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Author Topic: Complications synovial fluid leak  (Read 13055 times)

Offline tamter

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Complications synovial fluid leak
« on: November 02, 2004, 06:08:19 PM »
I had arthrscopic surgery 2 weeks ago on both knees they had to clean them up due to chrondamalachia and OA and do a lateral release on the patellas.  Went to my post op appointment well the left knee is doing good, but the right knee has developed a synovial fluid leak and is oosing, I have been so nasuated the doctors said it is not from the leak, he put me on antibiotics a week ago and also put my leg in a brace to where I can bend it at all.  I go back to the dr tomorrow it is still leaking.  Has anyone ever heard of this and what else can they do, it seems like it is leaking more.  When I went into my post op I felt so bad and didn't ask enough questions and I can't find anything really about this on the web.  Please Help....

Offline Heather M.

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Re: Complications synovial fluid leak
« Reply #1 on: November 02, 2004, 08:33:30 PM »
It sounds like one of your incisions hasn't closed yet, and synovial fluid is leaking out.  This is a situation to watch.  I've had this happen to me three times now.  It may be that the hole won't close because you've been too active (hence the brace).  On the other hand, as was true in my case, the incision wouldn't close because I had a low-grade infection in there.  It was only when I either A) had surgery to clean the joint out arthroscopically or B) was pt on a different antiobiotic, one that was actually strong enough to do the job.

If you have been on your current antibiotic for more than four days and still don't feel better--still feel icky, like you have the flu or something--then it might be time to call the doctor and askfor a different antibiotic.  Or just call the doctor if you continue to feel blah.

Look up post-op infection, incisions won't close, synovial fluid etc.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline tamter

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Re: Complications synovial fluid leak
« Reply #2 on: November 02, 2004, 08:47:58 PM »
Thanks for the information, I haven't been running a fever just been feeling yuk, so I don't know that it is an infection.  But the past couple of days it has been leaking the fluid more than last week when I went to the OS, you would think the brace and antibiotics it would have stopped by now.  I am wondering if I should not put weight on that leg, he said that it was OK as long as I didn't bend the knee.  And I still have my staples in since this is my second scope on that knee he wanted to leave them in longer,  but I wonder will he take the staples out of the hole that is leaking?  Thanks again

Offline Heather M.

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Re: Complications synovial fluid leak
« Reply #3 on: November 02, 2004, 11:28:43 PM »
Unfortunately, there is a reason that your incision won't close.  In my experience, the body knows best--and it will not close the incision in the presence of a foreign body (for some people who react badly to hardware or sutures) or an infection.  Even a low-grade infection that isn't causing any other symptoms.  I've had three infections post-op now, and EACH ONE started with an incision that wouldn't close.  The reason for this could be anything--I had cortisone (oral and injected) and this can suppress the immune system and slow down healing.  And then, because the healing is going slowly and I had open holes into my knee, an opportunistic bacteria that normally lives on the body without any issues makes its way down into the joint.  Mine was a staph infection--ugh!  Anyway, the longer the wound stays open, the greater the chance of something getting in there and going down into the joint.  Now in my case it was odd because the only thing I ever had come out of my knee was synovial fluid.  So I wasn't getting pus or any other signs of infection.  But it was there--that's why my body didn't close the incision up.  The bacteria need a drain to get oxygen and to eliminate the by-products they produce.

So anyway, don't write off infection just because you don't have infected goo coming out of your knee.  I never did, not in three different infections following knee surgery.  However, after my first serious infection I had to have another scope to wash the knee out, and the doctor found all sorts of nasty stuff inside the knee.  The second major infection I had was with my normal surgeon's partner; he refused to believe I could have an infection because the 'only' thing coming out of my knee was synovial fluid.  He put me on Cipro for 18 days.  On day 20 (two days after Cipro ran out) I was in the office feeling like garbage, chills, nausea, etc--and there was a giant red stripe on my thigh.  Sepsis.  

So anyway, keep a very suspicious eye on an incision that drains synovial fluid.  Because if stuff from inside your knee joint can get out, then other stuff can get IN, and you don't want to have a joint infection!  It's some of the worst pain I've ever had, and my last serious infection led to septic arthritis--the infection destroyed the articular cartilage in several specific areas.  Ouch.  Also, a severe infection can lead to over-production of scar tissue.  I've got this as well, and it's awful.  Very painful.  Not anything you want to mess with.

So anyway, I just wanted to give you some feedback on my experience.  Even though in each case my knee was 'only' leaking synovial fluid, that set up a pathway through which bacteria entered my leg.  And your body will not close the incision up if there is a foreign body in there--either bacteria or something else.  Some people reject hardware and internal stitches, and this leads to serious problems that present as infection.

Anyway, after my third surgery where the incision didn't close and I got an infection through that opening, I was placed on complete bed rest--non-weight-bearing, had to elevate all the time, STRONG antibiotics (Levaquin, one dose per day at $5 per pill!), and not bend the knee.  And BTW--within 36 hours of being taken off Cipro and put on the stronger antibiotic Levaquin, my incision closed up magically in the course of an afternoon.  It was a vivid demonstration to me of how the body will do things that seem to make no sense (not heal, for example)  but which in retrospect are perfectly rationale.

Heather

PS Have you had a cortisone injection or taken oral steriods as part of an anti-inflammatory program in the last 12 months?
« Last Edit: November 05, 2004, 07:11:36 AM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline tamter

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Re: Complications synovial fluid leak
« Reply #4 on: November 03, 2004, 04:02:14 PM »
Thanks for all the insight and yes I had a cortisone injections in both knees a couple of months ago.  Could this be the reason I have the leak.  I go back to the doctor today and will ask alot more questions.  Thanks again for all the info.  

Offline tamter

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Re: Complications synovial fluid leak
« Reply #5 on: November 04, 2004, 04:03:46 PM »
Well went back to the doctor still leaking fluid he took out my stables.  But now he has a Jones Dressing and the knee imbolizer back on and now I can't take it off at all.  Before he would let me take it off to take a shower not now so it is tub time I guess.  He said weight bearing was OK but he will not let me go back to work yet.  I am still real sick to my stomach but he doesn't think it is related to my knee.  I asked him if he thought my knee was getting infected he said no that it would be alot more swollen.  He said it could be like this for another three weeks.  That sux  :'( :'(

Offline dm

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Re: Complications synovial fluid leak
« Reply #6 on: November 05, 2004, 04:30:46 AM »
I would suggest that you take your temp about 3 times per day, and call the doc immediately if it gets to 100 during the daytime. Also write down the time of day and the temp you got, as a running record. Then, if something is trying to set up housekeeping in there, hopefully your vigilance will keep it from getting as bad as Heather's did.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline Heather M.

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Re: Complications synovial fluid leak
« Reply #7 on: November 05, 2004, 07:17:42 AM »
I agree that you should monitor your temperature, but be aware if you are taking any anti-inflammatories they may suppress a fever.  I'm talking about meds with ibuprofen (advil), acetaminophen (tylenol--especially percocet or vicodin, which have tylenol in them), and even naproxen sodium (Aleve, Anaprox, Naprosyn).  These all work to lower fevers as well as reduce inflammation and help pain.  So you may get a false sense of security.  I did run fevers with my infections, but it was mostly during the night (when my meds with anti-inflams wore off, because I would go 8 hours or more without taking anything).  So I had a lot of night sweats, waking up with chills, waking up and flinging all my covers off in February...

Keep an eye on the situation, but it sounds like you're doing everything that can be done.  Just keep a chart of your meds, temperature, and even pain levels.  Hopefully the Cipro will work well as a preventive measure, and your knee will close when it's ready.

Keep us posted.

Heather

PS Definitely the cortisone!  I had oral and injected steroids that caused problems with three surgeries.  When I read the product literature online for Prednisone (Medrol Dose Pack), I found that they reported problems with surgery for up to a YEAR following a single 5 day course of the Dose Pack!  The things I wish I'd known before having surgery....
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline IslandGirl

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Re: Complications synovial fluid leak
« Reply #8 on: November 12, 2004, 04:42:40 AM »
Heather, that's scary.  You had so many surgeries?  I hope you're doing better though.

Offline tamter

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Re: Complications synovial fluid leak
« Reply #9 on: November 16, 2004, 04:55:56 AM »
Last week on Wednesday went back to the OS my knee had not leaked the synovial fluid for a week.  So he said I could take the immoblizer off  :D I was so relieved, well I went back to work the next day walking real slow, and when I got home it opened back up and I had fluid running down my leg.  So I steri stripped it back and put the brace back on.  ??? I called my OS and he said keep the brace on so I did then Saturday night it leaked so bad it went through my bandage and soaked my jeans. UUKKK.  Anyway called the OS back this morning he said come in so I did.  And he said the immobilizer for at least 2 more week and stay on the antibiotics they changed my antibiotic to Keflex because the Cipro was killing my stomach.   Anyway my question is does anyone know how long can this leak before they try something else beside antibiotic and brace.  And is there anything else they can try to make it stop.  It has been leaking now for a month I just feel that is too long.  And another question is after having this leak for so long is it going to give me a problem on down the road?  My knee is swollen some and it is painful at times.  Any help would be appreciated.

Offline tamter

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Re: Complications synovial fluid leak
« Reply #10 on: November 17, 2004, 09:18:59 PM »
OK I am really getting frustrated I am at work and looked down because I felt something wet.  And my pants are soaked all around my knee all the way half way down my leg.  I understand a little leakage, but what I don't understand why at time it becomes a flood of fluid.  I will go all night and sometimes a day or so and it won't leak at all I start to get excited thinking it's closing.  Then it will become a flood and goes everywhere.  Has this happened to anyone or does anyone know the complications of all this.  I can't help but feel this will leave some damage to my knee.   There is very little information on the intranet on this.  I have gotten alot of information from Heather which is greatly appreciated and has helped me understand it better.  But I am concerned now that over a month since surgery and it is still leaking this bad.  Does anyone know of any questions or concerns that I should ask my OS when I go in next week.  Thanks

Offline Heather M.

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Re: Complications synovial fluid leak
« Reply #11 on: November 17, 2004, 10:50:20 PM »
That is a very long time to be experiencing synovial fluid drainage, I have to admit.  The longest I went was 22 days, and then I developed cellulitis, which is a broad sub-cutaneous infection just under the skin.  That's when I was put on Levaquin, the wonder antibiotic.

As for why your knee has been draining for so long, I can only repeat what I was told during the three different occasions when this happened to me--namely that there is a reason it's draining, and until you uncover it the drainage won't stop.  My OS gave me three potential reasons:  1) infection that was suppressed but not killed off by the antibiotics, 2) being too active and moving the leg too much--with the cortisone injection my rate of healing was radically reduced, and every time I bent or straightened in a single second I undid hours of my body's attempts to clot and heal.  3) My OS said sometimes when there is a 'channel' or drainage route that gets established in the knee joint, it is very difficult to shut off or make it stop.  The knee is producing a lot of fluid/inflammation and swelling.  This creates pressure in the enclosed joint.  But when you have drainage, it relieves things by allowing the additional fluid to escape and keeping the pressure from building up inside the knee.  The body 'likes' this, for lack of a better explanation.

Anyway, I was told that the only way to get the incision to close up was to address the cause.  In the first example, finding the right antibiotic is critical; sometimes it's necessary to wash the joint out in an arthroscopic procedure called debridement and lavage.  Then the incision can be closed from the INSIDE, as our bodies only heal from the inside out.  The surgeon can put internal as well as external stitches.  This will close the hole in the knee capsule and ideally stop the drainage.

In the second situation, where the cortisone has delayed healing and the patient repeatedly undoes the body's attempts to close the incision, the most effective treatment is supportive care to prevent infection from getting inside, complete immobilization and bed rest, and time.  To have synovial fluid draining from the knee is not a problem in and of itself, it's the possible complications in the form of infection that are worrisome.  Your body produces synovial fluid and can replace what is lost through drainage.  That being said, having a hole in your knee is very disturbing and not a good idea in general...I understand that an arthroscopy can be helpful, with additional supportive care like that used in wound clinics to help the body heal (oxygen therapy, hyperbaric chamber, regular dressing changes, debriding any dead skin tissue, etc).

In the third situation the treatment is again supportive care and time; when that fails, it is reasonable to do a scope to clean things up and remove any dead tissue, infection, etc.  And to shut off the avenue of drainage from the inside, which would hopefully allow the external wound to close.

So anyway, I would assume that you are doing regular blood tests to see if you have an infection?  And had a swab and/or aspiration done with a thorough study to attempt to culture any bacteria?  Has your OS discussed the possibility of arthroscopic debridement and lavage?  Complete bed rest?

I understand exactly how distressing this situation is.  I was deeply disturbed to be having stuff come out of my knee.  In my case, the cortisone was the culprit, and I eventually fell victim to an opportunistic bacterial infection.  It may be helpful for you to have an exam with an infectious disease specialist who can do a detailed culture of swabs taken from the knee.  It may be that you haven't had the bacteria identified correctly, and so haven't been able to target it with the correct antibiotic.  Or you may need a cleanout to allow the joint to heal from the inside out.  Unfortunately, the doctor can't just put steri-strips or stitches in the incision, as the healing and closure of the wound must come from the inside.

Beyond that, I can only advise you to pressure the doctor for some type of solution.  Your life is in limbo while the knee is draining--there is nothing more stressful or upsetting!  And the increased stress, pain, and likely sleeplessness is not going to do you any good when it comes to healing.  So you have to fight the good fight yourself--rest, keep the leg immobilized, don't overdo it, eat well, sleep as much as possible, reduce stress as much as you can--and press your doctor for answers.  I agree with you that the knee should not be open and draining for this long.  However, I don't want you to worry too much, as simply having drainage from the knee isn't going to cause you irreparable damage--it's complications of this that bring heartache.  So keep the wound clean, rest, and start talking to your OS on a daily basis.  If he can't or won't help you, I strongly recommend that you see another surgeon to put a stop to this situation that is causing you so much distress.

Hope some of this info helps.

Heather
« Last Edit: November 17, 2004, 10:53:11 PM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline tamter

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Re: Complications synovial fluid leak
« Reply #12 on: November 17, 2004, 11:17:45 PM »
Thanks Heather,  again you made me feel better knowing that yes while this is going on it is very frustrating.  But glad to know that it shouldn't cause me any problems later once we get it to close up. I go back to my OS on Monday last time he just told me at least 2 more weeks in the brace.  Well on Monday I am just going to point blank ask him OK after these 2 weeks are up which is right after Thanksgiving what are we going to do then if it is still leaking.  And if he just says we will just keep the brace on longer.  I think at that time I will get a second opinion.  As far as sleeping at night I am only getting a couple hours a night.  I just can't sleep well with this Brace on.  My OS asked me do you want something to help you sleep I said no I don't want to start taking sleeping pills.  And as far as blood test there has been nothing like that just steri strips, anitbiotics and the brace that's it.  Nothing about debridement or bed rest like I mentioned before I have been back to work since last Thursday. Thanks again for listening it sure helps.    

Offline tamter

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Re: Complications synovial fluid leak
« Reply #13 on: November 18, 2004, 05:13:51 AM »
KNOW MY OTHER LEG LEAKING..... :(Ok here is the scenerio a month ago I had both knees done they did a LR, smoothed cartlidge due chrondamalchia and removed arthritic bone.  As everyone can read my right leg has been leaking now for over a month now, tonight my left leg started leaking, but the weird thing it is not from my incision.  I noticed after surgery right above my incision a have a small scrap that still hasn't healed in a month's time.  That is where the fluid is coming from I have my right leg in an immobilizer I am going to call the OS in the morning and demand answers because I am afraid he will just say we need to immoblize the other leg to.  Well if that is the case how will I get around I won't be able to.  So there has to be something they are not checking me for.  And there has got to be something they can do.  Does anyone have any answers.  I am about to get a 2nd opinion... :'(

Offline Heather M.

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Re: Complications synovial fluid leak
« Reply #14 on: November 18, 2004, 06:45:17 AM »
Tammy,

I got your private message, but if you don't mind I'll answer here so it will be recorded for anyone with future knee leaks--it will help them to know they are not alone!

First of all, I want to assure you that you don't have some silent, dreadful disease.  Sometimes, the arthroscopy hole just doesn't close.  And if you had cortisone, you have to understand that it is doing *exactly* what it was intended to do--slow down your body's immune system.  So please don't think there is anything surprising or that you are a freak of nature, because your body is unfortunately responding appropriately to the cortisone--and whatever else could be at the root of your problem.

As for your other knee 'leaking' now, it would be helpful to get a bit more information.  Do you have the arthroscopy incisions or ports which have a single, usually horizontal line and then two tiny lines above and below it?  If so, is it the tiny puncture mark above the horizontal one that is the 'scrape' that is now draining?  And can you actually look inside this new leaking scratch and see some distance into the knee--like through some layers of skin, or maybe it looks like a hole with pink or whitish skin around it?  Could you have a small, superficial infection in this scraped or raw area that is perhaps different from the hole where your arthroscopic incision was?  Do you have any external stitches, or were your incisions closed with steri-strips?  

On the knee that is continuing to drain, if you look at the arthroscopy port do you see white or very pale skin on the edges of the incision?  If so, that skin is dead or dying, and it will not be able to heal together.  It may need to be debrided--scrubbed firmly to remove it and get to the healthy skin.  Same thing for the new suspect incision.

Finally, are you sure your doctor didn't do any kind of swab or tests for infection? It would have to have been done really before you started antibiotics, because they can often mess up the results of the test.  I had that happen--my knee culture came back negative, even though my surgeon had actually TAKEN the sample from 'green goo' inside my joint, which was obviously a pocket of infection.  Once it was cleaned out arthroscopically, the knee healed right up.
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell