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Case Study: K-Laser Treatment of TKR

Patient: P.K. Age: 71, Female

• Diagnosis: Post Total Knee Replacement with 2 revisions
• Complications: Methicillin-Resistant Staphylococcus Aureus (MRSA)

Dr. Dan Knapp
Private Practice: Sarasota, FL

History

Post Total Knee Replacement Surgery - Pre-laser Therapy

P.K. presented on March 20, 2006 for a total knee replacement of the left knee secondary to severe non-traumatic OA. The right knee received a successful TKR the previous year.

The first followup on April 13, 2006 revealed serous drainage from the mid knee. Cultures following incision and drainage were taken and oral doxycycline was prescribed.

An April 18th, 2006 office visit showed failure to improve resulting in hospital admission for a second I&D procedure and a switch to IV vancomycin. An infectious disease consult was arranged.

Abdominal distension and drainage was required one month later as a renal complication to the IV antibiotics.

On September 5, 2006 P.K. presented to her orthopedic surgeon with a reddened lump on the knee which cultured for gram positive staphylococcus. X-rays revealed early osteolysis around the medial aspect of the tibial base plate.

Revision TKR Surgery - September 11, 2006

P.K. received a temporary knee replacement as a 2 stage revision to bolster tissue quality and control infection in preparation for a definitive replacement.

Follow-up visit on November 15, 2006, findings included knee swelling and two small areas of granulated open wound with a small amount of drainage. IV administration of vancomycin continued via PIC line.

On November 20, 2006 examination revealed significant pitting edema of the knee and lower leg. The incision still had a small unhealed granulated opening. Skin discoloration was noted including duskiness. The knee was warm and tender to palpation. Ambulation could only be performed with the assistance of a walker for no more than 10-yards at a time.

38 days Post-surgery 1st Revision

Pre-laser on IV antibiotics

(Click on images for larger view.)

Class IV K-Laser Treatment

Class IV post surgical laser treatment was performed on four consecutive days with 1st revision and three days with 2^nd revision

• Setting: Deep 3 — 5 W
• Protocol: Edema (5) 1:50 sec periods direct contact, 1100 Joules total at 2 — 20 J/cm2 at surface per contact point
• Protocol: Pain (5) 1:30 sec periods direct contact, 900 Joules total at 2 — 20 J/cm2 at surface per contact point
• Setting: Superficial 2 W
• Protocol: Cutaneous (3) 60 sec combined direct contact/scanning at 1 cm2 distance
• 240 Joules total maximum per direct contact point

18 days Post-surgery 2nd Revision

Pre-laser Post Revision

Post-laser 1 treatment per day - 3 total

(Click on images for larger view.)

Treatment Results

P.K. exhibited decreased pain and swelling within 12-hours of the initial laser treatment. By day four edema had reduced 80% and she was able to ambulate without the walker. Follow-up with her infectious disease specialist day five resulted in the discontinuation of her long term IV antibiotics. She was scheduled for the final total knee revision 6-days later with excellent results. P.K. was discharged day three following surgery.

Class IV laser therapy was initiated on day eighteen post surgery. Quick resolution of the remaining ecchymosis and edema was achieved by the third daily treatment. Pain medication was reduced to as needed basis.