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I've been struggling for six months now with a persistent infection in my knee replacement. I've had the replacement replaced and still it rages on. I'm trying some alternative care such as acupuncture, naturopathic medicine, supplements, and a diet free of sugar, wheat, dairy, and meat. The surgeon is doing everything she can to save the joint. What are the treatment options if all this doesn't work?

Infection after any surgery is a major concern. One that lasts longer than 30 days is considered "chronic." Treatment options change when an infection is no longer "acute" (early on). Often, the bacteria are what we call "super bugs" -- they are resistant to the antibiotics we have available. You have probably already gone through a procedure known as irrigation and debridement (cleaning the joint out of bacteria and diseased tissue). And it's likely you have also had many weeks of intravenous (IV) and oral antibiotics. The usual approach is a six week period of time on IV antibiotics (delivered directly to the blood stream). Patients must remain infection-free for another four to six weeks before the implant can be replaced. Blood tests are used to determine your status. Tissue and/or fluid in the joint may be tested as well. Removal and replacement of any affected implant parts is the next step. The replacement procedure is referred to as an exchange arthroplasty. The exchange arthroplasty can be a one-step or two-step process (also known as one-stage or two-stage exchange arthroplasty). As the names suggest, in a one-stage procedure, everything is done in one surgery. In a two-stage exchange, the implant is removed but not replaced just yet. Instead a spacer that contains high-dose antibiotics is put in place instead. Once the infection is under control, then the spacer is removed and the replacement implant installed. It is important to make sure the areas down into the bones (both the femur -- the thigh bone and the tibia -- the lower leg bone) are free of infection before putting the replacement implant in. Using long, thin antibiotic dowels down into the canals along with the spacer helps solve this problem. The more extreme options of joint fusion or even amputation are only considered when all other treatment methods have failed. Amputation may be necessary when the infection cannot be stopped and the patient is either in terrible pain or their life is threatened by the infection spreading throughout the body. In all cases, every effort is made to save the leg, save the joint, save the implant. Fusion and/or amputation are only considered when all else has failed. Hopefully, you are a long way from either of these more invasive procedures. Your surgeon is the best one to advise you about what is next and what are your potential options. The surgeon will take into consideration several factors when making treatment decisions. For example, your health, the type of bacteria present, length of time since the primary surgery, and other risk factors must be reviewed and assessed before advising you. Your own goals and desires will also be taken into account since the final decision about what you want to do is ultimately yours.

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