Thousands of patients sign surgical consent forms every day, briefly glancing over three little words “Risk of Infection” without a second thought. My friend Shaun was attending college on a full ride football scholarship in 1983 when he learned the true meaning of those three little words. Shaun tore some minor cartilage in his right knee that required a scope job to repair. He elected to do the procedure over the Christmas break at a hospital where his mother was the vice president in charge of nursing. The surgery at first seemed to go very well, but a week later he noticed grey leakage from his knee incision. Two days after that, he could not bend his knee. By the following morning it had become septic and Shaun was rushed back to the hospital. It was the beginning of a grueling six-week hospital ordeal that progressed to osteomylitis that was eventually killed by six months of IV antibiotics.
Shaun was fortunate: they managed to avoid amputation but the infection damaged so much bone and tissue that he walked with a limp and could no longer ride a bicycle. His football career was over. One would think that having a very important mother on your side would lead to immediate discovery of what caused this tragedy. The staff tested every object and every person in the operating room and never did find the source of the bacteria. The clinical best guess was that a dye injection for an x-ray the day before surgery may have been the problem.
Shaun suffered with a very stiff knee with very little range of motion for six more years. In 1989 he found a US ski team doctor who cleaned up the damaged bone and scar tissue enough that he could jog and ride a bike. In 2005 he was letting his kids ride his ankle like a horse when the weakened knee fell apart. This time repairs were out of the question and a full artificial knee was installed. Shaun knew what I had gone through the year before and elected to have full decolonization therapy before his knee replacement to reduce the risk of another infection. It may have been one of the factors in his successful knee replacement, but sadly he developed a staph lesion on his nose after the operation that required more IV antibiotics.
Two years later, his good left knee developed a cyst that required surgery to remove. Again Shaun prepared for surgery by going through two weeks of decolonization therapy. This time the surgeon avoided an infection but nicked the bursa in his knee which required yet another surgery in an ambulatory surgery center to repair. This minor repair caused Shaun’s third staph infection. Unfortunately, the PICC line that was installed to administer antibiotics caused a blood clot which put him back in the hospital. The damage to his left knee from his third infection led to a partial left knee replacement in late 2007.
Shaun’s right knee now has a plastic button that has come loose and is putting pressure on his nerve. Like me, Shaun is very fearful of going back into operating rooms of any kind until the problems associated with infection prevention are brought under control. Perhaps Irish guys like Shaun and me should be contraindicated from having surgery.