Knee Infection* TKR2019 Revision 2021 Now possible infection

[EalingGran]

Low-grade periprosthetic knee infection: diagnosis and management - PMC

Diagnosis and management of low-grade periprosthetic knee infection are still controversial and debatable. The diagnosis of low-grade infection after total knee arthroplasty is often complex, as clinical symptomatology and diagnostic studies are ...

pmc.ncbi.nlm.nih.gov

This is a good review but a bit technical.
It is very complex and not necessarily easy to find low grade infections.
There is a procedure called sonication which breaks down the biofilm and helps to culture difficult to find organisms but it is done on the removed implant.

 

[Romans8:28]

Low-grade periprosthetic knee infection: diagnosis and management - PMC

Diagnosis and management of low-grade periprosthetic knee infection are still controversial and debatable. The diagnosis of low-grade infection after total knee arthroplasty is often complex, as clinical symptomatology and diagnostic studies are ...

pmc.ncbi.nlm.nih.gov

This is a good review but a bit technical.
It is very complex and not necessarily easy to find low grade infections.
There is a procedure called sonication which breaks down the biofilm and helps to culture difficult to find organisms but it is done on the removed implant.

Thanks EalingGran,
This is the very article that I have been reading!! I have searched high and low and read so much. the forum is a good help in confirming some of my thoughts... Best Regards

 

[Layla]

Hello Romans8:28
Wishing you the best for your appointment with the surgeon on Wednesday. Please let us know how it goes, we're here for support always.
I hope today is a good day!
@Romans8:28

 

[EalingGran]

Good luck for your appointment.
I had always assumed that a two stage replacement was the gold standard in suspected PJI but this review article suggests otherwise.

Systematic review and meta-analysis of single-stage versus two-stage revision for periprosthetic joint infection after knee arthroplasty: a call for a randomised trial​

Chengxin Xie 1,*, Wenjun Pan 1,*, Shouli Wang 1,*, Xueli Yan 1, Hua Luo 1,✉

• Author information
• Article notes
• Copyright and License information

PMCID: PMC11195333 PMID: 38828985

 

[Jamie]

Excellent study report, @EalingGran….thank you. This recent study changes the way I look at the single stage revision for infection and I hope it proves to be a good option for Romans8:28. You’re going to be a well-informed patient when you see your surgeon this week. Let us know how your discussion goes.

 

[Romans8:28]

Good luck for your appointment.
I had always assumed that a two stage replacement was the gold standard in suspected PJI but this review article suggests otherwise.

Systematic review and meta-analysis of single-stage versus two-stage revision for periprosthetic joint infection after knee arthroplasty: a call for a randomised trial​

Chengxin Xie 1,*, Wenjun Pan 1,*, Shouli Wang 1,*, Xueli Yan 1, Hua Luo 1,✉

• Author information
• Article notes
• Copyright and License information

PMCID: PMC11195333 PMID: 38828985

This is a very helpful article and may reflect my Surgeons thinking. I will report back after my appointment tomorrow. Thank you for your help.

 

[Romans8:28]

Hi All, Appointment went very well with my surgeon. The short answer is full revision surgery on 17 October. I chose this surgeon because of his interest in dealing with infected joints and the excellent reputation that he has. We talked about the interaction that he has with the Microbiologist and the testing lab. he has worked directly with them and is completely confident in the systems that they have in place, considering them to be of 'gold star' - up to top international standards. Their testing came back negative from the Aspirate in late May 2025. In talking with them he is confident that they are correct and that we are dealing purely with a loose femoral component.

We spoke at length on the issue of difficult to identify low grade infections. He is fully aware of all of the issues here and he acknowledged my concerns. He also agrees there is a possibility of infection, but thinks it unlikely. He was fully aware of the current debate about the better results from one stage revision and he spoke about the 'bias' that there is with the need for more controlled trials. He does both 1 stage and 2 stage revisions depending upon the symptoms of patients.

I must say that all of my questions were answered and he appreciated the challenges that I was bringing, considering that it helps sharpen him and think through issues well. For your information he is from the UK where he was trained and worked in a leading hospital. He migrated here to NZ.

The surgery on 17 October will be done in one day in two stages. Stage one is the full removal of the existing implant, with thorough cleaning, debridement, antibiotic treatment, specimen removal for culture investigation... The incision is then stapled closed and the theatre vacated by all staff (and me!). After a full sterilization, all staff changed and clean and also my leg etc., rewashed/iodised, the full replacement will happen. 3/4's of a day is set aside for the whole procedure.

The cultures will have an initial report after 2-3 days (I will be in hospital 5-6days). I will be having a full antibiotic treatment, and it will be the final culture results after 2 weeks that determine if any further antibiotic regimen is necessary.

I must say that I am confident that I have been heard and my concerns are relieved. It was good to hear of the Microbiologist feedback and interaction with my OS. Romans 8:28 is a fantastic verse and I know that with whatever outcome I have God has a path for me for my good and His glory!

Thank you all for your support - I will keep you updated with any news prior to the surgery and then following on from it.

 

[sistersinhim]

That is one of my favorite verses, too. I often quote that when things aren't going well. I know that God always has what is best for me, even though I might not think so!

I'm glad you met with this new doctor and like him. He sounds very thorough and explained things to you, while also answering your questions. You now know your path, and that's good. I will be praying that you are completely healed!

 

[benne68]

How wonderful that you were able to have such a thorough discussion with your doctor, @Romans8:28. Some surgeons just don't take the time to listen and to explain things, but yours sounds great. That would give me confidence, too.

We are here for you.

 

[Jockette]

Romans 8:28 is a fantastic verse and I know that with whatever outcome I have God has a path for me for my good and His glory!

I love your user name and I am also a believer. I’ll be praying for you.

Their testing came back negative from the Aspirate in late May 2025. In talking with them he is confident that they are correct and that we are dealing purely with a loose femoral component.

So, if I understand correctly, they don’t think you have an infection, but they are doing an “infection procedure” just in case?

 

[Layla]

Hello and Happy Wednesday!
It sounds like you trust your surgeon and you were heard. All of your concerns were discussed and you're ready to move forward in confidence, with the assurance of who orchestrates all things and works them out according to His purpose.

God is loving, in control...sovereign over all and obviously where you've placed your trust.
I will lift you in prayer for healing, a smooth and uneventful recovery along with comfort and peace of mind as you await your October 17th surgery date. Take care and please keep us posted.
@Romans8:28

 

[Jamie]

I’m impressed with your surgeon as well!! Good job selecting what sounds like a thoughtful and skilled doctor. I bet he was a bit surprised that you knew so much and could bring forth challenging questions. This all sounds very promising and I’ll be waiting for the outcome. I wish you well and you’ll be in my prayers.

 

[Romans8:28]

Romans 8:28 is a fantastic verse and I know that with whatever outcome I have God has a path for me for my good and His glory!

I love your user name and I am also a believer. I’ll be praying for you.

Their testing came back negative from the Aspirate in late May 2025. In talking with them he is confident that they are correct and that we are dealing purely with a loose femoral component.

So, if I understand correctly, they don’t think you have an infection, but they are doing an “infection procedure” just in case?

Yes that he thinks there is no infection. Regarding the procedure on the day, I did not ask him if this is his standard manner of working on a revision. He is very careful about possible infection, only ever taking fluid from a knee in theatre, never in a doctors consulting rooms, considering the risk too high. I will ask that question however!

 

[Jockette]

Better safe than sorry, I always say!

 

[Romans8:28]

Romans 8:28 is a fantastic verse and I know that with whatever outcome I have God has a path for me for my good and His glory!

I love your user name and I am also a believer. I’ll be praying for you.

Their testing came back negative from the Aspirate in late May 2025. In talking with them he is confident that they are correct and that we are dealing purely with a loose femoral component.

So, if I understand correctly, they don’t think you have an infection, but they are doing an “infection procedure” just in case?

Yes that he thinks there is no infection. Regarding the procedure on the day, I did not ask him if this is his standard manner of working on a revision. He is very careful about possible infection, only ever taking fluid from a knee in theatre, never in a doctors consulting rooms, considering the risk too high. I will ask that question however!

August 18 - just spoke to the Clinical Manager and my surgeon does all revisions that are one day surgeries in a two stage process on the day... Obviously he also does 2 stage for infections with the long gap in between...

 

[Jamie]

Boy, that will be a big day for you, then. Do you stay some period of time in the hospital afterwards?

 

[Romans8:28]

Boy, that will be a big day for you, then. Do you stay some period of time in the hospital afterwards?

Hi Jamie, Yes I will have 5 days in the Private Hospital, and longer if it is necessary, but should be all good
He allocates 3/4 of a day for this procedure, but obviously will work to minimise the time as much as possible. I am very ready for this in the sense that I am a bit over the challenges. Working hard on exercises and walking to make sure I am in good physical shape. Want to lose another 6kgs (13lbs) if i can as I know this will be helpful - I think that I can maintain that weight. Do you have any reading on diet pre surgery?

 

[benne68]

Do you have any reading on diet pre surgery?

It's best not to lose weight during the month or so prior to surgery because good nutrition is key to recovery.

Check out these articles:
Dietary Tips for Recovery
Nutrition Basics

 

[Jamie]

Deb is right about trying to lose weight at the last minute. You don’t want any extra stress on your body, so this is not the time to worry about calories. Think instead about just healthy eating. You can use the guidance in the links above to find foods that give you a health boost. Most important is to beef yourself up (sorry about the pun) on proteins both before and after surgery. This does really help with healing.

 

[Layla]

Hello Romans 8:28
It takes strength and discipline to be so thorough and proactive in getting ready for the surgery. Your efforts are setting you up for the best possible recovery and we will be following with interest, in support.
Much comfort to you as you wait. I hope you have a nice weekend!
@Romans8:28