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Knee Infection Whew!! it's finally done: the Good, the Bad and the Ugly

There’s also the pharmacies that are also keeping track of usage. But if you’re in more pain than the Tylenol can handle you can call the pain clinic your OS suggested.

I’ve had no issues with the infection, however at the 6 week mark my ID took me off the PICC line and oral Rifampin for 2 weeks because my body stopped making white cells as a result. She then put me on 200mg of doxycycline for 7 months, then down to 100 mg a day and I’m still on that dosage for maintenance. I see my ID once a year still for blood work to keep an eye on my kidney and liver function as well as to check on the presence of infection in my body. I’m allergic to penicillin, so my ID has had to be creative.
 
Thanks @KarriB for the insight as it gives me some idea what to possibly expect. Seems this whole ordeal is a learning process and no one is keeping me informed as to what to expect. Maybe I should be asking more questions to my OS and his team, but if I don't know what to ask when I see him... I'll get through it though and thankfully I can ask Q's here when they arise.

Once again, I know nothing...nothing about a pain clinic and no one including my OS or his team as mentioned it. All I know his he told me to 'suck it up' which does absolutely nothing as far as pain goes. Can you or anyone else tell me more about this pain clinic and how I go about finding one?

This whole affair is leaving me shaking my head more and more over how unorganized this is becoming. I did make a phone call about the IV supplies this AM because Thursday is a holiday and the day they have been shipping it. As it turns out, no delivery is scheduled this week, yet I don't have enough to last til next week. Glad I called...it's being handled now.
 
You can call your OS or PCP and ask for a referral to a pain clinic. My pain diminished at about 2 weeks post op infection surgery and I found I didn’t need anything. Then when the immbolizer came off I began taking a low dose of oxycodone ( what was left over from infection surgery) a few times a day to help the pain and stiffness. But every knee is different and I was very inactive the month I was in the immbolizer. My OS also prescribed Tramadol which is a synthetic opioid and although many have found it useful, it did nothing for me.

When you left the hospital did they ask you which home nursing /delivery service you wanted to use? They asked me and although I had no idea who was better I made a good choice without knowing anything. I wonder if you can change organizations since you’re unhappy with their service.
 
Just catching up on your thread. What an ordeal. :console2:
 
KarriB said:
You can call your OS or PCP and ask for a referral to a pain clinic. My pain diminished at about 2 weeks post op infection surgery and I found I didn’t need anything. Then when the immbolizer came off I began taking a low dose of oxycodone ( what was left over from infection surgery) a few times a day to help the pain and stiffness. But every knee is different and I was very inactive the month I was in the immbolizer. My OS also prescribed Tramadol which is a synthetic opioid and although many have found it useful, it did nothing for me.

When you left the hospital did they ask you which home nursing /delivery service you wanted to use? They asked me and although I had no idea who was better I made a good choice without knowing anything. I wonder if you can change organizations since you’re unhappy with their service.
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During Wednesdays appt, I asked my OS about the pain clinic and got a firm reply of "We'll handle your pain management. You don't need the problems that a pain clinic may cause, you have enough to contend with for now." At which I replied "if your idea of pain management is 'suck it up', that aint cutting it. I'll seek help on the street level if need be." I doubt he liked that reply and then wrote a script for Tramadol. He did mention that it is less potent as the Hydromorphone which made me think if that didn't do anything why give something of lesser strength. But I also remembered the BS concoction of Tramadol and Tylenol, so I'm willing to give it a try.

I never was given the option of selecting who would do the home nursing care. The WC insur carrier selected the care co after the TKR. After the infection surgery, the hospital and my OS selected a care co but that was denied by the insur because they were not in the network. So I'm going to assume both my OS and the insur carrier agreed to my current home care co. I may have given the wrong impression about being unhappy with the current care co. Actually I'm not other than the mixup about this weeks IV supply delivery was a bit annoying. If I'm going to be held accountable for taking medication, then those responsible for supplying it should have their act together as well. Overall I'm quite pleased with the level of care even though the constant phone calls and daily visits can be a bit tiring. At the same time I do realize my current condition warrants that kind of oversight, so I really shouldn't be complaining.
 
kneeper said:
Just catching up on your thread. What an ordeal. :console2:
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More like a traumatic horror show. As much as I hate to think it, let alone even say it, I still find my thoughts occasionally migrating to regretting having the TKR done at all. The pain level for the last 6 months or so prior to the TKR wasn't that bad, but I've also been out of work since Oct 2016 so I'm sure that played a role. In the end after all this is over and done with, I'm sure(hoping) that thought will diminish. I still clearly recall the torture that I went through when I was working, so I can't hide from that. The infection is what really threw me a curve as I never expected that to happen. And then the bullheaded tension created by my OS and his PA didn't help, especially when I'm a bullheaded alpha male myself.

Through all the agony of the infection I forgot all about the TKR itself. It's my opinion at this time that the actual TKR procedure itself was a total success with fit finish alignment and function. But that's only after the limited time of having any ROM. Now that the infection is on center stage, the only use I get is being able to allow full body weight on my knee with minimal pain. But that comes with a time limitation...usually 30-45 mins max before I have to sit down. I've also had other professionals make similar comments about my knee including the level of expertise my OS has. And knowing of others here complications with their TKR, I'm thankful for what my OS did.
 
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The remaining stitches came out this past Wednesday and believe me I had to suck it up! I thought the worst would be where the infection was located , but actually they weren't that bad. The real killer ones were the 3 or 4 in the center...they were deep rooted due to having to make up for what the lower stitches couldn't accomplish because of what the infection did to the surrounding skin. At one point I think I was on the verge of passing out...my eyes were closed yet everything was turning white if that makes sense. The OS even asked if I was alright and I replied with a colorful !!NO!! It was all I could say...sorry if that offends anyone here.

Afterwords my OS commented that I had the most sensitive skin he has ever seen and I replied "its not like I had any choice, that was the only option I had during production" He laughed and I did as well. In th end he did say the incision is improving compared to last week, so there was a positive out of all I just went through. I guess for now it's just a waiting game and see how I respond to the Vancomycin. Next week I see the ID Dr as well as the weekly visit to my OS. I was curious as to a time frame for when I might expect to be able to return to work and all I got was it's not even on the horizon, so no sense to think about it. Great, not exactly what I wanted to hear...
 
What about ROM? Now that the stitches are out, anyone care to offer an educated guess as to when I'll be able to start the flexion again? My extension is more or less 0 at which the OS even commented about as being a good thing. I didn't specifically ask the OS that Q and didn't want to push the issue. It seems at times some of this recovery phase is top secret. Or is it that I'm in that bad of shape due to the infection that they don't want to tell me anything.

I do know that forbidden zone with any flexion is brutal. I've entered it a few times just slightly while getting in/out of the car and dang that is an eye popper! I am able to move it a few degrees on my own, so there is some progress, but I know for sure its going to be a tough road to travel when I have to start. I do leave the knee immobilizer off now while in the house and feel fairly confident without it on. Just have to be alert and pay attention to everything I do when walking
 
After I was allowed to bend (4weeks after infection surgery) my OS prescribed non-aggressive PT. This meant simple heel slides with no devices to pull or push and just walking around the house trying to bend the knee as opposed to walking like a peg leg pirate. Then about 2 weeks later I began therapy, still non-aggressive with heel slides, rocking the pedals of a recumbent bike and massage by the therapist. It took 2 more weeks to get a full revolution but the bike definitely helped with ROM. I was released after 9 weeks with a ROM of 109 which continued to improve up to a year post op.

I advice you take it easy and don’t push too much early on. Your soft tissues are probably very sensitive from the infection and subsequent washout surgery where they basically scrub your tissue. This was the reason I was in an immbolizer, my soft tissue was too compromised to work at bending and the OS wanted it rest and heal.
 
Thanks KarriB, for sure I'll heed your advice. I've seen way too often where some here have pushed too much too soon. Tomorrow is 4 weeks post op for the infection surgery , so I hope its a turning point. The lower part of the incision still doesn't have much of a scar build up yet, and I'm sure it wouldn't take much too split it open. Right now I have those steri strips(??) as a bandage and I assume they are helping hold the incision closed.
 
I bet your knee will feel so much better with those stitches out! I found a big difference in mine once my staples were out. Be sure and baby that incision until you are sure it's completely tightly healed. KarriB has really good advice for you!
 
The main goal now, especially given your past experience and infection, is to not push too much. I'm so glad you've read some of the other recoveries and have seen for yourself how doing so can set a knee back. Yours doesn't need the extra grief, and neither do you! Walking should be gentle, good exercise and give you natural flexion. Just some very gentle bends, the gentlest of bends, can be good while not stretching your incision in harmful ways.

Things will turn a corner one day, it's just difficult to say exactly when. But it happens!
 
BionicBob said:
What about ROM? Now that the stitches are out, anyone care to offer an educated guess as to when I'll be able to start the flexion again?
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Don't worry about that for now, Bob. Let your knee heal first.
Remember, there's no need to rush to get ROM, because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.
 
sistersinhim said:
I bet your knee will feel so much better with those stitches out! I found a big difference in mine once my staples were out. Be sure and baby that incision until you are sure it's completely tightly healed. KarriB has really good advice for you!
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It took a day to recover from the removal of the stitches, but no doubt it feels sooo much better now. Plus now that I'm taking Tramadol and Tylenol that was suggested here, it too has made a difference. Not a whole lot, but enough to take more than the edge off. I'd say the average pain prior was easily a solid 4 if not 5 at times. Now its about 2, give or take. In fact I've noticed a couple times now that after I wake up, I don't feel any pain at all...makes me want to go run a marathon or something. Not that I'd be foolish enough to do that.
 
@SusieShoes and @Celle
I knew about not pushing to early, but thought that only applied to the TKR. Now that I've been 4 weeks post op and my knee has been locked full extension the whole time, I thought I had to start working on freeing it up. But if you're saying the wait also applies to having the infection and peg leg, no argument from me. I'll gladly wait and most definitely will refuse anyone...OS included...that wants me to start working the ROM again.

Thanks again for keeping me in line for recovery ladies!!! Much appreciated as always
 
Almost forgot...today was a day to celebrate. Not sure I'd call it a milestone, but I completed the 28 days of Lovenox injections:yay: While I did overcome the anxiety of doing the injection itself, the last few injections left me in great discomfort. Not quite a burning sensation, but enough to make me start hesitating again when it was time for the shot. Hard to believe I was able to stab myself for 25 of the 28 days.
 
BionicBob said:
The last IV change and blood draw, I was so tense I told the nurse she had to give me a few mins. Just the thought of a needle now makes my skin crawl. And then after all that, they expected me to self inject that Lovenox in my gut?
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Bob: I am new to your thread and am reading it all, but had to respond to this statement even though you made it a few weeks ago. I completely relate - I went to get a flu shot last week, and when the CVS pharmacist did the deed, I sat there and bawled. Like a little kid. She looked at me like I was nuts (which I am) (who wouldn't be after what we've been through) and asked me if I was taking any medications that would affect my mood. That brought me to my senses and I started laughing. Then I got out of there before she called the men in white coats.

My point is, thank you for sharing your thoughts and feelings because it helps me see that my thoughts and feelings are not off base.

ML
 
Yippee, no more shots! That is a great milestone!
 
BionicBob said:
The remaining stitches came out this past Wednesday and believe me I had to suck it up!
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I don't understand why these OS docs can't inject a little anesthetic under the skin before they mess with stitches. I often get "things" removed at my dermatologist's office, and she wouldn't think of doing it without injecting a little anesthetic under the skin. I had a terrible time when they removed my staples from my knees after my TKR's, because a couple of them were already enclosed by skin overgrowth, and they had to dig them out. It was horrible. Plus they missed one of the staples, which we only discovered a couple of days later when the steri strips came off. And the home health care nurse removed that one, after telling me to apply ice to the area for a few minutes prior to her visit so the area would be numb. I mean really, at least they didn't try blood letting. What is up with this stuff? Back to the dark ages, no pain meds, no numbing. . . . I'm just sayin'.
 
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