47 years old having TKA revision with static spacer block then new TKA

Posted by youngtkawarrior @youngtkawarrior, Sep 12, 2024

Hi all, I am 47 years old and had my first TKA in May of 2022. I am athletic, not immunosuppressed and otherwise healthy. This June (2024)- two years after my very successful first TKA I had a staph aureous infection in my knee and my dr performed a washout procedure, in which he reopened my incision, cleaned the infection, replaced a small part of the implant, and I was on 6 weeks of IV antibiotics via a PICC line which I administered myself. After the 6 weeks, I transitioned to oral antibiotics for the rest of my life.

I recovered very quickly, and by Labor Day I was back carefully going to ballet and yoga. However, my knee started to swell, I went to my DR yesterday and I now still have a staph aureus infection and they are going to open up my knee, remove the metal in the implant an replace it with a cement static spacer block (which is infused with antibiotics).

I will be "immobile" with a cast on my leg from my hip to my toes for 3 months and THEN will have a second surgery to remove the spacer, the old imp,ant and put in a new implant. So basically I'm starting over from the original implant from May 2022 only with 3 months of atrophied muscles and tight connective tissues (ligaments, etc) from being immobile in the cast.

My questions are numerous- has anyone had this done? what is the recovery time- I know a year, but what really happens? how do you manage with the whole leg cast? Has anyone had this procedure and had to do it more than once?

I started this journey when I was 45, and I know I'm a young candidate, and the rate of infection is 1-2%, and now I have a reinfection, so what is the rate of success after this? my head is really spinning and I don't know anyone who has gone through this at my age...

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algrieco | @algrieco | Sep 25, 2024

Sorry about your bad luck.

fcarlsen12 | @fcarlsen12 | Sep 25, 2024

In reply to @roodog575 "Hi, Had my TKA this past January at 52. I’ve always been healthy and active. Within..." + (show)

@roodog575

Hi,
Had my TKA this past January at 52. I’ve always been healthy and active. Within a month or two, the knee started swelling and remained so despite numerous drainings. The fluid was always bloody red. In just one draining, 130 ml was removed.

In July the fluid tested positive for Staphylococcus Salivarius and I was placed on an oral steroid for 10 days.

In August I tested negative for any infection including metal allergies but the swelling remained. The original surgeon reopened the knee, removed synovium and installed a plastic button behind the degraded knee cap. A week later it was just as swollen as before. He drained it and it was the same bloody fluid but it tested negative for infection.

This surgeon’s approach had always been “come back in 4-5 weeks and continue PT”. PT had been useless and my muscles had atrophied horribly because my knee was so swollen. The knee had also become very unstable.

One week ago I went to a new surgeon who immediately recognized there was an issue. Numerous tests were conducted and all were negative for infection but he was convinced it’s in there based on the long term swelling. He got me into surgery yesterday and removed the original implant and installed an antibiotic spacer. He said there was evidence of necrosis in the tissue. So far all tests he conducted for infection have been negative. I now have a pic line for antibiotics which I’ll be taught how to administer today. Hopefully the line will come out in 6 weeks. A new implant will be installed around 3 months.

The antibiotic joint is very noisy. My wife can hear it clearly when I move. It’s disturbing mentally and physically. I have a call into the surgeon to ask about that.

I feel your frustration and pain. I haven’t been able to my preferred activities (mountain biking, hiking and motorcycling) since last Fall and won’t be for the foreseeable future. I’m hopeful this new surgeon and his 30 years of experience are the answers to my problems.

Good luck and keep looking forward.

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similar sitiuation with myself, i had the spacer for 3 months , was able to move around a bit but it was not comfortable , i complained to the doc about the pain and mobility issues , he says grin and bear it as we are only concerned about the infection ! TKA May/28 have long stems that is creating pain for me constantly , doc says it will take some time for lower leg to get used to the implant ! wish you well !

davidinboulder | @davidinboulder | Mar 13 2:00am

I'm 68. Just survived Sepsis which attacked my spine, my two artificial knees (TKR's) and my shoulder. Was in the hospital 21 days. Spent three weeks in rehab. Now home recovering. Had both knees and my shoulder immediately washed out (debridement) to remove the Sepsis bacteria. My infectious disease doctor has told me I have two options. Option one - to have both my artificial knees replaced, a nine-month revision surgery and rehab process using spacers. Which I am very much dreading. Or option two, live with my existing knees (which work fine) but will always have Sepsis biofilm attached to the knee metal which it attacked. This option requires I will have to take oral antibiotics the rest of my life. Most doctors, nurses' orthopedic surgeons say this having to take oral antibiotics the rest of my life has lots of risk over time. As it can lower your antibiotic effectiveness over time and leave to gut problems or possibly C-diff. Has anyone faced this same post Sepsis situation - whether to have knee revision surgery to rid the body of residual infection or having to instead take lifetime oral antibiotics to avoid knee revision surgeries? Please give me your experience if you have perhaps faced this situation and any advice on the best option and why. Met with the knee revision surgeon two days ago. He said the antibiotic option is too dangerous long term and I should immediately get started with getting my knees out and the bacteria out once and for all. Dreading this. Opening my knees up many times, living with spacers, a nine-month process - Yikes! Help!