TKA 10/17 constant low level pain, swelling
Arthroscopy 10/18 scar tissue release, synovial fluid suggested infection (high CRP, WBC, cloudy) but culture negative after 1 week
Joint stable, good ROM but continued pain dismissed by several surgeons.
2/2022: Night after a strenuous Friday hike, I woke up with extreme pain in the knee, unable to bend it or bear any weight. I had excruciating rigors, body aches and a fever. I figured Covid but tests negative. I saw my NP on Monday. Bloodwork consistent with knee infection. First orthopedist appt. Tuesday when I was feeling somewhat better. Synovial fluid cloudy, bloodwork showed high CRP, white cell percentage consistent with infection. In spite of my belief that this was a chronic infection, ortho deemed it acute and did D.A.I.R. surgery and replaced the plastic parts. 1 week in hospital. On moderate pain meds I was able to race around the hospital floor with my walker and walk unaided. High octane IV antibiotics in hospital and with PICc line for 6 weeks at home. 2 months out my knee is still painful but my wound has healed quickly and I have full ROM and extension. Getting stronger with PT.
Here is my issue. Cultures grew propionibacterium acnes (now a Cutibacterium), a slow growing gram positive anaerobic bacteria which indicates that my infection is chronic and not acute. The only cure is surgery to remove and replace the implant. But my orthopedist has decided that surgery is too risky because of my 3 prior procedures and that the only course of treatment is lifelong antibiotics. I am 72, not overweight, physically and mentally active, no significant health issues other than mild asthma and osteoarthritis with some mild osteoporosis. The Ortho left it up to the infectious disease PA to give me the bad news Why??? This is not the preferred treatment unless someone is unable to tolerate further surgery. Previous DAIR makes replacement less curative but should not preclude it. I suspect they are afraid of legal issues and just do not want to deal with me anymore. 2 year survival with this treatment at 2 years is 68% at best. I am already having side effects from meds. I have tried to contact other revision specialists but none have returned my calls/messages. Discouraged. Advice?