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Knee Infection* Stage Two Revision Completed

Josephine

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Not sure if anyone knows anything about a MARS MRI. Apparently the MARS protocol was useless.
There's nothing particularly special about a MARS (Metal Artefact Reduction Sequence) MRI (magnetic resonance imaging). It's just a regular MRI with the settings and exposures adjusted. The radiographic technician needs to know what s/he is doing in fine detail else it will be no good.

Read this MRI scans and joint replacements
 
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arizonaone

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Thank you, Josephine . It does not appear that the tech knew what she was doing based on the report but what do I know. I'll have to wait for my doctor"s opinion as to whether it was in fact done incorrectly .
 

Celle

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I don't understand why it had to be your job to pick up the report and the CD and send them to your surgeon.
Doesn't your surgeon have an arrangement with the people who do X-Rays and scans, whereby the images and reports are emailed to him or transmitted some other way electronically? If not, he should!
 
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arizonaone

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Under normal circumstances he would .However, his office is 3 hours south --in South FL He is not part of the hospital system where I live. While he requested that the hospital forward the result to him they never did and I picked it up to make sure it was done .

I would have had it done near his office at the facility he recommended but they had no openings for the MARS (which they do only 2 days a week for a set time slot) for 2 weeks so I decided to have it done closer to home. Hope it didn't turn out to be a big mistake but I'm thinking it was.
 

PegGar16

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Hi @arizonaone! The name threw me when I saw that you are located in Melbourne, FL. Are you from AZ?

I also went through a staged revision. I was able to get around with the spacer using crutches. I guess doctors are of different opinions because mine was weight as tolerated with limited bend. I had my last surgery in Feb 2017 and have had no problems. I also do not need to take antibiotics. They made sure the infections was gone before the final surgery - that is when I had a number of aspirations done.
I am sorry your friend is projecting her issues (which is understandable) but you know there is definitely something wrong with the knee so let them fix it. I also did not have the biopsy/tissue sample until the surgery.
Good luck with your surgery.
 
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arizonaone

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Hi Peggy.

No, not from Arizona .Just been there many times and love the state! Funny story- years ago when I lived up north I sent out a resume for a job .Got a call for an interview and when I went in the interviewer told me he called me in because he liked Arizona too and was curious about my email address .I did not like the office- or him so when he asked my salary requirements I gave him a ridiculous amount. Never heard another word from him. Lol

Glad you were infection free when all done!

Question- I live alone with a small dog .Will I be able to care for myself with the spacer and a picc line in for the antibiotics? My closest friend is a half hour away and works so she will not be able to help much during the week. I'm really considering going to a rehab after surgery although I really don't want to . If you live alone how did you get along by yourself?
 
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arizonaone

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So sorry everyone. Appears there was an issue when I tried to post reply to Peggy. I hit the post button and it did not look like it posted and the 3rd time I tried got an error message. Did not think it posted at all and couldn't find way to delete duplicates.
 

alexthecat

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@arizonaone I deleted all those duplicates for you. The computer gremlins are having a field day today, aren't they?
 

PegGar16

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Hi! As far as being by yourself, how did you do after your initial TKR? There was not a great difference for me between the original surgery and the first spacer (I had some added issues that required another spacer :) It all depends on what your surgeon says about weight bearing. The PICC line was not difficult. They had me on Vancomycin which were delivered in small infusion balls that attached to my line. What I liked about the balls was that I could tuck it in a pocket or my bra while . I moved around or if I was out. If you are going to be on crutches I recommend the forearm type. I did not like the under arm pit ones while I had the PICC line...but that might just be preference.
I have family at home with me so didn't have to worry about a lot. I do suggest that you get some frozen dinners that you like or easy to cook stuff. Also if you use dry dog food , measure some out in ziplocks so you don't have to worry about balancing with the crutches. I really think you should be OK.
 
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arizonaone

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Thanks Peggy for all of your great advice! It does make me feel less apprehensive. :) I think I will feel more confident and stable with the forearm type crutches- never tbought of getting those. My doctor did tell me I should be able to get around on crutches or with a walker so I assume that means I can be sonewhat weight bearing.

I stayed with my mom after my tkr for 3 weeks. She took me to pt appointments, cooked for me, walked the dog etc. However, she is 85 and told me she doesn't want me staying with her this time .I totally understand. She was very worried and basically decided to be my nurse- up everytine I got up to take pain meds, use bathroom etc. Its way too much for her.

After I went home I did ok alone .Was in alot of pain but did what I could do.

Guess I just have pre op jitters .
 
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arizonaone

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I am really concerned. Last year about 6 weeks after my TKR my knee became more painful than usual. It was still swollen ( and remains so), stiff and I was having issues walking. Additionally, I just wasn't feeling well. Since I lived alone and had a manual transmission car I couldn't really drive so I called 911.

I was transported to a free standing ER and then ultimately taken to the hospital where I was admitted for observation for 3 days as they thought I had an infecion. Blood work was taken the evening of my admission and the following day. During my stay the doctors were in contact with my OS.

I had been told that the day of my admission my blood work was high and then was told that the next day it was no longer elevated which meant I didn't have an infecion. While they initially had mentioned that they wanted to aspirate my knee the PA in the hospital decided not to because my surgery was too recent and they didn't want any potential complications.

I never got the hospital records- never really thought I needed to because when I was discharged no one really said too much besides to follow up with my doctor.

I decided to obtain my records which I just received. On the day of my admission my wbc was somewhat elevated at 10.94 but had gone back to normal range the next day. However, my sed rate westergren was 48 on day 1 and 41 on day 2 both of which are in the high range. And as I indicated in my first post the sed rate is now 43. Still high.

Not only that but my discharge diagnosis was Cellulitis.

So, my questions are: Isn't cellulitis an infecion? Also, is it possible that back then the lab results were high simply due to inflammation after surgery? Or based on the lab work and diagnosis that I really did have an infecion.

I am really upset because no one including my OS who I saw 2 weeks after my hospital stay said not a word about a possible infection given my continued elevated labs. Nor did my OS order any more testing to definitively rule out an infecion. I feel like no one took either the blood work or cellulitis diagnosis seriously at the time and if they had I may not have needed a 2 stage revision but rather only a wash out and course of antibiotics.
 
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Celle

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Yes, cellulitis is an infection, but it is an infection of the soft tissues and not an infection of the knee joint.
It is probably not related at all to your current knee infection.

It's understandable that your blood results were elevated when you had cellulitis.
 
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arizonaone

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So I went to see my primary care doctor today or actually his ARNP. The doctor had no availability so I was stuck with her. I had already seen the results online of the labs my OS had ordered through my primary care dr. and knew based on that that I most likely have a UTI. Had only one in my life when I was like 10 and of course the only other one has to be 10 days out from surgery.

At no time did she even mention my lab results not even the results of my UA. Therefore at the end of the visit I mentioned it to her . At that point she tells me she wouldn't clear me for surgery with it but at no time mentioned prescribing antibiotics or anything else. I was so disgusted I didn't say another word and left the office.

I am really upset. Haven't been a fan of this doctor's staff for a while but didn't want to switch so close to my surgery.

So now what do I do? Will I be able to take antibiotics because I had read that if you take them so close to surgery they may not be able to tell what type of infection you have .

Should I call my OS in the morning to tell him? Will he prescribe antibiotics or will he refer me back to my primary care dr.? ( I hope not because my trust in them is now zero) I'm afraid this will delay my surgery and my knee is becoming increasingly more painful and am worried about living with an untreated infection.
 

SusieShoes

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No wonder you’re upset. You were left in medical limbo. :blackcloud: I say call the surgeon, explain the situation — that you saw your labs and visited GP/NP but got no guidance on what to do — and say you want to go ahead with the surgery. What should you do? The surgeon has almost certainly run into situations like this before and will tell you how to proceed.

If your surgery must be delayed (not necessarily a given until you know what the surgeon wishes to do), it won’t be because you’ve not done your part. You did all you were asked and tried to anticipate any issues.

I would also let the GP know you are unhappy with the treatment, or rather lack thereof, you received. “Nothing” is not the usual treatment for a UTI. The NP just telling you she would not clear you for surgery and sending you on your way without any guidance whatsoever isn’t great medical care. It doesn’t qualify as caring either.
 
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arizonaone

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@SusieShoes Thank you for responding .I called my OS office and the receptionust told me I had to speak to the surgery coordinator .Mmm don't see an MD after her name. She also was surprised that my NP did not prescribe antibiotics so she called them and they sent a script to my pharmacy. And she said I should be ok for surgery.

Of course now I'm getting conflicting messages .The surgical coordinator sent an email telling me the NP is waiting for the results of my chest xray to clear me but my PCP office told me that they will need another UA done before they give clearence.

Does anyone know what they are doing?
.
I am so tired of having to advocate for my own medical care . I'm stressed enough and this just adds to it.

I will be telling the GP exactly what is going on in his office- at the same time I request my records to take to my new doctor once my surgeries are done. Right now its not logistically beneficial to do so.

Thank you for listening to my rant (s) :)
 

SusieShoes

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Well, the NP should have told you she was waiting on an X-ray. That at least explains why she sent you off without clearing you.

A surgical coordinator is a skilled person in your OS’s office. She may be a PA or nurse and, even more importantly, knows the surgical protocols required by both her surgeon and the hospital where the surgery is to be done. She’s also on your side. She wants to make sure the surgery will go ahead without a hitch. Doing so makes the surgeon’s life a lot easier (fewer surprise cancellations or medical blindsides) and yours (all the t’s are crossed and the i’s are dotted). She may not be an MD but if she says your surgery is still a go, it’s a go. :)

She took care of the UTI issue and answered the “will this delay my surgery” question.

It doesn’t hurt, I suppose, that the surgical coordinator called your PCP’s office to ride herd a bit. She wants that medical clearance as much as you do. :yes:

Pre-surgery has a tendency to be a little crazy with tests and clearances. Just keep crossing off the obstacles as you get to them and ultimately it all gets done. :friends:
 

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