WolfBrother
12-01-04, 11:24
It's been an interesting year.
Last April, my wife had a "routine" arthroscopy, the Dr#1 said due to the degenerative changes brought about due to arthritis, she'd have to have a new knee in 4 to 5 years.
Fast forward to the end of August
- all post op office visits was seen be Dr#1 PA not Dr#1.
- a series visits with the PA aspirating her knee and injecting cortisone due to increasing pain in the knee.
- a visit to our Family Dr resulted in an MRI and a consult with Dr#2.
MRI result - two patches of Avascular Necrosis at the end of the Femur are visible, the medial patch is fairly small, the lateral patch is fairly large in size (a couple of cm in length). The Radiologist phoned Dr#2 to discuss the results ASAP after he read the MRI. The Radiologist asked Dr#2 to keep him informed as to outcome due to rarity of this type of knee MRI.
Dr#2 - a Knee/Hip specialist - Fellowship trained.
We had several visits June/July - pain still increasing - cultures of fluid obtained via aspiration negative. All indications - except for cultures - indicated infection.
Sept 2nd. due to the intense pain and the fact that everything but the cultures pointed to an infection, Dr#2 did a 2nd. arthroscopy with partial synovectomy. He removed anything that looked inflamed. A couple of the tissue samples had Staph E grow. We had 4 weeks of antibiotic therapy.
Very sore knee - pain moving it, pain not moving it. Therapy helps. CBC (sed rate etc) show elevated counts indicating inflammation or infection. Cultures of aspirations negative.
Dr#2 said he'd never seen a knee like this. He said he thought the pain and inflammation indicators were being caused by the body treating the dead bone as a foreign object.
His recommendations – get a 2nd. opinion, hold off on surgery as long as pain will allow, then knee replacement.
2nd. opinion
Dr#3 - - a Knee/Hip specialist - Fellowship trained.
Dr#3 said essentially the same as Dr#2, including the never seen a knee like this. CBC (sed rate etc) show elevated counts indicating inflammation or infection. Cultures of aspirations negative. He asked - if possible - to assist if surgery schedule allowed.
Dr#2 went to conference in Dallas about 3 – 4 weeks ago. Presented wife's case - turned to the group and asked
– “OK, what do you think??”
– Got back "Gee, that's a hard one, we've never seen something like that. What are you going to do? When you do it, be sure to write it up so we can know also."
Monday last week - new knee. Our choices were:
- surgery - make the cuts, put in an antibiotic spacer, 6 weeks of IV antibiotics, then 2nd surgery for new knee.
- surgery - new knee with antibiotic laced cement, 6 weeks of IV antibiotics.
The statistical pool for the two is so small that difference in outcome between the two is akin to a dime out of a thousand dollars.
We went with the 1 surgery. Dr#2 and Dr#3 worked together on it. (Nice - two fellowship trained Knee specialists )
At 48 hours - no growth.
Before 72 hours - Staph E.
Nothing in the knee presented any other indication of infection.
Infectious Diseases Dr said he suspected the Staph E was hiding in the dead bone, that since the dead bone had been cut out, that we'd do 4 weeks of IV therapy.
Wife is home, knee range of motions is working, IV antibiotic twice a day (I've been checked out by the Infectious Disease Drs office and am hooking the stuff up).
Dr#2 is going to write up wife’s case for Orthopedics journal. He said he'd let me know which issue if they choose to publish the case.
Will let the forum know which issue if published.
Last April, my wife had a "routine" arthroscopy, the Dr#1 said due to the degenerative changes brought about due to arthritis, she'd have to have a new knee in 4 to 5 years.
Fast forward to the end of August
- all post op office visits was seen be Dr#1 PA not Dr#1.
- a series visits with the PA aspirating her knee and injecting cortisone due to increasing pain in the knee.
- a visit to our Family Dr resulted in an MRI and a consult with Dr#2.
MRI result - two patches of Avascular Necrosis at the end of the Femur are visible, the medial patch is fairly small, the lateral patch is fairly large in size (a couple of cm in length). The Radiologist phoned Dr#2 to discuss the results ASAP after he read the MRI. The Radiologist asked Dr#2 to keep him informed as to outcome due to rarity of this type of knee MRI.
Dr#2 - a Knee/Hip specialist - Fellowship trained.
We had several visits June/July - pain still increasing - cultures of fluid obtained via aspiration negative. All indications - except for cultures - indicated infection.
Sept 2nd. due to the intense pain and the fact that everything but the cultures pointed to an infection, Dr#2 did a 2nd. arthroscopy with partial synovectomy. He removed anything that looked inflamed. A couple of the tissue samples had Staph E grow. We had 4 weeks of antibiotic therapy.
Very sore knee - pain moving it, pain not moving it. Therapy helps. CBC (sed rate etc) show elevated counts indicating inflammation or infection. Cultures of aspirations negative.
Dr#2 said he'd never seen a knee like this. He said he thought the pain and inflammation indicators were being caused by the body treating the dead bone as a foreign object.
His recommendations – get a 2nd. opinion, hold off on surgery as long as pain will allow, then knee replacement.
2nd. opinion
Dr#3 - - a Knee/Hip specialist - Fellowship trained.
Dr#3 said essentially the same as Dr#2, including the never seen a knee like this. CBC (sed rate etc) show elevated counts indicating inflammation or infection. Cultures of aspirations negative. He asked - if possible - to assist if surgery schedule allowed.
Dr#2 went to conference in Dallas about 3 – 4 weeks ago. Presented wife's case - turned to the group and asked
– “OK, what do you think??”
– Got back "Gee, that's a hard one, we've never seen something like that. What are you going to do? When you do it, be sure to write it up so we can know also."
Monday last week - new knee. Our choices were:
- surgery - make the cuts, put in an antibiotic spacer, 6 weeks of IV antibiotics, then 2nd surgery for new knee.
- surgery - new knee with antibiotic laced cement, 6 weeks of IV antibiotics.
The statistical pool for the two is so small that difference in outcome between the two is akin to a dime out of a thousand dollars.
We went with the 1 surgery. Dr#2 and Dr#3 worked together on it. (Nice - two fellowship trained Knee specialists )
At 48 hours - no growth.
Before 72 hours - Staph E.
Nothing in the knee presented any other indication of infection.
Infectious Diseases Dr said he suspected the Staph E was hiding in the dead bone, that since the dead bone had been cut out, that we'd do 4 weeks of IV therapy.
Wife is home, knee range of motions is working, IV antibiotic twice a day (I've been checked out by the Infectious Disease Drs office and am hooking the stuff up).
Dr#2 is going to write up wife’s case for Orthopedics journal. He said he'd let me know which issue if they choose to publish the case.
Will let the forum know which issue if published.