be able to washout/debride and replace the spacer. Well, that was the first thing I asked when I woke up. He performed a debridement washout spacer exchange. The first Dr I saw the day after surgery (surgery was late Thanksgiving Eve) was an infectious disease dr who reassured me they were watching the tissue samples but it would take a few days to know the outcome and then they would analyze and prescribe the right antibiotic, in the meanwhile I was on an IV antibiotic.

I think the only reason a washout was possible was because the infection was early onset and had not moved to the bone. I do still see my infectious disease dr yearly and take a maintenance antibiotic. I LOVE my revision doc and continue to use him for my left knee, but when an infection is concerned I think it’s wise to also consult an infectious disease Dr. So if you trust your OS go with him, but you’ll also need an ID I’d there’s an infection.
 

Jockette

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It's funny how when I had cancer many years ago none of my friends (including the one I spoke of ) or family ever second guessed or questioned my oncologist's treatment plan or care. But for a knee infection which is far less serious everyone is now a "doctor" .
One of the biggest shocks of this recovery has been anyone and everyone’s opinion on how to recover.

I now realize my partial is a failure and that’s probably one if the reasons my recovery has been so difficult. It was doomed from the start.

I agree, it doesn’t happen with other medical issues.

I’m so glad I found Bonesmart also!
 
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arizonaone

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Hi Karri.

Thank you for sharing your experience. I can't imagine how you felt not knowing until after the surgery whether a spacer would be implanted or not . Thank goodness they caught it sooner rather than later .

My OS told me that when he goes in for the first surgery an infectious disease doctor will be consulted and will be involved in my care for as long as my infection persists .

I guess until the type of infection is identified my doctor will not consult with the ID doc .

Will you have to take the maintenance antibiotic forever?

Also is there a way to reply to each poster individually? I only see one reply box for the entire discussion string .
 

KarriB

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You can’t reply to each poster individually, we are alerted to your reply and can view it with no problem. You’re doing great.

I’m glad an ID will be part of your team. My ID checks my blood work to be sure everything is good and so far no mention of problems or stopping the treatment. I’m ok as right now I’d rather not endure an antibiotic spacer if the infection should return after stopping the antibiotics. I live in a ranch house, however there are 13 steps from the garage to the living area and I’m not sure about getting up/down my stairs on crutches for 6 weeks. My OS said if I had to have a spacer I’d be on toe weight only. I also will need my left knee done sometime in the future so I’m hoping the doxycycline helps to keep another infection from taking hold at that point.
 

celynda

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Welcome to Bonesmart! I am so sorry to hear of your challenges with your knee. You’ve gotten excellent advice from the advisors on this forum.

Keep us posted on your progress and surgeries. I am not too far from you in Orlando so will be thinking of you.
 

sistersinhim

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If you click on the red button that says 'infection' you can read threads from people that had infections and how they were treated.
 
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arizonaone

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Not sure if anyone knows anything about a MARS MRI - or had one but I thought I would ask.

Since my OS was not sent the results by the day of my appointment I went to pick them up today .

The radiologist report stated that there was a tremendous blooming artifact significantly limiting the sensitivity of the study. And after a short paragraph said that the study is quite limited .

I thought that the whole reason for having the MARS was that the reflective elements of my implant would be lessened and that would allow clearer images and enable the radiologist and my doctor to better see the implant/surrounding tissue to determine if there is a problem .

Apparently the MARS protocol was useless.

Was I expecting too much and was the resulting limitations "normal" given the implant? Or was the MRI done incorrectly? If you had one was the radiologist actually able to see anything?

I know my OS is the best one to ask but I have to send the results and CD to him but concerned I may have to have it redone and not sure insurance will pay for it again .
 
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