The REHAB DEPARTMENT > General rehab issues and pain problems

Rehab after staph knee infection

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Hans:
I suffered from a staph infection in my knee in the summer of 2002 and after surgery, two weeks on IV antibiotics and another four weeks on oral antibiotics started rehab.
As the rehab didn’t go as well as expected, a new MRI-scan earlier this year showed a meniscus tear and other cartilage damage in that knee as well, which led to another arthroscopy in April of this year. The recent surgery showed that I miss most of the cartilage behind the kneecap, most likely because of last years’ staph infection. Since then the rehab is painfully slow, also because I never really came back to normal after last years’ surgery.

The surgeon told me that a staph infection in the knee is relatively rare (mine most likely caused by steroid injections in the knee) and in most cases will lead to irreparable damage to the joint. As the surgeons themselves are not very forthcoming with predictions, I hope to learn from other experiences.
Is there anyone who went through a similar experience? What can I expect to regain after all this? Range of motion is back to normal. Currently cycling is ok, but any walking (even trips into town) for more then half-an-hour or so will lead to a stiff knee and pain. Some days I am limping, while other days are relatively ok. Playing soccer with my kids and running are totally impossible and the quads the physio advised me to do are almost impossible without pain. Apart from exercises, I don’t take any medication or diet-supplements.

Heather M.:
Hans,

It sounds like you've been reading my diary.  I had two post-op staph infections in 2002.  The first, in February, was cleaned out surgically, but I ended up with my knee completely frozen by scar tissue.  The second was in June, following a scar tissue cleanup scope.  That time, we treated it medically with antibiotics.  Again, I ended up with tons of scar tissue in the knee which created problems worse than my original knee issues!  I had another scope to clean things out in December, and am considering a sixth scope in the Fall, because the scar tissue is back.

So for me, the problems was initially staph, but it turned out that the complications from that (abnormal formation of scar tissue) and the loss of articular cartilage are really the things keeping me from a normal life.

Have you been evaluated for scar tissue problems?  You can have adhesions, even with full ROM...unfortunately, I'm living proof of that!  The scar tissue has actually caused my patellar tendon to shorten and thicken, which pulled my kneecap down out of place and keeps me with bone on bone contact in my knee.  So I have several grade II osteochondral lesions on my patella.

For me, the pain comes from two sources:  the actual scar tissue itself, which entraps nerves, causes lots of swelling and heat in the knee, and keeps the muscles from firing correctly by attaching to the fibers of the quad muscle and patellar tendon.  So the doctors try to remove the tissue, but have to leave some behind or they end up taking too much healthy tissue.  The second source of pain is the osteoarthritis due to the mechanical problems caused by scarring and my basic knee anatomy.

I've not been given a lot of hope for full recovery, but that's because of the patella baja (kneecap pulled too low by shortened patellar tendon).  You may have a totally different situation.  I do know that infection and scar tissue go hand in hand.  Also, you are at risk for further infections if you have more surgery, because apparently the scar tissue encapsulates the bacteria and it lies dormant, waiting to come out again.  I've been REALLY lucky in the last 7 months not to have a recurrence of the infection.  Unfortunately, a lot of the options for Osteoarthritis pain (Synvisc, cortisone shots) are now off-limits for me because of the risk of infection.

Anyway, I would definitely seek out highly specialized doctors who deal with complex knee issues and particularly patello-femoral syndrome.  You may have a bit more than cartilage damage going on, or that damage may be secondary to something like scar tissue or patella baja, tendon problems due to adhesions, and so on.  It's also possible that you have something else going on like the meniscal tear.  If you have an otherwise healty knee, just have damaged cartilage due to infection and multiple procedures--well, you could be a candidate for some of the cartilage restoration surgeries or an open realignment procedure.  That's why it's important to see a really good doctor.

I know this isn't too helpful, I just wanted to say that I've been through what you are experiencing--heck, I'm slam in the middle.  So far, I've had to handle it with very specialized PT, a variety of pain meds, anti-inflammatories, acupuncture, home TENS for pain control, and lidocaine patches.  All of these take the edge off, but nothing has fixed the problem.  And my doctors don't think much will be changed in the future.  I really hope your situation is different, and the only way to tell is to have a thorough evaluation from several knee specialists and kind of average their diagnosis and recommended treatments together....

Heather

Hans:
Heather,

Thank you so much for your reaction, it helps to read about similar experiences. It sounds really awful what you’re going through and I think that for most (all?) of us these are life-changing experiences.
Did it ever become clear what caused the staph to be in your knee in the first place? For me it really came out of the blue and the surgeon can only suspect the cortisone injections, but he is not sure. Just bad luck?

Earlier in my rehab my kneecap was too low as well, making it hit soft tissue in the lower-leg. That caused a type of pain like a trapped nerve, like the hitting the elbow-bone.
This was due to weakened muscles (I had not been able to walk properly or do any quads since the first surgery last year…). The PT taped it in place several times for a couple of weeks, while I worked to increase the muscle tissue that keeps the kneecap in place. That seemed to have worked as since then that pain is much less (with the tape the pain during quad-exercises was almost completely gone). After last years surgery I had a MRI-scan showing the meniscus tear, but not any scar tissue. Also during this years arthroscopy they “only” found lesions (the picture they showed me looked like a crater of a meteorite!), so I seem to be more lucky there then you and my problems may be caused by “just” the loss of cartilage. Also with me the surgeons are reluctant to use Synvisc for the fear of infection, but I never heard a theory of dormant bacteria in scar tissue that can flare up again. Sounds hairy.

Heather M.:
Hans,

We know exactly what caused my staph infections--cortisone shots.  I had two rounds of oral steroids in the three months before my first surgery and infection.  This caused extremely slow healing as my immune system was suppressed by the drugs (exactly what they wanted to happen, but not for such a long time after I did the oral therapy).  Due to this slow healing, one of my incisions kept popping open and draining fluid.  The doctor believes the staph bacteria, which normally live harmlessly on our skin, got into the open incision and went right inside the knee joint.

The second time I had surgery and staph infection, the doctor actually did a cortisone injection after my surgery, because of the continuing scar tissue problem.  Again, the incision didn't close, and I ended up with an infection that went on for weeks--despite antibiotics.  More scar tissue formed.

I'm so glad your patella baja was temporary and related to muscle weakness!  The faster you get past the patella baja, the better you will be in the long run.  For me, it seems that after 2 years the changes in my patellar tendon are permanent--so the patella baja isn't the result of weak muscles, but an actually mechanical issue.  Unfortunately, it becomes a cycle--because the kneecap is too low it will keep the quad from firing correctly, which will result in quad weakness and further dropping of the patella.  It's a very frustrating problem.  I've had some luck with taping, but it doesn't eliminate the bone on bone contact for me.  

You're right that it's a life-changing experience.  I hope since your knee mechanics are okay, that you will be eligible for some of the cartilage restoration techniques that are out there.  As for the dormant scar tissue--it's my understanding that it will only flare if you cut the scar tissue out and expose the bacteria again.  The scar tissue is your body's way of isolating the bad stuff to protect you, and the body is pretty good at this kind of thing.  But that's why no doctor will do a cortisone or Synvisc injection for me.....

Good luck with your knee journey.

Heather

Jillian24:
Hans,
   I had a LR on both knees at the same time. I developed staph in only my left....something was not steril in the hospital. I have had many of the sam things that heather had, clean outs as well as severe scar tissue. I am planning a TTT next month, but that was because the OS released my knee cap to far and now it's to long gone for a simple surgery.
I would tell you this. After my knee healed and we got my staph under control(two months in the hospiatl and then 6 weeks of iv) I really didn't have that much pain. I have always had achy knees, like when sitting in a car or not being able to stretch out. BUt all in all if I hadn't had a clean out and all the problems that had gone along with it, I would have been okay.
I had done all the PT patella wrap as well, adn was in PT for what seemed like forever! And it did help. But it sounds like we had a lot of the same things. Goos Luck to you and I hope you find some relief soon....Jillian

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