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Author Topic: Yankee's Arthrosurface Patello-Femoral Implant Diary  (Read 20601 times)

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Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #15 on: November 05, 2013, 02:12:26 PM »
Day 18 - early Monday morning....  I woke up to a bloody mess.  After removing the surgical glue and using butterfly closures to keep the wound together but leave it open so it could dry, I woke up Monday morning to *wet*....my entire bed was soaked with bloody sero fluid, which was also running down my leg.  Apparently there was a sizable pocket of fluid around the kneecap that I knew was there but I assumed it would dissipate on its own.  Because the surgical glue made the wound crack, the fluid took the path of least resistance and exploded out the middle of my knee when I bent it in bed.  Back to the doctor first thing, with all kinds of half humorous accusations 'what did YOU do this time', which at this point I didn't find funny in the least since it wasn't anything that I did that caused this problem.  In fact, aside from my falling down under the influence of a femoral block, none of the problems I've had with this wound have been caused by me...  It was decided that the pocket was superficial, that it wasn't infected,  so I am to keep it bandaged, allow it to continue draining, cleaned every day in the shower and with peroxide and now that the fluid was out it is assumed that the pocket will close of its own accord.  Back on the Keflex as a precaution, the draining has slowed and I hope by the end of the week will be non existent.  I am beyond annoyed and discouraged.

The pes ansurine pain is still excruciating, I mentioned it to the doctor and told him how much it hurt and he basically didn't address it.  If the PT can't do anything to help it, we'll be having another chat to see about a lidocaine/steriod injection to calm it down.  It's like a lightning bolt shooting down my leg when I walk and it IS affecting my recovery, since that's the major source of pain that's holding me back.  I doubt he will even consider it if my wound has not closed, as steroids are going to affect healing.

Meanwhile I ice, ice, ice, and take the pain meds when I can't stand it anymore, but I"m back at work so that's not frequently.  On the positive side, the extreme pain from under my kneecap is gone, no more arthritis, but it would be nice not to have the other pes ansurine pain so that I could fully appreciate it. Note to self, never have surgery while Mercury is retrograde......

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #16 on: November 06, 2013, 04:34:36 AM »
Day 19-Tuesday.  Thought I was out of the woods with the fluid in my knee, I had a compression bandage on it and sat with my knee bent for most of the day in order to put pressure on it and get it to drain.  Not much came out, so I figured I was over the worst.  While I was at PT tonight, the therapist bent my knee up while I was laying down and fluid shot out of my knee and half way across the room, all over me, all over my clothes, she said she thought she'd need a hazmat suit.  There's still a lot of fluid hiding in there, she soaked three surgical pads working it out, and I soaked a bunch more bandages after I got home.  It's not infected, but it easily could be with all those pockets in there. I suspect that the wound is either going to need revision or will need a drain, neither of which I'm prepared for.  Pretty angry, in fact.  This is not what I need. I have no sick time left, and I need to be able to drive. I should be doing stairs by now.  Very discouraged.

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #17 on: November 08, 2013, 01:42:57 PM »
Day 21-Thursday. Had to go back into surgery under general anesthesia for an incision/drain, clean up the wound and resuture.  They are going to culture what they took out and hopefully it's nothing bad.  It was superficial and didn't go deep enough to affect the implants, which says to me that the "infection" or whatever it was is from the very poor suturing job in the first place. Forgive me, I am an angry person right now.  As if having to go through this a second time wasn't bad enough, the surgeon who appears to enjoy causing me as much pain as possible once again (I say again because he pushed me back on the table during follow up visit and threw in some sutures without novocaine) didn't use novocaine when he sutured (sutures, not staples, again) so I woke up feeling EVERYTHING, stinging and burning and on fire, and it still is.  I'm told I can bend my knee to drive to work, except that when I do it causes excruciating pain because there's no anesthetic. 

As if I have not said so repeatedly, I HAVE to work, no more sick time, living hand to mouth, I cannot miss work.  So, how hard would it have been to be considerate and diminish the pain as much as possible so that I can get on with my life? I think all of the room taken up by that giant overblown ego has displaced the compassion for a patient a doctor is supposed to have. Definitely not happy with this surgeon at all, crappy bedside manner, would never recommend him, and it's very very doubtful that I would ever let him do my other knee, which was tentative for December.  He can't be bothered talking to me without his hand on the doorknob - he has zero personality, except that of a arrogant bully.  The OR nurses asked me if there was anyone the doctor should call after the surgery was over, and I said "Yes me, he can't be bothered talking to me otherwise!" After surgery he did grace me with two minutes of his time, not long enough for me to question him about the lack of novocaine. He was long gone by that time.  Bad enough that this surgery turned into a clusterf*ck through poor management, but to make it as painful as possible?  Whether out of ignorance or arrogance or just mean-spiritedness, not acceptable.

Sorry for the rant, I wanted this to work out and I wanted my life back by getting both knees fixed. Not going to happen, at least this year, and it didn't have to be like this.

Offline Lee Tipton

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #18 on: November 08, 2013, 11:14:07 PM »
You have every right to rant - AND - to find yourself another doctor!!!  ASAP!!!

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #19 on: November 09, 2013, 05:46:11 AM »
Day 22 - Friday - I cannot tell you how much agony I have been in all day.  The sutures hurt like they are on fire, all day long I have had like electric shocks that are so painful they make me gasp out loud. If I move, or the bandage moves, I want to scream, so painful.  I was driving to work (and no, that doesn't feel good either), so no narcs, although I did finally give in and take a half of one mid afternoon, I just couldn't stand the pain, but sadly they don't do much for it.  I had to sit quietly in my chair, not moving, I put ice on it but the cotton is so thick that ice is basically useless, and that's the one thing that might make it feel better.

The Nurse called today to see how I was doing, and I said "You can tell him this verbatim. If he was standing in front of me right now I'd probably punch him in the face. There is NO excuse for him not using any anesthetic for these sutures, it's cruel and it's inhumane when there's no need for me to be in this much pain. Unacceptable.  We'll have words when I come back, and they won't be nice ones".  I think the business end of that hospital is going to get some letters too, he should at least be forced into some kind of sensitivity training if he is incapable of judging what kind of pain he's causing. Not acceptable for a doctor to behave like that.

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #20 on: November 09, 2013, 07:16:20 PM »
Day 23- Saturday- Still in excruciating pain from these huge sutures, like electrical shocks up and down my knee.  If I thought I could tolerate the drive and the probably 4-6 hour wait in the ER, I'd go and ask them to at least numb it, but I can't.  Taking Norco every 4 hours since last night, which is doing pretty much nothing for the nerve pain.  I thought it would have calmed down a little by now, but it hasn't. I'm getting ready to remove the dressing and try to get some ice to the sore part without touching the sutures, something, anything to calm it down.  When will this be over, I wonder......

drmark

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #21 on: November 09, 2013, 08:00:47 PM »
This sounds like an infected joint.  Were the cultures negative?

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #22 on: November 10, 2013, 12:49:05 AM »
drmark, I was told the following morning that the cultures were negative, but I was also told by a nurse practitioner that cultures usually take up to 48 hours, so what they would have checked for was white cells first, and that supposedly was negative.  It did not feel infected, it was just full of fluid that was building up in pockets left from a lousy suture job (IMO) and because the skin had cracked from the surgical glue, it found an avenue out.  I was told it was superficial, it didn't go deep enough to get into the joint.  I will believe that when it's healed completely.

drmark

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #23 on: November 10, 2013, 02:11:49 PM »
People with a superficial collection of fluid, don't have very much pain.  Was the culture from the knee fluid, or from superficial?


Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #24 on: November 10, 2013, 05:13:11 PM »
I don't know what they took, I assume it was from what they cleaned out when they opened it, not much was draining out at that point, it was building up inside again. I didn't have any pain per se except from the increasing pressure of what was collecting inside - if something is infected usually there's 'heat', and I didn't feel any of that - but I sure it would have headed in that direction if it wasn't addressed.  No fever or chills, and have been on Keflex since the day after the first surgery when I fell and blew open the steri strips.

I just talked myself out of going to the ER to beg someone to numb it, mostly because the drive and the probably four hour wait would be worse.

drmark

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #25 on: November 10, 2013, 05:39:43 PM »
 Antibiotics by mouth can mask an infection and make the symptoms somewhat less clear, and cause a false negative result from the wound cultures.
« Last Edit: November 10, 2013, 06:23:21 PM by drmark »

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #26 on: November 10, 2013, 06:18:51 PM »
Oh that's just super.  I'll try to comfort myself with the knowledge that the fluid that came out it was just clear, yellow/pinkish fluid, not cloudy or with pus.  And hope this doesn't turn into a mess.  The sutures (I have had to rebandage because the bandage keeps creeping down, dragging on the sutures and exposing them) look pretty tight, no wonder they hurt.

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #27 on: November 12, 2013, 01:54:24 AM »
Well, the news just gets better and better.  I called the doctor this morning because I'm watching this once dry wound kind of start to deteriorate - what last Friday was a clean 'seam', is now starting to degrade a little bit.  I want to CLEAN IT.....Everything this doctor tells me about wound care is exactly the opposite of what I know to be true from experience, and from what is published on the company website.  Keep it dry for 24-48 hrs then wash gently and keep it dry. I had a 2" wide and 1/4" deep hole in my leg from Mohs surgery for basal cell cancer.  Kept it clean for three months by cleaning and dressing every day, never had a problem.  He wants me to leave it covered for five days.  Which IMO is going to just make it rot, stuck in that moist wet dirty bandage for five days.  I insisted today (day 4) that I be allowed to bathe and clean it, and I did.  It's red, but hard to tell if it's red from irritation of the bandages rubbing, or the sutures are too tight (they are VERRRY tight) or if something else is going on. I'm icing now to cool things down. I personally hate the synthetic bandages made of poly and rayon, they extremely irritating to my skin friction wise, and they seem to just make everything wet.

Meanwhile I get the news that the culture of what was taken out of my knee has pseudomonas and enteroccus in it - I did not see the path report so I have no idea exactly what organisms.  I did especially like the accusatory tone by the doctor "That comes out of YOUR COLON!", as if I wipe my butt and smear it on my sutures.  I'm such a germophobe in real life it's not funny, so this insinuation I find very insulting.  It also comes from dirty hospitals, more than likely it DID come from a dirty hospital especially if it's a resistant kind.  I've been on Keflex for almost a month, I am a yeast factory, so I'm not sure what good that actually did except to exacerbate the problem.  Now I'm supposed to see an infectious disease doctor.  I'm trying not to freak out, because a) I was told it did not penetrate the joint capsule, it's superficial, and b) it's what was supposedly cleaned and flushed out with bacitracin - with any luck there is nothing left in there.  IV antibiotics during surgery, did they help or hurt, I have no idea.  I'm pissed. And scared. And wondering why the hell I ever thought this was a good idea.
« Last Edit: November 12, 2013, 01:59:12 AM by Yankee »

drmark

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #28 on: November 12, 2013, 03:29:51 AM »
I am no apologist for anyone, but I have a hard time believing that someone would wipe their butt, and then use the same toilet paper to wipe their wound.  Beyond that I have almost never seen this combination of germs in an infected total (or partial) knee replacement. 

The AAOS's CPG for diagnosis of periprosthetic joint infections (aka PJI) requires the positive cultures to have occurred in more than one culture specimen, assuming that there were no other blood of tissue test that indicate infection.

The AAOS CPGs also warn strongly against the exogenous use of antibiotics absent cultures taken prior to the onset of antibiotic administration.  When I inherit an new patient with these problems, I stop the antibiotics, wait a week or two and then reaspirate the knee for culture and synovial fluid signs of infection.  Then I use the CPG for the diagnosis of PJI to determine my next step.  The CPG (Clinical Practice Guidelines) are available for free from www.aaos.org




Offline Lee Tipton

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #29 on: November 12, 2013, 03:31:45 AM »
Yankee - I am calling your name into our prayer team tonight.  When my husband was alive - he was a double transplant recipient.  He was given a kidney and a pancreas.  He lived 4 years with those 2 transplanted organs.  He spent the last year of his life battling every kind of infection you can imagine.  They operated on him 21 times trying to save his life.  During that time there was a specialist that did nothing but handle those infections.  I am terribly sorry - but I do not remember the name of those doctors - but you need to find out what they are called and then find one.  You need to get on top of this situation now.  A specialist is what you need and if your doctor won't recommend one - then find one on your own.

May God Bless you Yankee.
Lee Tipton















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