Knee Infection* TKR Infection 2 Years Out

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When you see your surgeon on Friday, @TKRsharon , make sure that he/she takes a swab of the discharge from your knee. You need to be sure you're taking the correct antibiotic.

You definitely need an Infectious Disease control doctor on your case, and a wound specialist wouldn't be a bad idea either.
A suction dressing may help to heal this up faster, too.
 

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Sending positive support and energy your way..
 
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TKRsharon

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I had my TKR 2 years ago and everyone here was extremely helpful in getting me through my recovery, and I am so grateful for that. A week ago, the surgical knee became very swollen and red. I saw the surgeon on Thursday as that was the earliest he could see me. The knee was and is very painful. The PA was very alarmed. I was put on Doxycycline and am having an aspiration on Monday. There is a "bubble" on the surgical scar, that looks as if it is going to rupture. The doctor said an infection at this point is rare. I did not fall or bang the knee, or had any other surgical procedure or dental work. I have not been sick. Has anyone had any experience like this. Again, it is very painful, but the swelling is a bit less as I now have more bend in the knee. I want to get a new surgeon who is more responsive, especially when there is an urgent need. Will another surgeon, from another practice take me on as a patient? This practice won't let you see another doctor in their practice, which I don't understand. Thank you again for all your past support.
 

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@TKRsharon Welcome back to BoneSmart! You will notice I merged your latest post into your original recovery thread. That way we can see your history in one place.

From reviewing your original thread I would say you have certainly had some problems with this knee. I would suggest you ask your GP to refer you to an specialist in infections. This isn't the first time you have had a problem with the knee. Time to find someone who can help you get this resolved.

Who are you seeing currently and which hospital. We may be able to help you find someone.
 

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I had a similar experience 3 years after my TKR . l kept getting small bubbles or sores just below my knee cap . After treating it several times and then even a surgical clean out of the sore , it always came back after stopping the antibiotic . The orthopedic surgeon also told me that he was sure it wasn't in the joint , since the sore was below the joint . After almost a year of this , they sent me to a revision specialist . That surgeon said right away what was going on , the infection was in the joint and had made a trail down to below the knee , where the infection was showing up . l was immediately hospitalized and the next day surgery , he took the entire knee joint out and put a spacer full of antibiotic in , l was hospitalized 8 days and went home with 6 weeks of home IV and a wheelchair !
Just be really persistent in getting this followed , l too had an aspiration check for infection , that didn't save me from all the misery . The aspiration found a small amount of staff epi which they kept treating me with oral antibiotics until the sore got as big as an egg ! Only then did l get referred to a specialist .
 
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TKRsharon

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@TKRsharon Welcome back to BoneSmart! You will notice I merged your latest post into your original recovery thread. That way we can see your history in one place.

From reviewing your original thread I would say you have certainly had some problems with this knee. I would suggest you as your GP to refer you to an specialist in infections. This isn't the first time you have had a problem with the knee. Time to find someone who can help you get this resolved.

Who are you seeing currently and which hospital. We may be able to help you find someone.
Thank you for your advice. My surgeon's office is on Long Island in NewYork, but he operates in NYC. He will see patients in NYC on days he operates, but this is very inconvenient - to drive into the city, park walk....especially when in a lot of pain. I did this once (took a car service!) and he never came to see me - sent a colleague. I did see a doctor who specializes in infectious disease a while back with a different issue. If you could refer me to someone, i would be grateful! My surgeon's attitude leaves much to be desired but I thought I should see him first. Thank you so very much
 
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TKRsharon

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LaJudes
Thank you. This sounds similar to what I am going through. I am sorry for all the pain and misery you had to go through. I find the surgeon to be pomous and his wait and see attitude is dangerous. I will seek help elsewhere
 

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I agree, that’s quite a hike all the way into the city, even if you are not in pain.

I find the surgeon to be pomous and his wait and see attitude is dangerous. I will seek help elsewhere
Definitely time for another doctor.
 

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Perhaps my colleague @Jamie can check and see if we have any surgeons in the Long Island area who are specialists.
 

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@TKRsharon .... I can help you find a revision specialist. Please tell me the name of the surgeon you're currently seeing so I can do a little research on him as well. I agree that his handling of your case has not been the best and it is time to seek out someone else who will be more responsive. Infection can happen years after surgery and the story told by LaJudes illustrates how sneaky joint infections can be.

Can you post a photo of your knee so we can take a look?
 
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TKRsharon

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@TKRsharon .... I can help you find a revision specialist. Please tell me the name of the surgeon you're currently seeing so I can do a little research on him as well. I agree that his handling of your case has not been the best and it is time to seek out someone else who will be more responsive. Infection can happen years after surgery and the story told by LaJudes illustrates how sneaky joint infections can be.

Can you post a photo of your knee so we can take a look?
Thank you so much Jamie! His name is Scott Marwin. I appreciate your help
 

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Try saving the image to your device, then post here from that device’s photo library.
 
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0.jpg
 

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I have ZERO medical expertise, but that does not look like a ‘wait and see’ situation to me! I agree with the advice to see a completely different surgeon asap. Hopefully Jamie will have some names for you and you can get in with someone very soon. Keep us posted. Wishing you the best of luck!
 

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You are right to be concerned and to seek immediate action. Your knee has some of the signs of infection and "wait and see" is not a good approach.

Since you mentioned you have seen an infectious disease doctor before about another issue, I suggest your first step is to arrange an appointment with him on an emergency basis. When you call the office to schedule, tell them you believe your TKR is infected and, if possible, send them these photos. The fact that this "bubble" that appears to contain pus has appeared since Thursday, is significant.

Go ahead with the aspiration on Monday. That is typically one of the first steps when an infection is suspected and it should yield some answers about that possibility. If the doctor didn't order blood tests for you, ask if you can have test for elevated serum erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) concentration as well as elevated synovial white blood cell (WBC) count. These are necessary along with the aspiration to determine if an infection might be present. Normally, the aspiration and blood work would be done right away and I'm not sure why there was this delay, but it shouldn't be a problem. It may take a few days to get the results from the tests of the fluid drawn and know exactly what you're dealing with. The blood results should be faster.

Periprosthetic infections can occur for a number of reasons and not all are completely understood. There doesn't have to be an external cause such as an injury or other means for bacteria to enter your body. Even though everything is considered surgically sterile when your implant is placed, there is the possibility of bacteria on the implant itself encased in a protective biofilm. It can remain there dormant for extended periods of time until something triggers it to activate.

Here is a pretty comprehensive thread on the subject from our BoneSmart Library.
Infection: peri-prosthetic infection - also known as late onset infection

Here are some surgeons for you to explore. You are fortunate to be in an area where there are many possibilities. My recommendation would be to go to one of the surgeons connected with the Hospital for Special Surgery (HSS). I am personally familiar with Dr. Della Valle, but others on the staff there would be equally good.

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 fee for your case review. This center is headed up by Dr.Thomas Sculco.

Revision surgeons at Hospital for Special Surgery, New York City (revisions of both hip and knee):

Dr. Goeffrey Westrich
Dr. Russell Windsor
Dr. Seth Jerabek - recommended by Skybig. Working with him on severe metal allergy (Nickel, Chromium, Molybdenum, Vanadium and Aluminum and Zirconium sensitivity).
Dr. Michael Cross
Dr. Michael Parks

New York City
Hospital for Special Surgery (HHS) surgeons for knee revisions:

Dr. Bostrom - Speaker at 2018 ICJR workshop on problem hips and knees
Dr DeFelice
Dr. Della Valle (I have heard several recommendations on this surgeon)
Dr. Jerebek
Dr. Westrich
Dr. Jose Rodriguez (primary hip recommendation, but does knees as well)
Dr. Mayman (primary hip recommendation, does knees as well but doesn't take Medicare)


New York City area

Dr. James Nicholson
14 Tech Drive, #11
East Setauket, NY 11733
(Suffolk County)
(631) 444-4233

Dr. Bradley Gerber
36 Lincoln Avenue
Rockville Center, New York 11570
(516) 536-2800

Please let us know how things go with your knee. I will be looking forward to your updates. Thanks so much for the photos. That really helps determine the urgency of your situation.

 

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