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Total Knee Replacement with secondary infection - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Average Posted in: Bones, Muscles and Joints
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
User :   my mother aged about 62 yrs a rheumatoid arth patient for last 18 years went for tkr in both the knees at the same time.while the right leg is ok which was the more probiematic one .she has an infection in the left leg.the poeration was done on 9th march
2010.there wasdischarging of fluid in the left knee.she was posted for wound debriment on 31/03/2010.c/s revealed acinetobacter baumanii& enterobactereciae cloaca.now she is under amicacin 500mg iv +oral nitrofurantoin100mg qid .her right knee is asymptomatic at present.she has a past history of uti.my mother is in serious mental trauma and we are very very concerned for her.what is her fate ?
                                                  
                                                  
Doctor :   Hi
Doctor :  
Let me read.
Doctor :   Can I ask a few more details about your mother?

Doctor :  
Does she has diabetes?
User :   YES
Doctor :  
Ok
User :   YES
Doctor :   Is she having fever?
User :   NO SHE IS TAKING PYRIGESIC1000
Doctor :  
Do you have other her other blood reports?
User :   LIKE WHAT?
Doctor :  
I would like to know about her complete blood count, serum creatinine levels.
Doctor :  
Do you also have those reports?
User :   YES
Doctor :   May I know those reports as well?
Doctor :   May I know the location of the wound?
Doctor :  
Does she have swelling of the left knee?
User :   PRECALCITONIN LESS THAN 0.50NG/ML,ON26/03,HB 8.LEUCOCYTE 5300,NEUTROPHIL 87,EOSINOPHIL 03,BASOPHIL 0,LYMPHOCYTE 10,MONOCYTE0 ESR 140,CRP103MG/L.PREVIOUS RESULTS SHOW ABOUT 93,UREA 35ON 26/03 CREATININE 1.00 ON 26/03
Doctor :  
Ok.
Doctor :  
May I know the location of the wound?
User :   LEFT KNEE MIDDLE
Doctor :   What type of discharge is she having?
User :   LIKE BROWN BLOODMIXED WITH WATERY DISCHARGE
Doctor :   Ok.
Doctor :  
Is her blood sugars controlled?
User :   YES ABSOLUTELY
Doctor :   Ok.
Doctor :   Let me brief you now.
Doctor :  
From the brief history that you have provided to me, the cause of the infection could have been contamination either peroperatively or post operatively.
Doctor :  
Since her blood counts are in the normal limits, it probably under control now.
Doctor :  
The choice of the antibiotics would depend on the reports of the culture tests done on the discharge sample.
Doctor :  
If the antibiotics that are presently used are sensitive to the organisms that grew on the samples taken during the debridement, then it should be effective in treating the infection.
Doctor :  
And it should help in treating the infection.
Doctor :   In the mean time her sugar levels have to be under check with good diabetic medications.
Doctor :  
Hence the treatment has to be managed by both the orthopedician and the diabetologist.
Doctor :  
In extreme circumstances, if the infection is not getting controlled, then the last alternative would be removal of the implant and arthodesis which means joint fixation.
Doctor :  
Have you followed?
User :   YES THE WOUND IS STILL DISCHARGING WILL SHE BE ABLE TO LEAD A NORMAL LIFE AFTER ARTHODESIS?
Doctor :   The disadvantage of the arthodesis is that since the joint is fixed, the mobility of the joint would be lost.
Doctor :  
Hence there would be limited movement of the knee joint.
User :   I.E SHE WILL NOT BE ABLE TO WALK?
Doctor :  
She would be able to walk around after a course of physiotherapy, though it would not be a normal walk.
Doctor :  
I cannot predict the amount of disability that would be there now.
Doctor :  
It would depend on the condition of the joint, the physiotherapy that she receives and few other factors.
Doctor :  
This we have to wait and watch.
User :   i came to know about two stage revision surgery ? is that very costly?
Doctor :   The cost of the surgery varies depending on the institution where the procedure is performed.
Doctor :  
Hence I would not comment on its cost as this can vary.
Doctor :   It also would depend on the type of implant which would be used.
User :   i want to know the range like from lowest to highest?irrespective of the institution.
Doctor :   Since I am a general practitioner, I do not know the present cost of the implants that are used during the revision surgeries of TKR.
User :   ok i want to consult with a specialist
Doctor :   I can suggest you to take an opinion from our orthopedician, if you are interested.
Doctor :  
I shall provide you the link to it.
Doctor :  
WWW.WWWW.WW User :   yes absolutely
Doctor :   Do you have any other query that I can assist you with?
User :   does she hava any life threat?
Doctor :  
Based on her blood reports, she does not have any life threats now.
Doctor :  
Continue with the antibiotics, with good sterile dressing, and a proper diabetic control is necessary.
Doctor :  
And generally it should be fine.
Doctor :  
Have you followed?
User :   yes.thank you
Doctor :  
Do you have any other query?
User :   no
Doctor :  
Please fill the feed back form too.
Doctor :  
Thanks for consulting me. Bye for now. Please refer your friends to our service.
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