Doctor's In: A Persistent Infection after Knee Replacement

Q: John in Pennsylvania mentions that three years ago he had bilateral knee replacements and it went well until last year. He developed a staph infection in the left knee and cellulitis. No cause was determined. He received months of antibiotics, was informed that he was free of infection and the prosthetic knee was replaced. Within a week of his discharge another infection developed in the same knee and John is still being treated with antibiotics. 

He also cites a severe athlete’s foot, left and wants to know if it could be related to the knee infection. He also would like to know if hyperbaric oxygen therapy might be indicated.

A: It is unlikely that the athlete’s foot relates to the infected knee. I would suspect it is a separate issue.  Long-term antibiotic therapy has caused fungal infections but not athlete’s foot to my knowledge. But doctors do like to live by the adage, “Horses not zebras." The desire is to tie all the symptoms and illnesses together in their patient. 

As for Hyperbaric Oxygen Therapy, it has been used very successfully in wound management and a number of other conditions. It has been proposed for certain orthopedic related infections and cellulitis by proponents of this therapy. I am not sure if it would be recommended in your case. 

Your treating physician knows your history, has your X-rays, scans, and other information relating to your persistent infection. Those diagnostic tools are essential in planning appropriate management. 

My suggestion would be to consider a second opinion by another orthopedic surgeon or infectious disease specialist. They could determine any potential advantage of Hyperbaric Therapy or other treament alternatives.  

Hyperbaric Oxygen Treatment is not without controversy.  I wish you the best and a complete resolution for this unfortunate and complex problem.

Have a question for Dr. Yacht? Email mjyacht58@gmail.com.