Infected Total Knee Replacement. A dreaded complication. What you need to know.
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- Опубліковано 30 чер 2024
- I hope no patient ever develops an infection. Most studies show around 2% of total knee replacements will get infected and the risk is higher if you have certain risk factors.
Here I will discuss many of the symptoms you may see with an infected total knee. I will review how we work up the suspected infection to prove if it is infected and what bacteria may be causing the infections.
I will go over the different treatment options that may be required such as surgery and antibiotic therapy.
Be sure to check out my book: The Knee Book - A Guide to the Aging Knee. It is available as a paperback and an ebook on Amazon and Barnes & Noble and on Google Play.
Check your countries Amazon page in Canada, Australia, UK and others.
In the US
Amazon (paperback and ebook)
www.amazon.com/Knee-Book-Guid...
Barnes & Noble (paperback and nook)
www.barnesandnoble.com/w/the-...
Be sure to listen to my Podcast: Your Knee Your Health
www.buzzsprout.com/732407/web...
WWW.DRADAMROSEN.COM
You can find more information about infections from the AAOS here: orthoinfo.aaos.org/en/disease...
Disclaimer: The information found in this media presentation represents my own views and opinions. This has been produced for educational and informational purposes only. This does not qualify as medical advice. This in no way should take the place of professional medical advice. You should always talk with your physician, doctor, surgeon, therapist or other health care provider regarding your specific questions, complaints, diagnosis, and treatment. Do not delay seeking care based on what you find in these informational videos. Use this information at your own risk. No doctor-patient relationship is formed through watching these videos.
#totalknee #totalkneereplacementsurgery #totalkneereplacement #infection #health #healthcare
![Prosthetic Joint Infection [Hot Topic]](/img/n.gif)
Can't believe I'm learning about my health issues from UA-cam instead of from the many orthopedics that I'm visiting for Years. Why no doctor explains!?
Thank you for this information.!!
Lots of people talk about success but you have touched reality of failure thanks a ton for explanation on every aspects
My wife caught a Staph infection after a knee replacement of a knee replacement. An upgraded knee. She was on oral antibiotics for five months. Now the bone grew into it. The doctor said he can’t get it out. He has to hit it really hard with a hammer. And he’s probably gonna break the bone. She’s facing an above the knee amputation. We are so overwhelmed. I’m her husband. I’m 65 with an injured spinal column. I don’t know how we’re gonna get through all this. My poor beautiful wife. She keeps asking me why this happened. I don’t know how to answer her. I hope we don’t lose everything.
Wishing the best for both of you!
I'm so sorry
@stevescontriano860 I am praying 🙏🏾 for you all!
Please please update!!!
I had both knee replacements removed due to infection, with 2 months of IV antibiotics at home. I'm on 'functional' temporary spacers. I'm facing terrifying revisions.
What happened with your wife????
please consult with a ilizarov surgeon that means infection controller surgeon.no need to amputation
I am in the midst of this right now. Very good explanation of what is happening. My orthopedic surgeon explained everything similarly. I am on week 3 of my iv antibiotics after surgical debridement and modular replacement and I am hoping that we do not need to go in and do another total knee replacement.
Praying for you. :)
I'm 10 weeks out from my fifth surgery RTKR (hopefully final) due to infection. 18 weeks IV antibiotics (PICC line). Having a difficult time getting to 90° and Doctor talking MUA, which I am working hard at physical therapy and at home to get it bending, but very painful to do so. Now I am on two oral antibiotics for perhaps a year. Everyone's been so kind and I am very thankful we're nearing the end of this difficult journey. 🥴
Same problem with my mother. Plz explain me where u get good treatment
Right TKR surgery 15/2/2024, went well. Range of motion , physio all good until week 8. Got infection, back for second surgery 24/4/2024 for debridement.
6 days in hospital, 6 weeks attached to an IV Baxter bottle.
Think it’s beaten.
This video is perfect.
Sorry you had to go through that. Hopefully things are all better.
@@dradamrosen thank you doc, I think infection has gone, no pain, and slowly getting there.
I had an infection a dental infection because the dentist didn’t give me any antibiotics, they said they weren’t needed.
I just remembered this! It was horrible, and if my friend hadn’t gotten me to the hospital I wouldn’t have made it!
I just remembered that!
The orthopedist says take antibiotics before any dental work! Forever!
The infection will go to wherever it can and mine went to my knee joints I had replaced!
The dentist says it’s not necessary!!!
In 2019, I almost died and ended up in the hospital for a week and then they sent me to another hospital to have my surgery! It’s taken a long time to get the infection out.
Antibiotics Forever when you have dental work!
Thank you for your video!
Bless you Doctor Rosen!
Scary, sorry you had to go through all of that. Wishing you health.
@@dradamrosen thank you!
I am thankful mine was a success! Great information! Thanks again! This video should be watched several times over!
9 days post op I got a bladder infection. My pain level had been increasing two days before. Sure enough I have what the Dr. thinks is a superficial infection because my skin hurts but not the joint. I need to see a urologist to see why I get bladder infections 1-2 times a year. I never thought about what a risk that is to me. I am on oral antibiotics and praying for improvement before seeing my doctor again in 5 days.
Thank you Dr. Rosen for all the information, I only wish I had watched your videos before my surgery. My surgeon, the PA or even the nurse during pre-surgery visits never mentioned anything about the risks from an infections. I had a root canal done 6 weeks before my TLKR, during the final visit before surgery it was only then that there was one line mentioning dental work. Dr said as long as there is no infection we are still a go. The tooth still has some discomfort but no severe pain or abscess , I’ve been back to see the endodontist twice, scans and X-rays show no infection but still concerned since at 8 months post TLKR I started to have tightness around my knee.
I wish I had seen this years ago, I have had the two stage and revision since 2019, this is what I have now.
Thank you for the video. Thank you
sorry you have to go through all of that. glad the information has been helpful. wishing you a good recovery.
I got staff and THEN sepsis NEVER been so sick in all my LIFE!!!
so sorry to hear. hopefully everything gets better.
Bloody great I need a TKR every time I see one of these vids it makes me change my mind
Very well explained. Thank you.
You are welcome!
Great explanation. I recently went through this process and I had a culture where nothing grew and also tested negative for MRCA and staff. I was prescribed non spectrum antibiotics cefepime and vancomycin for 6 weeks. The first 2 weeks of Vancomycin the numbers were low so then had 2 more weeks of daptomycin. Because the first 6 weeks, meds needed to be given twice a day, I was admitted to a nursing/ rehab facility. I hope that I NEVER need to experience anything like this again.
I did have a total hip replacement 4 yrs ago and am doing well, no problems. But 10 yrs ago I had abdominal surgery and got MRSA. I was hospitalized 6 wks. Anyway that was a concern in my hip replacement and I was put on Vanco., for a safety measure. My Ortho was thrilled there was no infection( ME, TOO)!
Unfortunately my daughter was one of the unlucky ones who got a long term infection . She had 25 surgeries to flush out and debride and spent over 80% of the last 3 1/2 years in hospital with it. She had MRSA & VRE and they struggled to get her well the last time. They eventually got to the stage where she didn’t have enough skin left to close up the knee to ankle operation site and couldn’t do anything else. She was sick of being so unwell and being in hospital, so she had a through knee amputation a month ago. The infection was destroying her tibia and fibula and had started getting into her kneecap. She’s still in hospital and feeling really unwell as they had to do another surgery for a haematoma after two weeks. I really hope things get better soon and she can go to rehabilitation and start living life again.
So sorry to hear. I hope things work out for her. Be sure to make sure her nutrition is optimized. When we fight infections we burn a ton of calories and proper nutrition can aid in healing.
I had a two stage and a different revision after that. With longer stems on either side of the knee, it isn’t normal knee but I am getting stronger and getting to walk better. Thanks for making it clearer what I went through. Infection and all. It has been a long road. It has answered a lot of questions I had . Thank you so much for this video.
Hope you get better soon, it's a big operation and a truly painful one. 🙏🏽
Hii
How did you know that it was infected?
Did have 2 stage replacement
Thanks for the information, I'm now on my fifth operation with this infected knee replacement surgery.
Praying you're doing well. I had bilateral done about a month ago. Knock on wood...I'm hoping I'm in the clear.
Excellent information! Thank you. 😊 Had a right TKR last week and am thrilled with my progress and am working hard but not overdoing it. Feel richly blessed to not having been a person with infections throughout her life. In my mind maintaining compliance is essential before, during and after. Sadly, I believe that many people fail to follow instructions and pay the price down the road for shortcuts or returning to unhealthy lifestyles. So thankful I’m not one and between compliance and a positive attitude I can only see success. Wishing successful outcomes to everyone and please follow your doctor’s advise. Cheers!
Se
I did all that you have done but after ten weeks pain free with good progress, I had a fall in a place where there were no handrails. Now infested, sometimes iy jusy doesn’t matter, I am a cautious person.
@@ferryman4520 I have been doing exceptionally well and about 3 weeks ago was knocked down by a group of 4 very playful dogs , including my own. Ended up with a sprained ankle (severe soft tissue injury) that seems to have taken longer to heal than the two TKRs I’ve had. We can be cautious but things happen.
No matter how cautious you are it can happen. It happens when bacteria gets in the wound in the surgery. You are not better than any one else. Even with “positive attitude”
Infection is viable anytime after knee replacement surgery even years after surgery. It has nothing to do with a patient not following Dr’s instructions. You can’t even get your teeth cleaned because of the risk of infection. Don’t be so condescending.
Very good explanation.
Glad you liked it
The best info I've ever heard on the topic. Thanks.
Glad it was helpful! Thank you for the kind words.
All surgeons should warn you about this
I love your video you are so good
Thank you so much!
Not a Knee replacement but I had Multiple Quad Tendon surgeries and after the third one I ended up with a Staph infection which required An Arthroscopic cleanout and two months of Antibiotic infusions. That last operation has also partially failed too - there is a small tear but there is not another possibility but rehab. I had been complaining about my leg swelling up most of the time and had fluid removed several times but the tests never showed the infection which turned out to be extensive. Frankly I wish my doctor had discussed this possibility before my first surgery as something to look for - not that I had other options. It is now 6 months later and this delay in rehab is causing me problems with Knee Flexion too. The last operation included a Graft and I was told not to expect more than about 100 degrees of movement. I have actually passed that some though. It is now 13 months since the event and I am now walking with a cane. And am still on oral antibiotics. However I must say coming from a medical family of Doctors and Dentists and having myself a pre-medical degree (My doctorate is in Music), My team has been great, even with all the complications, not all mentioned here. If you are going through this, ASK QUESTIONS no matter how trivial or stupid they may seem to you. Doctors are generally pretty good and explaining and while my background means I understand better, some of them actually speak plain English pretty well for those who do not have a pre-medical degree. And sometimes the smallest thing to you might be something the Doctor considers significant.
My brother is going through this now. Initial plan was to do a two stage revision with iv antibiotic therapy. The spacer and nail had to be removed because of complications, and now he will get a fusion if the infection clears. My brother has also been advised that an amputation might also happen. Im not sure what caused his knee infection, but he did have a foot infection caused by a small cut in the foot on his other leg about five months before the knee got infected. I advise a really good foot care regimen after youve had a tkr.
Thanks!!!🥰🥰🥰
Thank you for the information, I have had two total knee replacement and the temporary spacers, also. All do to infection with three rounds of IV antibiotics. Very painful after the second replacement, it is always swollen, limited movement and the Doctor said that I have a lot of scare tissue. Now he is concerned about scoping out the scare tissue. Worried about infection coming back, just hoping that too get cleaned Out some time. I understand what happened to me.
I've had 6 operations since last November and I still don't have a knee I'm running out of hope
Hope very much you get through this praying you will recover and heal. Its been hard the pain and sleepless nights, but we will all get there in the end 🙏🏽
Add sorry
I just found your site. I have had bilateral Lymphedema of upper and lower extremities for 39 years. I know have advanced OA of both knees. I have read that I would be at a greater risk for post prosthetic infection and/ or joint failure. What would I expect if this happened?
My mother is going through TKA failure due to Immunosuppression: Chemotherapy can suppress the immune system, In the context of TKA, infections can be a significant concern, and a compromised immune system could impact the body's ability to respond to infections. We are planning spacer for temporary but not sure this going to be in future. Uncertainty of success because lymphoma can come back and chemotherapy again
Ok , I know how to treat it now . Put me in coach.
what should be the count of WBC, CRP & ESR for second stage of revision knee replacement? My father done with antibiotic spacer and antibiotic treatment of 6 weeks. now all medication is stop for 2weeks.
Thank you, i'm waiting now to go into hospital to remove my infected knee replacement of 5 years ago, it's never been right, swollen stiff and very sore from day one, lets hope this new one gives me relief. they said all procedures and recovery will take about 12 months.
Sorry to hear. Hope you have a successful recovery.
@@dradamrosen Thank you.
I got an infection, and {susceptible to getting infections from problems with injury to my right knee after fracturing , and hypertension, and blood clotting years ago.) So, just got the honeycomb bandages removed and knee replacement looked great…..& 11 days later I had an reaction, that attacked the surgery area of which I believe my reoccurring fungal rash ( about every 3 months it crops up ) . 25 or more blisters that itch arrived causing much pain. Therapist took pictures and sent to Dr. , whom prescribed antibiotics for 21 days, and it’s been 12 days thus far. I’ll see Dr. In a couple days and hopefully medication will have reduced or stopped the infection. 11.20.23 ( history…. after hypertension, it was 11 years later that my right leg developed an infection “ sepsis “ causing me to stay in hospital 49 days. So my immune system has been compromised, and have to be really careful and watchful of anything, including vaccines that can trigger something harmful to me….) thanks for your explanation and video 👍🏻
My friend is having her implant removed today due to chronic infection. The plan is to put a temporary spacer in.
She had sepsis over a year ago which has probably caused the infection in her knee.
The knee has been really swollen and hot and there are two drainage sites where the puss leaks out. She has been so brave her other knee is useless too. No op on that, shd has been imobile since the sepsis.
So sorry to hear. Infections are rare but very bad. Wishing your friend a good recovery.
What are activities or places to avoid after an artificial joint replacement infection years after surgeries, due to staph infection. After revision due to acute infection concurrently with Covid for the first time.
I'm 17 days PO of my total knee replacement the first week I broke out in a rash on my back from hydrocodone which I itched and I think it bled a little I went for my 2-week follow up at the surgeon and took x-rays looked at my incision everything looks good I didn't mention the rash do you think I'm okay of not getting an infection in my knee joint?
My mom went through a total knee replacement surgery post 1 week of surgery onset of fever - every day and onto the 6th day now....the normal pain from knee surgery not severe, there is no redness or pus drainage or leakage around the stitch area and all blood tests are normal, knee xray is normal too awaiting blood culture report - is it still possible that the knee is infected or it requires further tests to rule out knee infection - maybe some viral fever?
How soon can a TKR patient go for a manicure or pedicure without putting themselves at risk for an infection on their fingers or toes that can or may travel to their operated knee?
I was told that there is always a chance. Even if its a cut. I am 5 months post op and dont plan on getting a pedicure again. I will do them myself. I have been seeing a podiatrist for an ingrown toenail and i have been very cautious.
I'm going through an infection after my TKR.
I had a knee replacement and found out I was allergic to the nickel that was in the knee replacement.
I had to go through surgery again 😩 this time they used a titanium replacement. I still can't bend my knee all the way 😢 I feel like my quality of life had gone down the tubes 😢
Sir my father had a infection after knee surgery this the third time go the surgery what can we do any home remidies for reduce infection at knees
I had revision on 2 Jan 23, and got MRSA infection now on my 3rd operation in 3 weeks with a CRP 700 looking at the 4th operation if the infection wont come down this is the 8th time under the knife
I had 2 ops in 1 week but my crp wasnt as high only in the 200. Wow having an infectionus no fun
Do you recommend antibiotics for dental cleanings? I believe my surgeon does it for 2 years. Also, should my PMD be more likely to prescribe antibiotics for URI due to my knee?, now 3 months po
I still do but there has been some new data from the UK. Check out my video on antibiotics for the dentist.
My orthopedic surgeon said I should take a prophylactic antibiotic before any dental work for the rest of my life.
My doctor said antibiotics for life when having dental work.
I am 74 male with chronic knee infection after revision, not getting any better taking oral antibiotics,would wash out help me , doctors are waiting for me to get sick before they do this!
What happened if you get MERSA in your total knee replacement
Patients are expecting miracles. Surgeons should educate them on every single complication. The realities of complications are more common than the statistics of patients studied.
Informed consent is important. Any complication is a serious problem.
Sir, I have IM rod in my tibia bone, one screw stitch from distal end got infected and a wound become at that place, my surgeon give me linezolid 600 mg twice a day for 10 days, and wound cleared, but after 20 days wound become again this time I have to take same antibiotic for 14 days but it didn't heal, and after 1 month screw become lose and came out of wound, which is removed, now I am again on antibiotic linezolid 600mg and ciprofloxacin 500 mg both twice a day, my surgeon is saying that infection will be cleared with antibiotics and no need to remove complete implant, we will remove other screw after 14 days and there is no spread of infection. at the same time I visited another orthopaedic surgeon for 2nd review and he said it is totally useless to rely on antibiotic, implant must be remove to eradicate infection, antibiotics are useful as long as you are using them when you stop infection would come again . My bone is 75% healed (unioned) I can bear my weight and walk easily. It is now 6 months of operation, what is your suggestion for me, either to rely on antibiotic or get my implant out? Please guide me. Thanks
Am i the only person on youtube, or the internet to have an infected knee after a ruptured quad tendon, because i can not find one other example, plenty of knee replacements, but not a ruptured quad tendon, so 2 surgeries, 3 braces and 7 casts later i find myself 12 weeks on and around 20 degrees range of motion
Hi there, my husband had his knee replaced and as he was leaving the hospital his Quad ruptured. He fell 3 times afterwards not knowing it ruptured. Had to go back to surgery for repair and now in a brace. It is such a rough recovery? I see you posted this 4 months ago? How are you now? I hope you are feeling better! Are you walking normal? What caused your Quad rupture? We think my husband was released too soon out of the hospital. They made him leave 3-4 hours after surgery and we think the nerve block on leg didn't wear off yet and why he fell getting in the car. It's been very frustrating and painful for him.
@@zp8127 Thanks for the message, and im improving it's just a long slog, It's the worst my worst injury, ive been shot stabbed, the lot this is a long time o heal. I'm makng slow steady progess, i car run, the rom is still around 100-105. i live alone so i was walking in a cast, bu the ley was herredous. I stayed in a week boh times,you cant go home same day. Lots of streching, walking up and down stairs, strertchng the quead mucle aswell. Bio oil, stetching and body weigt squats are key
@@WhySoSerious551 hey there, thank you for responding! It sounds like your doing pretty good considering how much trouble you bad with your quad.. I'm very happy to hear that for you! Thank you for responding, this gives me some hope for my husband. I think the hardest part about it all is being patient with the recovery process. I know my husband won't be running as he is 59 yrs old but we will be happy if he could at least walk normal again. Thanks again for responding! Merry Christmas!
Spontaneous patella fracture 4 weeks out with quad tendon rupture. Got home and immediately started running temps. MDs office said no need for er, called in rx for abx, 2 days later knee redder, temp 103, called office told take bactrim. No need for ER. Next day 100.7!in am, went to ER, Sed rate, Crp. and wbc elevated even with 2abx. Get to ER cultured, xrayed scanned head to toe. Ortho consulted, refused to come to ER. Saw next am and since no fever and knee slightly less red he said discharge home with oral abx(same ones I came in on) I refused demanded a consult with infectious disease she ordered a ct and it showed lots of fluid pockets “likeky abcess” reccomendation to washout. Ortho ghosted me and rest of team for 2 days. Finally showed up tried to say that drainage that began day before was clear(it wasn’t. It was milky red) I was clearly responding to the antibiotics but he refused to say it was infected. Like a blind person could tell it was. Next day the culture and sensitivity came back and showed staph pseuditermidius. Commonly found on dogs. I have 3. I dehisced my original incision at 3weeks post op and they sent me out with stetistrips put On by a MA and no abx. When the patella broke my incision opened. No one ever took those off while I laid in bed for 2 days. So back to this visit for the “not infected” infected knee, only saw an attending on day 6/7 after I threw a fit and demanded a meeting with the CMO and threatened to call AHCA. He towed the line. I decided I’ll go home on my 3 weeks after abx abd then when I spoke a fever again I’m going as far away as I can to get appropriate care.
mom is dealing with this right now
sorry to hear that! Mine too :( It is frustrating for both of us. I have no tears left in my eyes from crying. I hope she got well!
I had my 2nd knee replacement and its been a painful nightmare. I am sure its infected..
I've just had a surprise, when one of my surgeon's nurses told me that prophylactic antibiotics before dental checks, colonoscopies, etc. are no longer recommended. Confused, I sent a portal message to the same office, and the answer was that yes, they are. I posted the question on a FB group for post-tkr runners: evidently, the surgeons of the respondents are all over the map on this question. Some practices require them, some don't; some for years or lifetime after surgery, some for a couple of months only; some for all potentially invasive procedures, some only for dental work. There is obviously some disagreement in scholarly literature that is driving these contradictory practices. What do you know about it?
Great question. I'll put this on the to do list of topics for future videos. The short answer is we don't know. To do a study with enough patients to be statistically significant is almost impossible since the risk of infection is low but not zero. I used to recommend for life as I have seen patients get infections from dental issues many years after their surgery. Some data recommends it is not needed while others recommend it for high risk patients. The common middle ground, I and many others follow, is for 2 years for most patients. But, you should always talk with your surgeon because each patient is an individual and has different risk factors. Most important is take care of your teeth - get regular checkups, brush and floss daily.
@@dradamrosen Thanks, Dr R. I'll be checking for the future video, too.
This resistant bacteria, is it biofilm?
My mom had total knee replacement in year 2017 last year she got infection In knee and she got into sepsis and we lost her
I'm so sorry to hear this. Had a replacement four years ago recently had kidney infection that turned to sepsis which of course attacked the knee. I was lucky to come out of the situation
@@carolynbuchanan7248 how long was your hospital stay. My mom was on life support system how about you. did you were on ventilator?
Mine refuses to admit it is infected, infectious disease put me on abx but ortho only saw me 3 times in a week and 2 of them were because I complained.
Sorry to hear. Sometimes a second opinion is a good option. Labs can help in the diagnosis but the gold standard is taking fluid from the knee but you should be off antibiotics when the fluid is sampled.
Is it normal not to get antibiotics after surgery?
Two antibiotics that I think you are asking about. Everyone should get IV antibiotics just prior to the surgery. Most places will continue the antibiotics for 24 hours after the surgery. As for antibiotics at the dentist most surgeons will prescribe antibioitics, most frequently for 2 years. However, some surgeons recommend them for life while other surgeons do not recommend them at all. Confusing but there is not strong data in either camp.
WHAT ABOUT CISPLATIN INTERFERING WITH THE METAL TO BONE BONDING.
I honestly would not know. May be a question for an oncologist.
I have had two aspiration and the surgeon could not get any fluid.
Did they do it using ultrasound as a guide. The first aspiration no fluid. The second one under ultrasound Drew out quite a bit of fluid
How coming Are these infections Years after the surgery?
Apparently they can happen days to years on. Mine only came a year later and boy o boy its no fun. Get antibiotics for every little inf be it bladder or throat whatever. Keep the imune system strong.
@@moiraduplessis2900 did you Had surgery after infection or only you Had antibiotics?
I had my bi-lateral TKR in Dec 2021, and now close to 5 months past the surgery
I had some puss coming out of my stitches of left knee, which ultimately was found to be suture line, superficial infection. The sticking threads came out of the skin..Still I was treated with antibiotics for extended period of 12 days . It was lot scary though, howevr I feel I am saved by my doctor.
I wish to know whether it can come back in me...my left knee feels little warmer as compared to right knee..inhave started playing golf also.There is no pronounced pain in my knees.
Thanks,
What a nightmare
Man this guy scares the @#$% out of ya wish I never listen to this