Monday, September 1, 2014
Soon to be an amputee
I am a 53 yr. old grandma. I had a TKR in 2002 and lost my knee to MRSA in 7/06. Apparently I am a carrier of MRSA and I have gotten it 7 times since 2002 when I had a RGB. Any foreign object that is implanted in my body is eventually taken out because of MRSA attacking it. I have chronic pain now where my knee used to be. I am in a mobility chair and use a walker to get into the bathroom and tight places. For every day that I am up, I am down 3 days . I am starting to get depressed. I run into doors and everything else and I get so frustrated. I was very active before I went down and now I can`t do anything unless I take a couple of pain pills. If I don`t take anything, I cry all day and I can`t do my exercises or anything. My vasular surgeon has agreed to amputate my leg. I`m not sure if it will be a through the knee or above the knee. My question is - Is there any other option out there? I am not a good candidate for another knee and I want to walk. I want to play with my grandkids. If I`m stuck in a wheelchair for the rest of my life, I`m afraid depression will get the best of me. I am usually a very strong-willed person but being in a chair for the rest of my life is not me. I feel if I can rehabilitate and walk on a prostheisis. Am I making thr best decision?
You state that you are not a good candidate to receive another total knee prosthesis, but does that mean you are NOT a candidate? Assuming you received several weeks of antibiotics after your prosthesis was removed, if complete absence of any remaining infection can be confirmed, implantation of a second knee prosthesis, possibly using antibiotic-impregnated cement, may be an option, depending on the condition of your remaining bones.
Long term "suppressive" antibiotic therapy may or may not then be implemented, also. You should verify with your orthopedist whether or not another total knee prosthesis is out of the question, and also consider getting a second opinion from another orthopedist who specializes in revision ("re-do") arthroplasty.
If another total knee arthroplasty is not an option, a knee fusion may or may not be appropriate in your case... again, you are advised to discuss whether knee fusion is an option for you with one or more orthopedists. This option may be preferable to amputation if you still have full sensation, strength, and range of motion of your ankle and foot on that side.
If you are not a candidate for either another knee replacement nor for a knee fusion, weightbearing on the leg from which your knee prosthesis was removed isn't really an option, but despite this, you may have the option of walking on your good leg using crutches or a walker for shorter distances, with a wheelchair being more functional for longer distances, and your pain may well become adequately controlled by working with a physician who specializes in Pain Management.
Since amputation would not be guaranteed to rid you of your pain symptoms, you'll need to keep this in mind as you come to a decision about what you're going to do. Amputation could always be performed later if another knee replacement - and/or a knee fusion - was done but didn't work out for whatever reason. If you end up undergoing an amputation, the level of amputation would not actually be "through the knee," since you mentioned your knee was previously replaced, and then this knee prosthesis had to be removed. Regardless, there are a greater number of prosthetic component options for an "above-knee" - compared to those for a "through-knee" - amputee.
If your arms and other leg are without problems, and being a strong-willed person, you needn't be concerned about being "stuck in a wheelchair" for the rest of your life.
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University