Joe A Shaw PA-C - 1/29/2008

Question
QUESTION: I obtained mrsa in my left knee approximately 1 year ago.Now my knee has to be constantly in a knee brace as something is constantly popping out of place causing severe pain my mri shows severe degeneration I see a orthapedic surgeon tomorrow.What can be done to save the knee

ANSWER: Jeannine,
You don't list your age, but if your 45-50 or older, and have appropriate height and weight measurements he may be more likely to suggest a total knee replacement (TKR) sooner rather than later. Synvisc (sin-visk) injections have been shown to reduce pain in pts with DJD of the knees. Sometimes it last up to 12 to 18 months, however, this does nothing for the severe instability of your knee. Cortisone injections can also help with the pain etc...but it also won't address your instability.
Most pts that have a good outcome with a TKR can be active again w/o the severe pain and often wished they would have done it sooner. Your case is more complicated though in that you had MRSA in the knee, so your ortho will have to take this into account. In other words do you have enough good stable leg bone, so that the TKR can take hold.

---------- FOLLOW-UP ----------

QUESTION: My age is 41.Following surgery having already had mrsa in that joint would I be at higher risk for mrsa again following surgery.I am at proportionate height and weight and have always been very athletic.Is there any chance I may play softball,basketball or soccer again.I will even settle for just golf.Thank you very much for all your help.Jeannine

Answer
Okay, you may be in a little better situation...but if what you are saying that it is "constantly popping out of place" and you "constantly have to wear a brace" and you are having "severe" pain and you have severe DJD..and this has been going on at least a year...To me that says we need to try something more aggressive to help this lady out. It really depends on how you present to him and how much you complain about the pain and symptoms and quality of life issues...all these things can factor in on how aggressive a surgeon will be. I don't know any stats about being at a higher risk for MRSA again..but if you do have surgery again.. I bet he will have his whole team scrub extra good,be extra careful etc..., and watch the incision like a hawk..
About 1/3 of the population are carriers of MRSA anyway.