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Author Topic: Successful TKR 4 months ago now big problems -Help !  (Read 9114 times)

Offline wanna

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #15 on: February 23, 2005, 04:29:48 PM »
Jan

Was on IV antibiotics for 7 days and now oral for 6 weeks. Surgeon seems to think a stomach bug 2 weeks ago may have caused the infection and so we have caught early.

However, still possibility of infection being in knee from TKR 4 months ago and only blowing up now. However, as I've had no problems until recently and there was no obvious sign of pus , infection or fever in the joint (apart from inflammation)- he believes it may be the problem above.

But you're right I'm still under threat of infection  not clearing up and becoming worse after antibiotics have finished

Trying to research prosthetic infections - In the UK it's difficult to get referred across to an infection specialist ( in fact not sure if they exist over here )

Andy
82-carbon fibre Ligament construction
04/04- synovectomy after ACL snap
09/04- TKR
02/05- TKR revision
07/05 & 09/05 Joint out then Revision TKR
05/07 Revision TKR.
12/07 joint out Stge 1 revison,Stge 2 revision 03/08
08/09 Revision TKR
05/12 Quads Y plasty, scar removal & straight cast for 6 wk

Offline Teresa_S

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #16 on: February 23, 2005, 07:55:42 PM »
Andy, Glad you got a definitive answer, I know that infections can be obscure and difficult to diagnose. My Os swears to me and the op report states so that HE sent biopsy off during the scope before the revision, and it came back negative, and again when he opened the knee up (through the quad again, like you) he did the bone biopsy, and joint biopsy and they came back negative also before he continued with the surgery for the revision. HE also replaced the spacer. However, my knee is still not improving, and I am having tremendous sweats, where I actually drench my clothing. AT night, I am awakened by them, and have to throw off all covers for awhile.  I have an appt at the UNIV of MO for a vascular surgeon to see about the huge clot I have in my subclavian from the port I had put in to get the IV antibiotics, and will ask for him to refer me to infectious disease. I don't think that being ALLERGIC to the prosthesis is really a problem as I have pins in my ankle and have had 4 ports.  BUT something is causing enough inflammatin to keep the entire leg from thigh to calf big, and swollen, and painful .  I think that part of the problem is  that I have fluid that can't escape in the joint, and it is like the entire lymph system in that leg is obscured .  Nobody in Pt has seen a leg with the tissue react like mine to a prosthesis.  The present treatment is to use ultrasound on the quad area (not the prosthesis as supposedly it heats up the prosthesis)  and after 10 minutes or so, then I drop the affected leg over the side of the table where it hangs and does not touch the gound and bend the other knee back towards my shoulder and the therapist stands between putting pressure on the thigh of the affected leg and pushing the knee farther to the other shoulder. THEN flip over and do the thing where the therapist bends my knee and pushes against the calf, and then has me push against her, and if the joint is still loose, she pushes towards me as I stop pushing, and we do this holding for a minute, over and over as long as she can still feel give in the joint. WHEN I have pushed back abou 3 or 4 times, I can usually no longer push back against her, and barely stand the pain while trying to stay relaxed. Then as she finally lets it come down she wiggles it back and forth so there is not such a shock to it unbending, and that does help. WE repeat this over and over about 6or 7 times. She told me that she wished some of the other patients could see me do this, because, (since it does HURT) most patients will not do it. YOU do see a BIG difference in the final bend than the beginning. I asked how the elderly patients handle this, and they told me, for some reason, they don't have to usually worry about the bend in them. Only had one ultrasound treatment so far. Hope you continue to improve rapidly. Teresa
On going instrumentation failure, chronic infection,
Arthroscopes Left 11 Right 2, MRSA, L TKR  ,  Revision, LR x5, Medial and lateral meniscus repair, Broken prosthesis
Osteochondral Fracture,untreated 6 mths. Revision new tkr 01-07 awaiting new hip and right knee
R TKR pending

Offline wanna

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #17 on: February 24, 2005, 01:10:37 PM »
Teresa

Sorry to hear your story , seems that your problems are infinitely worse than mine. When you had the spacer replaced and had initial IV antibiotics did you get any initial improvement ? if only temporary ?

I have never had swelling up the thigh but I have had swelling in the calf.

The treatment you describe re bending is not far away from how I got my bend sorted. I placed one leg on the stairs and pushed my body forward. Massive pain but improved the bend.

Are you able to walk unaided ? or do you need sticks/crutches ?

regards

Wanna
82-carbon fibre Ligament construction
04/04- synovectomy after ACL snap
09/04- TKR
02/05- TKR revision
07/05 & 09/05 Joint out then Revision TKR
05/07 Revision TKR.
12/07 joint out Stge 1 revison,Stge 2 revision 03/08
08/09 Revision TKR
05/12 Quads Y plasty, scar removal & straight cast for 6 wk

Offline Teresa_S

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #18 on: February 25, 2005, 12:43:37 AM »
Wanna, I usually walk without crutches, but I never know when I may put my foot down and the pain shooting through the knee will cause it to give way. All the therapists I have seen keep telling me that they have never seen the tissue react like mine, with all the swelling, etc. I worked really hard immediately postop toget back to a normal gait walking heel to toe, and I do fairly well if not fatigued but EVEN my hamstring drew up and needs stretching because of the way I did walk.  I know there is some kind of thing going on with theprosthesis . I think it is too big andheavy for me, and is actually damaging more and more bone. The therapists say it is the mechanics of the knee causing me problems, and will until the OS gets it right, and he says there is nothing more he can do. At the end of my first tkr op report, the last statement is that : Incidental finding was very poor bone quality. I asked and asked what that means, but have never received an answer. I rather imagine that the bone ends had been bone on bone for so long that too much bone was cut for the prosthesis, and that the ends may still be necrotic,as they show up on nuclear scans with increased dye uptake. I really cannot go through another knee surgery right now. The past two weeks have been really painful,and I am really not getting enough sleep, I sometimes fall asleep trying to type. I AM GLAD you are doing so much better. Teresa
On going instrumentation failure, chronic infection,
Arthroscopes Left 11 Right 2, MRSA, L TKR  ,  Revision, LR x5, Medial and lateral meniscus repair, Broken prosthesis
Osteochondral Fracture,untreated 6 mths. Revision new tkr 01-07 awaiting new hip and right knee
R TKR pending

Offline wanna

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #19 on: February 25, 2005, 12:04:21 PM »
Teresa

Sorry to hear your problems. Way above and beyond my experience and knowledge I'm afraid.

However don't give up. If I've learnt anything it's keep your spirits up even if it means more ops. The possibility of the bone not been able to support the joint is a strange one, although you would think the OS would be aware of these problems.

I still believe that infections can cause a lot of silmilar problems despite every test showing negative .

Hope you feel better soon

Wanna
82-carbon fibre Ligament construction
04/04- synovectomy after ACL snap
09/04- TKR
02/05- TKR revision
07/05 & 09/05 Joint out then Revision TKR
05/07 Revision TKR.
12/07 joint out Stge 1 revison,Stge 2 revision 03/08
08/09 Revision TKR
05/12 Quads Y plasty, scar removal & straight cast for 6 wk

Offline wanna

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #20 on: June 08, 2005, 12:58:48 PM »
dear All

Thought I would update the forum on my progress. See thread

16 weeks after knee wash out after infected TKR and 12 weeks of heavy antibiotics (including 10 days of IV) , and thought I was in the clear.

However, now off antibiotics for 2 weeks and more problems.
I am struggling to walk with a very swollen and painful knee. My surgeon suspects that the infection may have been deep rooted and is in the bone, although
every test suggests no infection. Think he's running out of ideas !

CRP - OK, X Ray - showing implant in place and cement OK

If this is the case, I'm heading for prosthesis out and knee left with a spacer and antibiotics for 6 weeks and then new TKR.

However, he's sending me for a 2nd opinion, cos although my knee is swollen and I'm struggling to walk - it improves slightly under rest. would an infected knee do that ?

anyone know what a loose prosthesis feels like ? Not sure why it would work loose only 8 months after a TKR. Any other ideas ?

Wanna
82-carbon fibre Ligament construction
04/04- synovectomy after ACL snap
09/04- TKR
02/05- TKR revision
07/05 & 09/05 Joint out then Revision TKR
05/07 Revision TKR.
12/07 joint out Stge 1 revison,Stge 2 revision 03/08
08/09 Revision TKR
05/12 Quads Y plasty, scar removal & straight cast for 6 wk

Offline SuburbanLife

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #21 on: June 08, 2005, 04:12:51 PM »
Hi Wanna, boy do I wanna know more!
I had my TKR right about 4 months ago. I did have an infection appear about 8 weeks post op, down at the bottom of my incision, the lower 2 inches just started spouting puss. Oral antibiotics, weekly OS checks, then he started looking around in there with tweezers when the infection wouldn't clear up. First time he did that he said there must be a dropped stitch in there. Found nothing, week later still infected, he poked around in there some more with tweezers and finally pulls out a 1/2 inch piece of string/thread. Case solved as far as he was concerned. Slow, very slow to heal, but it finally healed over with that area being sore. Here I am down the road from that and things seem to be deteriorating for me. I'm loosing ROM, was up to a forced 115 of bend, yesterday in PT she could only force me to about 90. Knee is warm and somewhat swollen at the area of infection, but I am now having very extreme pain there, like take me to urgent care pain. Sharp stabbing pain there periodically. Pain elsewhere, groin, knee cap, upper knee. Basically I can feel the points of implant with pain. What I am wondering is, if you can remember, how did you feel when you first noticed the problem? I'm feeling fine other than I tire easily, way easy. The difference here is that I did have the previous infection. Concerns me. OS never did blood tests or any other tests to determine the infection was gone, it was just a visual thing. Altho he still must be looking for something as I see him every 2 weeks. I found your post very interesting and simular to me. So sorry to hear that all this time later things are still not working out for you. Thanks...Lisa
March 2005-Total Knee Replacement

Offline wanna

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #22 on: June 09, 2005, 12:05:15 PM »
Hi Suburban Life

Yes sounds similar to mine apart from mine swelling up and getting very warm - it has never shown any pus. In fact when the infection first started to show,it was almost impossible to walk .all CRP and blood tests showed negative, yet when they operated ' a swab' showed the Coagulese Negative infection.(no visual sign)

Mine is detoriating similar to your's with loss of ROM, not being able to straighten leg anymore and pretty significant pain when attempting to walk. I also feel fine overall despite pain all down knee and leg, but as you, tire very easily.

Seems strange that your OS sees you every 2 weeks , yet hasn't done a CRP test or other blood tests.(Saying that mine ,have always proved negative despite an infection being found in the joint)

When my infection (1st time around kicked in ) I got some very heavy pain periodically almost like extreme cramp that shot down my leg. I also got some hot/cold sweats when asleep.
Hope this is of some use and you feel better - please keep me informed, as yours may not be an infection but possibly something else which can help both of us !

I'm due for my 2nd opinion next week hopefully - although I sometimes get the impression that they are playing for time. A couple of weeks between appointments and the knee (if infected) will show it's true colours.Good luck
Andy
82-carbon fibre Ligament construction
04/04- synovectomy after ACL snap
09/04- TKR
02/05- TKR revision
07/05 & 09/05 Joint out then Revision TKR
05/07 Revision TKR.
12/07 joint out Stge 1 revison,Stge 2 revision 03/08
08/09 Revision TKR
05/12 Quads Y plasty, scar removal & straight cast for 6 wk

Offline Jan_L.

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #23 on: June 09, 2005, 02:44:18 PM »
Hello Andy,

An infection offen causes a prosthesis to come loose.  My mother had an infection following a total hip replacement and it caused her hip to come loose.  After her infection had been treated she continued to complain of pain and was worried that the infection was back and her doctor finally explained that infections offen cause an implant to come loose.

If possible, when you go for a second opinion, it would be great if you could see a doctor who limits his entire practice to joint replacements.  I did this and it was very helpful.  He was much more knowledgeable on TKR.

Jan
1985 - auto accident- both knee went thur the dash.
1985 - 1990 Four scopes left knee
2002 - Fulkerson TTT
2003 - Scope Rt knee
2003 - Right  TKR
2003 - MUA, 2004 - MUA
2005 - Right TKR  revision
2006 TKR - left knee, 2 MUA
2007 2nd TKR  revision - Rt knee

Offline wanna

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #24 on: June 09, 2005, 03:19:29 PM »
Jan
Agree with you re an infection can cause a prosthesis to come loose, but how can an OS test if it's loose or not ?

At the moment my OS has taken X rays of the joint which he says shows the bone cement in excellent condition with no crumbling or evidence
of bone cement being loosened - consequently prosthesis cannot be loose (his words - not mine)

So that's where I am - He believes;-
- Joint not loose (from X ray)
- Possible infection still around (although all negative tests are worrying him) - so not sure
- Joint was fine 2 months after Op - Not now!
- Degree of ROM and ability to straighten worsening.

Consequently OS look of despair and push me to 2nd opinion.
We don't have doctors in the Uk who specialise in joint replacements, although I understand I'm being put across to the best knee specialist in the area.
thanks for your help

andy
82-carbon fibre Ligament construction
04/04- synovectomy after ACL snap
09/04- TKR
02/05- TKR revision
07/05 & 09/05 Joint out then Revision TKR
05/07 Revision TKR.
12/07 joint out Stge 1 revison,Stge 2 revision 03/08
08/09 Revision TKR
05/12 Quads Y plasty, scar removal & straight cast for 6 wk

Offline SuburbanLife

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #25 on: June 09, 2005, 03:25:03 PM »
Hi Andy,
My OS ran the blood tests yesterday, but he is going to put my leg in a cast for 2 weeks to give my knee a rest. Interesting isn't it, guess we will all have to wait and see how that turns out, sounds as tho I am the first to have that done. He re-xrayed the knee, and all looked great. He has never been concerned about my ROM, I think pain is his first concern myself. His nurse said she has seen him do that for a couple of patients and she said it worked great for them, so who knows. My be a bit of a different treatment, but I'm willing to try it. Will be a bit of a pain for the time, since it's my right knee so there goes my driving independance! I'll keep you posted on how it goes. We're right about the same time after surgery on the issue altho it does sound like you're not doing too well, I hope that improves, do take care...Lisa
March 2005-Total Knee Replacement

Offline wanna

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #26 on: June 09, 2005, 03:44:29 PM »
Lisa

After my recent antibiotic 'washout' and change of spacer, my OS managed to cut through my tendon. - so he put me in a full length leg brace
which had to be locked straight if I moved.(for 6 weeks)
When I was sat or in bed I had to do exercises to keep the knee joint from seizing up - so had to take the brace off.

It will be interesting to see if the cast improves your knee. Please keep me informed.
Prior to the cast - how easy was it for you to walk? do you walk with a limp ?

Good luck

andy
82-carbon fibre Ligament construction
04/04- synovectomy after ACL snap
09/04- TKR
02/05- TKR revision
07/05 & 09/05 Joint out then Revision TKR
05/07 Revision TKR.
12/07 joint out Stge 1 revison,Stge 2 revision 03/08
08/09 Revision TKR
05/12 Quads Y plasty, scar removal & straight cast for 6 wk

Offline SuburbanLife

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #27 on: June 09, 2005, 08:59:29 PM »
Hi Andy,
Ya, I have trouble walking now. Limp, yelp in pain periodically, have to stop, readjust, go again. Pain all the time, it really feels like the knee was never done. Bone pain. Wondering if that is why the cast, let the bones take a break from the implant beating on them. Tough that you had to go thru so much. I was in an immobilizer brace for 6 weeks when I got out of the hospital, pain, hated that thing, but it has some give to it, and like you could do, it would come off if I was in bed, so the cast thingy really doesn't thrill me much, but what can one do?! I trust my OS, he has been there for me, but I do think his main concern is pain control, not ROM, but I would give up ROM for no pain, just me tho...Lisa
March 2005-Total Knee Replacement

Offline Teresa_S

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #28 on: June 09, 2005, 11:19:12 PM »
Lisa, I was unhappy to hear of your chain of events, but surprised to hear you describe the pain like I had, as if the tkr had never been done, and the knee was being walked on with the bone rubbing against bone. I have the same pain I had prior to the TKR, but in addition, about 4-6 additional inches in the circumference of my knee, and leg, and thigh. I awakened with the tkr knee over 3 inches larger in circumference than my  other knee. Also, elevation, and ice do nothing for it. MY thigh has really cause me alot of pain recently, and keeps me awake. I continue to have night sweats, and chills, I run a little bit of a temp-around 100 to 100.6. Last time it was checked my CRP was elevated, but the internist rules out the infection by saying my white count is normal. Granted, he did not take into consideration, that my normal wbc is 2000-3000, and my now count is aboutn 9000. In addition, WHEN I had confirmed M RSA of the joint my wbc(whiteblood count was NOT evelated). IF you read about knee infections, that is one thing that is often pointed out, that blood count do not often reflect the infection.  I am so exhausted, that dragging myself out of bed is a major event every morning. I want nothing more than to sleep, and sleep and sleep. BUT that is not to be, as the rotten leg won't allow it. Hope you are feeling better, and getting some answers. Teresa
On going instrumentation failure, chronic infection,
Arthroscopes Left 11 Right 2, MRSA, L TKR  ,  Revision, LR x5, Medial and lateral meniscus repair, Broken prosthesis
Osteochondral Fracture,untreated 6 mths. Revision new tkr 01-07 awaiting new hip and right knee
R TKR pending

Offline wanna

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Re: Successful TKR 4 months ago now big problems -Help !
« Reply #29 on: June 10, 2005, 02:31:25 PM »
Teresa

After the infection did you have a 2 stage revision or 1 ? How long did this take ? and more importantly what are you like now ?
Can you walk OK ?

I get very frustrated with my OS's dithering over whether the problem is an infection or not. when he went again in Feb 2005 , he found an infection and
now he doesn't seeem to have a clue.
All he can see is me struggling to walk and in big pain. My knee is also 4 ins larger in circumference than the good one !

My problem is my OS seems to think if not an infection then it will not be a loose implant and so should be OK.

A
82-carbon fibre Ligament construction
04/04- synovectomy after ACL snap
09/04- TKR
02/05- TKR revision
07/05 & 09/05 Joint out then Revision TKR
05/07 Revision TKR.
12/07 joint out Stge 1 revison,Stge 2 revision 03/08
08/09 Revision TKR
05/12 Quads Y plasty, scar removal & straight cast for 6 wk

 















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