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Knee Infection staph infection on LTKA

@KarriB how do you research that? I know Doc Ting has done quite a few and he repairs others work. Dr Amanatullah works for Stanford and worked at Mayo clinic...he is young, practicing since 2007 and outside California, so not a lot of info.
 
You can ask their offices how many revisions they've done. But you want an OS who will work hand in hand with an ID. So your aspiration showed an infection? Staph? When was the aspiration done? Was it done because of pain you're experiencing, swelling or some other symptom? For there's an infection I'm confused as to why the doc is waiting until November.
 
The joint was aspirated 28 May, 2016 (trace staph lugdenensis) 1 month later (no infection) pain and swelling returned 1 month later same staph. I have been on antibiotics and herbal formula which is controlling the bacteria (pain and swelling). Waiting until November for Stanford doctors and my schedule. I will talk to my original doctor next week.
 
If you have a staph infection in the TKR joint, it doesn't sound like a good idea to wait until November.
From what I have read here, I got the impression that oral antibiotics will not treat the deep-seated infection adequately, and you need to have the infected hardware removed and an antibiotic spacer inserted.
However, I will ask @Josephine for her opinion.
 
skygirl said:
I have been on antibiotics and herbal formula which is controlling the bacteria (pain and swelling).
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So far as I am aware, herbal remedies don't control bacteria!

So far as waiting until November, it's actually the opposite as with a common or garden infection which generally needs to be dealt with as a matter of urgency. But with PPIs (peri-prosthetic infections) the situation is quite different because the infection arises from a film around the implant called biofilm. In these cases, the immature organisms need to be given time to mature and thus be affected by the antibiotics. Read this for more information Peri-prosthetic infection - also known as late onset infection.
 
@Josephine, thank you for responding. Now I understand what my OS was saying about no one touching the joint with trace evidence of the bacteria. I read your article and it sounds like a better idea to wait to let the young cells show themselves and have the revision in 6 months as long as I can control the pain and swelling with antibiotics. The herbal formula is for my immune system to strengthen it from the many surgeries. Thank you for all the valuable information, you have relieved my stress so many times.
 
Sorry about my delay in answering your questions. My knee was very painful and on occasion it felt like it was going to give out though I never felt it want to shift out of place. My pain increased as time went by and my ROM decreased.
 
Have you considered getting an opinion from broken link removed: https://www.dfwsarcoma.com/ in Plano TX? He is the 'go-to' person for these kinds of issues. He will look at your records and xrays and give you his opinion by phone or email if you can't travel to see him. I do strongly recommend you contact him and ask his opinion.
 
@Josephine, I called there and they said they will only look at x-rays etc for existing patients. All new patients must be seen by him. That is an option, will see what my doctor says about time line and his revision history, then maybe can get to Dallas sometime in the next couple weeks. I need to go back to work for at least 1 trip (flight attendant) to keep from losing my job (been out for almost 2 years, this started as a workers comp injury and of course they turned down the tkr, so am on my own dime and company policy is to separate employee after 3 years on sick list. If I fly 1 trip, starts the 3 years over). When I wear the brace and take antibiotics, I feel pretty good as brace helps the instability.
 
skygirl said:
Hi @RestAssured,
What was the procedure for your single phase replacement? Did they treat the bacteria prior to replacement ? Did you have the entire prosthetic replaced? What was your recovery time? Sorry for all the questions, but I'm getting all the info I can. Thanks
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Dr. Maale started Daptomycin before the surgery and I had 6 weeks of followup Daptomycin. Before the surgery I was on doxycycline and was moved to Bactrum after C-Diff. The ID specialist can help you figure out a treatment plan. The fibula came loose several months before I had my revision. I wore a brace. Recovery time is different for everyone but I was exercising 3 months? after my knee replacement I think? It is so fuzzy and I would have to go back through my Bonesmart "journal" to remember! :oyvey:

I can tell you it is the best decision I ever made. My knees get stiff if I can't exercise but other than that, I can kneel, get on the floor, do full pushups, Zumba, about anything I want.:happydance:
One of the many selling points with Dr. Maale was the fact that it was only a one stge revision. He said the more times the knee is opened, the better for a recurrance and it is easier on the body.
 
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Thank you@restAssured. I am trying to figure out the procedure for the single stage revision. Does he put in the antibiotic spacer? Antibiotic cement? Stanford doc said he could do 1 1/2 surgery remove the spacer on second surgery but may not have full range of motion...not an option for me as I am a flight attendant. Sorry to request technical info but it helps me understand my options. How does Dr Maale handle out of state patients?
 
skygirl said:
Thank you@restAssured. I am trying to figure out the procedure for the single stage revision. Does he put in the antibiotic spacer? Antibiotic cement? Stanford doc said he could do 1 1/2 surgery remove the spacer on second surgery but may not have full range of motion...not an option for me as I am a flight attendant. Sorry to request technical info but it helps me understand my options. How does Dr Maale handle out of state patients?
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Hello again! To answer your questions, no he doesn't or at least didn't put in an antibotic spacer when I had my revision. He does use antibotic cement though. The antibotic spacer is usually for the two stage revision. I have encouraged and sent many people from out of state to him. Dr. Maale is world renowned and I can understand why! I have sent people that were told amputation, even a fusion might be possible, and he fixed these people.
I hear from them regularly and no one has been sorry that they chose him:console2:
 
Hi. Going in for the 2 stage revision on my knee. They want to put a picc line or central line in during surgery, but I don't want it, have not had good luck so far and do not want to take a chance of having heart problems(hereditary minor heart rhythm) or a worse infection. The chances for infection, blood clots, heart problems are there, told Doctor I would prefer oral antibiotics(maybe fluid)...any thoughts on the picc line or alternative methods?
 
Maybe a power port? Its a very simple process , I think easier than a picc line. As for antibiotics, the ones you will need have to be IV. when I dealt with my hip replacement infection year long nightmare, I was lucky (? Ha) I had a power port from chemo the year before and I was self administering iv abx for months.
 
Thanks Diane Helen, trying to avoid anything invasive especially through my heart...also, I am allergic to quite a few antibiotics. The sulfa drugs are out the the question, Levofloxcin is bad news, joint swelling, headaches, foggy brain, Rifampin can tolerate for 3 days, then severe headaches. Erythromycin is tolerable...will have to see what the cultures bring back for susceptibility.
 
I had a PICC line for my infection. They didn't put it in during the surgery, they waited until the results were back from the cultures. The PICC didn't hurt going in at all. The technicians used a sonogram and I have really good veins. One tech stayed on the opposite side of the PICC going in and engaged me in conversation. I didn't even realize it was there. The biggest issue was showering as it can't get wet, so I wrapped my upper arm in cling wrap and used the hand held shower head to keep water from hitting it directly and soaking through. I don't recall what the IV antibiotic was, but I was on that and oral rifampin for 6 weeks. My ID did weekly blood labs to keep a check on everything and at 6 weeks my body did stop producing white cells, so I came off the PICC first, then the rifampin. After the white cells started producing again I went on 200 mg of doxycycline and am now on 100, blood is getting done next week before I see my ID. She said we were going to have a long relationship.
Someone on BS had an infection and was allergic to multiple antibiotics. She ended up seeing an allergist who helped figure out which meds she could tolerate. I can't remember who it was, but I'll search.
 
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