Where to go to fix a serious knee infection after total knee replacement?

Request: Where in the United States could we go to get the most effective and EXPERIENCED infectious disease specialist and surgeon to fix a really bad periprosthetic joint infection (PJI) after a total knee arthroplasty (TKA)? I want to maximize the chance of a good outcome and avoid options like fusing the knee, or god forbid - amputation.

Condition: Serious bacterial infection of left knee several months after TKA. Infection has not progressed to the blood, or spread to other places in the body at this point, but it is doing real damage to his knee and overall health. It has definitely taken its toll - he is extremely weak & fatigued, can't stand, walk or even roll over. Looks terrible like he's been aged 10 years. His right leg/foot is also swollen. Genitals swollen. After months of misery he's really depressed and feels like he's dying.

We've started a 2-stage replacement, prosthesis removed. Surgeon is not confident he can fix the knee and is already talking about amputation...

The surgeon seems competent but I don't think he's handled a lot of cases like this.

Sequence of Events

• Before this knee replacement nightmare, my 71 year old dad was in pretty good shape for an old man: he went to the grocery store and cooked every day, rode a motorcycle and went the the gym 3-4 times a week. He used to be a bodybuilder.

• His knees were worn out so he had the left one replaced back in November. It wasn't very well executed... they neglected to get him off of blood thinners 1st so the surgery was long with lots of bleeding, and MASSIVE swelling of his legs afterwards, so much so that the incision would not heal. He was in the hospital for a week, and incapacitated for over a month. Dark black bruising spread all the way up to his waist and private parts.

• Just as he started to get things under control around February, his patella became dislocated. This required a revision surgery in April - another week in the dirty hospital.

• Late June - He finally seemed to be doing pretty well and could walk around.

• Early July - Then suddenly a switch flipped and there was a massive relapse in one day. Unable to walk, confusion, excruciating pain, extreme swelling of knee. Doctors aspirated the knee and determined there was an infection. On approximately July 9th he had a surgery to wash-out the joint.

• Suspected pathogen: staphylococcus aureus, but it could be anything. They were unable to tell me.

• Initiated IV antibiotics for about a week, infection worsening. He looks seriously sick, is demoralized. Doctors say: "the infection is winning."

• July 26 - Docs execute a 2-stage replacement

• After the 1st stage the surgeon says it's one of the worst cases he's ever seen, the infection has eaten away a massive amount of tissue. He has removed the prosthesis, cleaned out the joint as much as possible, and filled it with a spacer and antibiotic cement. Scheduled for 6-10 weeks of antibiotics. Surgeon is not optimistic about being able to cure the infection and install a new prosthetic joint.

The hospital: I've really lost confidence in this hospital after what seems to be some seriously "botched jobs." The hospitals in this state have some of the worst records for MRSA infections, and the doctors give me vague answers when asked about rates of infection in the hospital. They seem to be badly understaffed, and some of the nurses have terrible attitudes and are borderline incompetent. We go for hours with alarms blaring from machinery without being able to find a nurse. The bed is broken and doesn't adjust. The IV machine only works intermittently or they neglect to hook it up... It's crazy. He is constipated for a week at a time and bladder balloons to 1000cc. There have been multiple incidents with nurses trying (unsuccessfully) to forcefully jam catheters inside of him even after they've been explicitly told it can't be done except by his urologist with special tools. (because of his swollen prostate). Could this have been the pathway of infection?

If family members weren't there advocating/taking care of him around the clock... I'm not sure what would happen to him......

Worse, I never felt there was an urgency to get this infection addressed. They sent us off for several weeks without an appointment, no doctoring, until we finally demanded to come in.

In conclusion:

My dad broke his neck when he was young and was exposed to tons of x-rays. It's suspected this was the cause of his neck cancer later in life. Anyways, in the 1990s when he had cancer surrounding his spinal cord he was in big trouble. He had a doctor who was planning to give him the standard chemotherapy/blanket radiation treatments.. My dad had been doing research in a library, looking up names of doctors, calling them... until he found out about some new technology/techniques being used by a doctor at Mayo Clinic - special pinpoint radiation using a cyclotron. He spoke up about it and it turned out his doctor had studied under the Mayo Clinic guy. He asked the doctor, "where would YOU go?"

The doctor said, "I'd go to that guy...."

Long story short, he applied for the program at Mayo Clinic and was completely cured against the odds.

This is what he needs for this knee. Where can I find the most advanced care, the most experienced infection guy & surgeon who handles serious cases like this all day long. I don't care how much money it is, I've got to save my dad's leg!

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