Total knee replacement infection after 9 years.

Posted by rguribe @rguribe, Oct 2, 2019

I recently had an infection on my total knee replacement, they went in and clean the infected area. I was on 6 weeks of Vancomycin antibiotics through a PICC line, and afterwards, the doctor stated that I would have to be on a low dose of antibiotics (Doxycycline 100mg) for the rest of my life, that it was the new recommendation from the AMA. I have not been able to find that info in the AMA website and my concern is the side effects of taking antibiotics for the rest of my life. Has anybody gone thru a similar infection and is presently on antibiotic for the rest of their life? Thank you

Hi @rguribe – Welcome to Connect. That is so scary that you developed an infection 9 years later. I've had 2 TKR's – one in 2017 and one earlier this year. I never dreamed that an infection could develop after so many years. You must have been devastated. My doctor has told me I have to take antibiotics before teeth cleaning for the rest of my life, but its just 4 amoxicyllin ever 6 months so it's not the same as your situation. While we are waiting for others to chime in, can you tell me what the rest of your recovery was like? Were there extenuating circumstances or did this kind of hit you out of the blue?

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I am so very sorry you had to go through this. It totally took me by surprise! I thought, aside from premeds for dental procedures, we were all safe from infection, but I guess not. Do they have any idea what caused it? Scary to say the least, especially after 9 years.

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@rguribe I, along with the others, wonder what caused an infection so many years after your TKR. That's something for all of us to be aware of the possibility of it happening. I am about 6 years post TKR on my R knee, and 2 years post TKR on my L knee. I too thought I was out of the woods except for taking an antibiotic before dental procedures. Many orthopedic surgeons don't even suggest that after two years but mine wants me to do it forever.

Looking forward to hearing more from you. I can definitely understand your concern with taking antibiotics forever. I will be interested in hearing what you can find out about that also.
JK

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Did you also have a revision surgery?

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@debbraw

Hi @rguribe – Welcome to Connect. That is so scary that you developed an infection 9 years later. I've had 2 TKR's – one in 2017 and one earlier this year. I never dreamed that an infection could develop after so many years. You must have been devastated. My doctor has told me I have to take antibiotics before teeth cleaning for the rest of my life, but its just 4 amoxicyllin ever 6 months so it's not the same as your situation. While we are waiting for others to chime in, can you tell me what the rest of your recovery was like? Were there extenuating circumstances or did this kind of hit you out of the blue?

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Hello Debbra, regarding my infection, I woke up in the morning and I went to step down from the bed and I almost fell down from the pain. I could not walk on it, it was swollen, so I went to the ER. I had no prior symptoms. They drew some fluid from my knee and it was bloody/puss like, and the tests showed an infection. They did emergency surgery the next day. The doctor said that I was fortunate that I did not wait long to get it checked out because the infection could have spread into my bloodstream.

According to the doctor, they cleaned/scrubbed the infected areA, and then they put antibiotic pellets inside the knee before they stitched it up. Unfortunately, they had to put 41 stitches because it was too swollen for just put glue and tape. I now have a pretty nasty scar. I had to be on Vancomycin antibiotic thru a PICC line for 6 weeks which I administered myself twice a day. I lost 20 pounds because the antibiotic took my appetite away, I could barely eat once a day, nausea, dizziness and it killed my stomach, even thou it was administered intravenously.

After 4 months of physical therapy, I am getting better every day. I have to say that this recovery has taken longer and more painful.
The downside is that I have to be on antibiotics for the rest of my life. Oh well, the alternative could have been worse.

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@emb123

I am so very sorry you had to go through this. It totally took me by surprise! I thought, aside from premeds for dental procedures, we were all safe from infection, but I guess not. Do they have any idea what caused it? Scary to say the least, especially after 9 years.

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The doctors told me that it could have been as simple as inhaling germs from someone that had a bad cold around me and/or from a minor cut were bacteria entered my bloodstream. Medical procedures (surgeries, ect) can also cause it if germs enter your bloodstream. They also said that it could have taken months after the germ(s/bacteria) attached themselves to the metal parts of the replacement, for it to grow and spread to the tissue (muscle/tendon ect) within the knee, that's when the infection spreads and your body reacts.

I am now very cautious when I do any kind of work, I wear gloves, will definitely clean any kind of cut that I may get to prevent future infections (I was really bad at that), even thou being on antibiotics is suppose to help from now on.

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@micky19

Did you also have a revision surgery?

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Fortunately I did not

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@contentandwell

@rguribe I, along with the others, wonder what caused an infection so many years after your TKR. That's something for all of us to be aware of the possibility of it happening. I am about 6 years post TKR on my R knee, and 2 years post TKR on my L knee. I too thought I was out of the woods except for taking an antibiotic before dental procedures. Many orthopedic surgeons don't even suggest that after two years but mine wants me to do it forever.

Looking forward to hearing more from you. I can definitely understand your concern with taking antibiotics forever. I will be interested in hearing what you can find out about that also.
JK

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I am researching taking antibiotics for the rest of my life, but I have found/gotten mixed responses from doctors/websites. I am making an appointment with Mayo clinic to discuss this further. Unfortunately, I have taken great amount of antibiotics for past illnesses thru the years and so it is of great concern.

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@rguribe Thank you for explaining what happened. What a nightmare you went through! It’s a good lesson for all of us to get medical care quickly, things could have been much worse.

It’s a cautionary lesson too. I am sure many of us may have skipped washing our hands at some point when we should have. Those of us who are post-transplant so on immunosuppressants need to be especially careful. It’s very surprising that it could have even been inhaled.
JK

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@rguribe

Hello Debbra, regarding my infection, I woke up in the morning and I went to step down from the bed and I almost fell down from the pain. I could not walk on it, it was swollen, so I went to the ER. I had no prior symptoms. They drew some fluid from my knee and it was bloody/puss like, and the tests showed an infection. They did emergency surgery the next day. The doctor said that I was fortunate that I did not wait long to get it checked out because the infection could have spread into my bloodstream.

According to the doctor, they cleaned/scrubbed the infected areA, and then they put antibiotic pellets inside the knee before they stitched it up. Unfortunately, they had to put 41 stitches because it was too swollen for just put glue and tape. I now have a pretty nasty scar. I had to be on Vancomycin antibiotic thru a PICC line for 6 weeks which I administered myself twice a day. I lost 20 pounds because the antibiotic took my appetite away, I could barely eat once a day, nausea, dizziness and it killed my stomach, even thou it was administered intravenously.

After 4 months of physical therapy, I am getting better every day. I have to say that this recovery has taken longer and more painful.
The downside is that I have to be on antibiotics for the rest of my life. Oh well, the alternative could have been worse.

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Oh my gosh @rguribe – my heart is just aching for you. I cannot imagine the trauma you've been through with this. I've been on Connect for awhile now and I can truthfully say that I haven't heard of anyone getting an infection so far out of surgery. You must've been in shock when they told you what it was. I was so glad to hear that you have an appointment at Mayo to discuss the implications of antibiotics for life. Can you ask the doctor point-blank what the possible side affects are and whether there are alternatives? Also, can you keep us posted? You can see that there are many of us who have had TKR's who are closely following your situation and interested in the answers you get.

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@contentandwell

@rguribe Thank you for explaining what happened. What a nightmare you went through! It’s a good lesson for all of us to get medical care quickly, things could have been much worse.

It’s a cautionary lesson too. I am sure many of us may have skipped washing our hands at some point when we should have. Those of us who are post-transplant so on immunosuppressants need to be especially careful. It’s very surprising that it could have even been inhaled.
JK

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I would agree, and find your experience alarming. I am relieved you sought treatment so promptly. It is an important reminder of the need for vigilance with hand washing etc. Thankyou for sharing, it’s a timely reminder

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I had both knees replaced about 10 years ago. I developed an infection In my right knee about 6 years later. I had cellulitis in my chin and the infection traveled to my knee. My doctor told me that sometimes an infection in one place (my chin) will travel to places where there is an artificial part…in this case my right knee. It started hurting about 2 weeks after the cellulitis and my knee was hot, red, and swollen. The first time I went to the ER they gave me pain meds. I followed through by seeing my surgeon several day later. At this point he put me on an antibiotic and was simply watching it. By 2 weeks it was so swollen and painful I could hardly stand it.
I went in to see the doctor and he removed some fluid and sent it for testing. I received a phone call from his office several hours later telling me to go to the hospital and check in, they had a room for me. They said he would be surgically removing the infected tissue, etc. They called it “debride and irrigate” the area. This was surgery #1. I woke up with a “soft immobilizer ” which kept me from bending my knee. I was also on IV antibiotics. I stayed in the hospital several days and the moved to rehab. I was on antibiotics for several months. I recovered and things were fine.
#2 Surgery- About 5 months later I fell in the garage. I whacked my knee, broke 3 ribs, and broke 3 vertebrae above where I had titanium rods in my Lumbar spine. Boy, I was a mess and in terrible pain. Back to the hospital….the fall caused the infection in my knee to kick up again. As my luck would have it I had MRSA. Apparently minute pieces (cells) of the infection can linger on the artificial parts. So all the hardware in my knee was removed. A cement block saturated with antibiotics was placed in that area and once more I was on antibiotics. Before I left the hospital I had a PICC line inserted and for several months I administered the antibiotics through the PICC line. It must have been about 6 months before Infectious Diseases cleared me for surgery #3 to give me new hardware.
At this point I was turned over to a Reconstruction Specialist. He put in my new hardware. And I was still on antibiotics…he said most likely I would need to take them forever. I had another PICC line and more antibiotics again. This time the brace was an immobilizer that went from ankle to the highest possible area of my thigh. My incision was 27 inches! After 3 months I got to remove the brace.
I was doing great except my kneecap seemed to be off center a bit. Within a month or so, my kneecap worked it’s way almost to the side of my leg. So surgery #4 was done to move my kneecap over and “tied” in place. Back to the killer brace. Passed go and the brace came off. It wasn’t long before my kneecap started moving around to the side. So…
You guessed it, Surgery #5! My own tendon was shot. My doctor said it was like elastic that have been stretched too far and lost it’s elasticity. This time I had a bone graft, a new patella, and a new tendon that connected to what was left high in my thigh. I was doing great, getting around fairly well while wear my brace that allowed no bending. I also developed another infection, but it was quickly attacked by more antibiotics.
I know you will find this unbelievable but there was Surgery #6! The bone graft started to separate so he went back in and used larger screws and wrapped wire around it so it wouldn’t separate. I am now about 2 months post surgery from the last surgery. I have to wear the brace for another 3 months-making 6 in total. Two weeks ago I fell but no damage to my knee! My back is a different story.
But after all this covering about 3 years, I can see the light at the end of this tunnel. I am taking Minocycline, maybe forever and another antibiotic for the small infection I had at the end. I have that lovely 27 inch incision scar but it is funny what really matters. I don’t care what my leg looks like. I just want to be able to walk, drive, and enjoy life. I think I am close to doing those things again. Long trip but I am still positive and look forward to living again. Sometimes I cannot believe my own story. What I have discovered it that there are so many nice and caring people out there. Male, female, every age, everyone stops to help me through a door or in and out of a chair, etc. it gives me hope for the world. And I so appreciate my group of family and friends who have done so much to help keep me going. I have been fortunate indeed.

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@boislandgirl

I had both knees replaced about 10 years ago. I developed an infection In my right knee about 6 years later. I had cellulitis in my chin and the infection traveled to my knee. My doctor told me that sometimes an infection in one place (my chin) will travel to places where there is an artificial part…in this case my right knee. It started hurting about 2 weeks after the cellulitis and my knee was hot, red, and swollen. The first time I went to the ER they gave me pain meds. I followed through by seeing my surgeon several day later. At this point he put me on an antibiotic and was simply watching it. By 2 weeks it was so swollen and painful I could hardly stand it.
I went in to see the doctor and he removed some fluid and sent it for testing. I received a phone call from his office several hours later telling me to go to the hospital and check in, they had a room for me. They said he would be surgically removing the infected tissue, etc. They called it “debride and irrigate” the area. This was surgery #1. I woke up with a “soft immobilizer ” which kept me from bending my knee. I was also on IV antibiotics. I stayed in the hospital several days and the moved to rehab. I was on antibiotics for several months. I recovered and things were fine.
#2 Surgery- About 5 months later I fell in the garage. I whacked my knee, broke 3 ribs, and broke 3 vertebrae above where I had titanium rods in my Lumbar spine. Boy, I was a mess and in terrible pain. Back to the hospital….the fall caused the infection in my knee to kick up again. As my luck would have it I had MRSA. Apparently minute pieces (cells) of the infection can linger on the artificial parts. So all the hardware in my knee was removed. A cement block saturated with antibiotics was placed in that area and once more I was on antibiotics. Before I left the hospital I had a PICC line inserted and for several months I administered the antibiotics through the PICC line. It must have been about 6 months before Infectious Diseases cleared me for surgery #3 to give me new hardware.
At this point I was turned over to a Reconstruction Specialist. He put in my new hardware. And I was still on antibiotics…he said most likely I would need to take them forever. I had another PICC line and more antibiotics again. This time the brace was an immobilizer that went from ankle to the highest possible area of my thigh. My incision was 27 inches! After 3 months I got to remove the brace.
I was doing great except my kneecap seemed to be off center a bit. Within a month or so, my kneecap worked it’s way almost to the side of my leg. So surgery #4 was done to move my kneecap over and “tied” in place. Back to the killer brace. Passed go and the brace came off. It wasn’t long before my kneecap started moving around to the side. So…
You guessed it, Surgery #5! My own tendon was shot. My doctor said it was like elastic that have been stretched too far and lost it’s elasticity. This time I had a bone graft, a new patella, and a new tendon that connected to what was left high in my thigh. I was doing great, getting around fairly well while wear my brace that allowed no bending. I also developed another infection, but it was quickly attacked by more antibiotics.
I know you will find this unbelievable but there was Surgery #6! The bone graft started to separate so he went back in and used larger screws and wrapped wire around it so it wouldn’t separate. I am now about 2 months post surgery from the last surgery. I have to wear the brace for another 3 months-making 6 in total. Two weeks ago I fell but no damage to my knee! My back is a different story.
But after all this covering about 3 years, I can see the light at the end of this tunnel. I am taking Minocycline, maybe forever and another antibiotic for the small infection I had at the end. I have that lovely 27 inch incision scar but it is funny what really matters. I don’t care what my leg looks like. I just want to be able to walk, drive, and enjoy life. I think I am close to doing those things again. Long trip but I am still positive and look forward to living again. Sometimes I cannot believe my own story. What I have discovered it that there are so many nice and caring people out there. Male, female, every age, everyone stops to help me through a door or in and out of a chair, etc. it gives me hope for the world. And I so appreciate my group of family and friends who have done so much to help keep me going. I have been fortunate indeed.

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Hello @boislandgirl, Welcome to Mayo Clinic Connect. Thank you for sharing your story of staying positive under some really scary and bad circumstances. I had my right knee replaced a year ago in April and I cannot imagine what you have been through. Sharing your experience will be beneficial to many members on Connect.

You mention you have had a lot of support from your family and friends to keep you going. Do you have any tips to share with others who may be struggling with infection and knee replacements?

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That is disturbing – am sorry to hear of the infection. Just a question: My 1st TKR surgeon said take 2000 MG Amoxicillin for lifetime before any intrusive dental work (including quarterly periodontal cleaning/gum maintenance).
My 2nd TKR surgeon said take it for 2 years. Do you mind my asking if your surgeon or dentist recommended this and if they think dental work could have caused your infection? Thank you and best wishes.

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I have read that. Not sure. Will C in Saint Charles, MO

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