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Suffer cellulitis and red skunk on leg. Having itchy rash on body. Prescribed antibiotics. CAT scan showed staph abscess. Cure?

Jul 2013
User rating for this question
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Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
I had a TKR on my right knee in August 2019.beginning in October, 2010, I began having issues such as cellulitis and a red skunk stripe on my leg. I also had a rash that was over 80% of my body and it itched incessantly. I went to the ER, the orthopedic surgeon came in and bent my leg and said it was fine. The other drs. disagreed. I was admitted and given antibiotics for a week. This was repeated 3x until May, 2011 when the surgeon say my blood work and did a cat scan. He said the appliance was loose. In XXXXXXX he found a staph abscess under the kneecap, it was also eating into my tibia bone. He removed the appliance and inserted spacers. I was out in IV antibiotics for five months.i changed surgeons and had the revision done in March, 2012. I had blood and a course of antibiotics for 3 months after the new appliance was inserted. I have normal abilities with bending and flattening the knee joint. I attended PT and was dismissed after 6 weeks. Recently, I have issues with a rash and extreme swelling of the knee after walking of sitting in my desk chair for an extended period. It takes several days of elevation to allow the swelling to decrease. Finally, I have found that I am falling frequently and am unable to get up without assistance. I walk with a limp. It is also impossible to walk up and down stairs without going one stair at a XXXXXXX bone is sore and I appear to have frequent bruises on my knee. The surgeon took a regular X-ray, he said nothing was abnormal and he would see me Ina year. Is this a normal outcome for this much time post-op? I am 59 year old widow in reasonably good health. My children are extremely concerned about my safety.
Posted Tue, 8 Oct 2013 in Bones, Muscles and Joints
Answered by Dr. K. Naga Ravi Prasad 25 minutes later
Brief Answer:
I suspect INSTABILITY as the cause of symptoms.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

As a general rule, the pain and inflammation should become better as the days pass by after a primary or revision total knee replacement. And the knee should be totally symptom free after about third month onwards from the day of surgery. Any symptom persisting after 3 months period from the surgery date always suggests some problem inside the prosthetic knee joint.

My primary suspicion in your case in INSTABILITY. The points that goes infavour of this possibility is swelling in the knee (effusions) after walking, falling frequently, unable to get up without assistance, walking with a limp, difficulty in walking up and downstairs.

The only other possibility is INFECTION. The symptoms which favour this are soreness in the XXXXXXX bone, frequent bruises in the knee and a past history of an infected TKR.

A detailed clinical examination is necessary to establish Instability and Investigations are needed to diagnose an Infection.

In either case, the definitive management is always a Revision surgery.

Hope I have addressed your query. Happy to help further

Above answer was peer-reviewed by
Follow-up: Suffer cellulitis and red skunk on leg. Having itchy rash on body. Prescribed antibiotics. CAT scan showed staph abscess. Cure? 2 minutes later
Is it common to need another revision and is it common to need more than one? What are the probabilities that the same problem will occur?
Answered by Dr. K. Naga Ravi Prasad 9 hours later
Brief Answer:
No immediate Revision is necessary.

Detailed Answer:
Hi, Nice to hear from you.

DON'T TAKE IT GRANTED THAT YOU HAVE INSTABILITY. It's only my suspicion that the cause of your symptoms could possibly be Instability and this has to be confirmed by a direct clinical evaluation only without which its practically impossible to diagnose based only on the symptomatology.

Yes, as i said the definitive management for instability is always a revision surgery. This revision is not needed immediately. If the symptoms are hampering your daily activities in a very severe manner, then only it is indicated.

Always the success rates in a joint replacement surgery declines with each revision incrementally. It is very hard to tell whether you get the same problem after another revision because one has to define the cause of instability first and that cause is to be addressed during the revision surgery.
Simply performing a revision surgery without knowing the cause for instability will inevitably ends in failure.

Hope I have justified your query. Good day
Above answer was peer-reviewed by
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