two stage knee revision due to infection set for 1/16/15

[RestAssured]

@Diane,

Thanks everyone for the well wishes I go in to the hospital in a couple hours and my surgery is scheduled today for 1 o'clock this afternoon. I have been in so much pain with the infection and achiness all over that it will be a relief to have it done with

I can relate! The pain was horrendous from the infection! Having a washout, debridement, and spacer replacement at the time helped tremendously. Of course, down the road, I had the complete revision done, but it got rid of the pain from the infection!

 

[Lovestoread]

Hope everything went well for you @diane33.


Sent from my iPad using BoneSmart®

 

[diane33]

Update. Antibiotic cement and spacers in place. I have a knee brace that has been on since surgery. Today 1/21 I am able to have the brace off except for walking with the walker. I am being transferred to extended care facility this morning. They discovered 3 infections and I am being treated with,two different antibiotics. I never twice a day for two weeks. The other once a day for seven weeks. The dr said I should be off work for five months. Pain is tolerable with meds.

 

[RestAssured]

@diane33,

I am glad that you are through surgery and that they got the infections cleared. Be careful with the knee and I hope you like the rehab facility they send you to.

 

[Phil75070]

I don't know why antibiotic laden cement (ABLC) isn't used as the "standard". It was used for both of my knees due to a compromised immune system but I believe it is the standard in certain countries. I was told by my OS that it is more expensive and maybe having to justify its use to insurance companies is why it isn't used more often. I did find this:

ABLC was released for commercial distribution in the United States in May 2003, specifically for the treatment and reimplantation of infected arthroplasties. In Europe, however, ABLC has been available for many years, and the indications and scientific evidence for its use have expanded to primary arthroplasty. Use of ABLC for this purpose, however, remains controversial in the United States.

 

[RestAssured]

Well, when I had my revision, Dr. Maale put two different antibotics into the cement. He said he does that for every replacement that is infected. I'm not sure if the patient is having it revised for a different issue if he used antibotic cement or not.

@diane33,

I hope you are getting settled to the rehab center, and that you find the people there very helpful!

 

[skigirl]

at least this should resolve the pain of the infection. I hope you like the rehab center--some seem nice and some not so nice!

 

[Jamie]

@diane33 ... I am so very sorry that I'm just reading your thread! I missed the tag somehow. It sounds like you are through your first surgery and doing okay. I'm glad. Just take things one day at a time. I know you are eager for all this to be behind you and it will be soon. Probably the best person to talk with is Sonja, as she will be able to relate to anything you may be feeling as you recover from this surgery and prepare for the second stage.

@Phil75070 .... could you please post a link to the quote that you posted? Whenever you add quoted material to a post or discuss something like this that you read, you should always provide a link to the full article or website where the quote originated. Here is the portion of our forum rules that applies:

d. Do not breach copyright rules by placing documents or images onto BoneSmart unless you have permission from the originator. You can post excerpts (20% or less) from a document with a link to the full text. If you post a link, please at least explain briefly what people can expect to find if they click on the link. Links without such an explanation may be deleted. BoneSmart cannot be held responsible for the content of external websites

 

[diane33]

Thanks all. I finally made it into rehab facility tonight. The have not got my pain meds so I am not comfortable at all. I was supposed to get my oxyconton at 9pm and it is 11:43 so I think it will be a long painful night. They are also missing my Tramadol an I am going to see if they have my klonopin. I d int take it every night but I definitely need it or xanax to try to sleep! Big pain tonight!

Partydi33 (Diane)

 

[kneeper]

Hope you were able to get your meds and get some sleep.

 

[Phil75070]

@Jamie Sorry for breaking the Rules. I won't post anymore since I will be done with PT next week anyway.

broken link removed: https://www.aaos.org/news/bulletin/may07/clinical7.asp

 

[Josephine]

I don't know why antibiotic laden cement (ABLC) isn't used as the "standard". ..... I believe it is the standard in certain countries.

This cement came into use in the late 1970s before which it was common practice for us to open vials of antibiotic power and add it to the cement powder before mixing. We'd done that for years. However, it was known that as the antibiotic leached out of the cement, it left behind cavities where the abx powder had clumped during mixing. Obviously this had a risk of weakening the cement mantle. I was actually in print in a journal for theatre (OR) nurses advising that great care should be taken to mix the two powders thoroughly before use.

So when the first company (Palacos) brought out a cement with abx mixed in at an industrial level of purity so this would not happen.

And yes, you are correct that most countries consider it to be a routine requirement in primary joint replacements for obvious reasons. Personally I would take a dim view of any surgeon who used unmedicated cement in my knee or hip.

 

[Margueritte]

@diane33
Hi!
I hope things are getting better for you! I had my second stage procedure on Monday 1/26 at Duke. This time I have had no pain due to the placement of a peripheral nerve catheter. I am home with a "pain ball" that will last at least through post op day 5. It uses Ropivicaine .
The hospital pain regimen included - celebrex 100 mg twice a day, aspirin 325 mg twice a day, lyrica 50 mg every 12 hours, Tylenol 650 mg every 6 hours, OxyContin 10 mg every 12 hours, and a prn order for 1 to 3 tabs of oxycodone 5 mg every 3hours depending upon the degree of pain.
On post op day two i declined the pain meds as I was not having any pain due to the catheter.
Believe me - I have had all sorts of regimens throughout the 7 surgeries and this has been the best so far. We will have to see how I do on Saturday though.
My first replacement was incredibly painful but I think it was due to trauma to my perineal nerve. I do like the regimen given this time as it uses both a long acting pain med with options for 1-3 tabs of shorter acting oxycodone as needed. This is what I'll be doing on Saturday.
Placement of the antibiotic spacer took more OR time than my knee replacement did. I was anemic after the spacer was placed but this time am not- so I'm hoping you too can look forward to that. I did not have much swelling with the spacer and as of today not much with the new knee.
Let me know how you are doing. I'm not sure if the above is helpful- but just know I'm thinking about you!!

 

[diane33]

@Margueritte
Hi. Thanks for the info. Glad to hear you're doing so well! I'm in a lot of pain with antibiotic spacer right now. Will try to keep a positive attitude to see how this all plays out!

Partydi33 (Diane)

 

[Margueritte]

Hope you will be feeling better with less pain. I've been doing fine but woke up this morning feeling like I'd been run over by a truck! The knee rules- so I'm elevating it with ice and pampering it today. Thinks about you and hope you are better soon!

 

[Jamie]

Sorry for breaking the Rules. I won't post anymore since I will be done with PT next week anyway.

Phil, thanks for the link!!!! It's not a problem and please don't feel like you have to rush away from the forum.

 

[Margueritte]

@diane33
How are you? Have been thinking about you!
I had the second stage 3 weeks ago and think it was not as bad as the first stage. I had a mid thigh block placed at surgery that gave excellent pain relief. I went home with it and it was removed day five. I'm now doing PT and actually have more pain due to the exercise but am doing OK.
Keep me posted on your progress! Are you still on antibiotics?
I can feel a real difference since the second stage. It's a long road but I think we'll worth it!
Sending a hug!