From crisis to recovery: The complex knee reconstruction that saved Issa’s leg from a hidden infection

No one knows this reality better than Issa Abdalla, a Toronto-based entrepreneur who runs a gym and wellness clinic.  

After years of living with debilitating pain and navigating complications from an initial joint replacement, he is finally able to get back to the activities he loves – pain free. Learn how Sinai Health’s team of experts is helping patients like Issa reclaim their mobility and well-being.

When recovery didn’t feel right, Issa kept pushing for answers

Five years before coming to Mount Sinai Hospital for care, Issa had both of his knees replaced at an outside institution. Over time, these joint replacements had started to loosen – a common complication of a replacement procedure – so he needed to have revision surgery to restore the joints to proper function.  

The first revision surgery, on Issa’s right leg, went well. But after the second revision, his left knee remained swollen and painful. He had trouble putting weight on it and no matter how much pain medication he took, or physio he did, the pain wouldn’t go away.      

He couldn’t shake the feeling that something was wrong, but initially he was told that his pain was an expected part of the recovery process.  

“I was ready to cut my leg from the pain,” says Issa. “They kept giving me all this pain medicine and I said, ‘I don’t think so. I think there’s something wrong with the knee.’”

Eventually, after continued self-advocacy, Issa was referred to Dr. Jesse Wolfstadt, Head of the Granovsky Gluskin Division of Orthopaedics at Sinai Health, who took his pain seriously and was determined to help him find the source.

Expert care makes the difference in complex revision joint surgery

The Orthopaedics team at Mount Sinai delivers some of the most complex reconstructive orthopaedic care in Canada, with a specialized focus on complex hip and knee replacement and revision surgeries. Revision procedures are required when a joint replacement fails or complications develop, and they demand a high level of expertise. Each year, Dr. Wolfstadt and his team perform approximately 180 revision hip surgeries and 150 revision knee surgeries – more than all the other academic hospitals in the GTA combined.  

This level of expertise can be crucial when dealing with cases like Issa’s because the risks of complications increase with multiple revisions.  

Patients who have experienced revision surgery are at a higher risk of developing Periprosthetic Joint Infection (PJI), which is a deep infection within the joint that’s been replaced. After an initial joint replacement, a patient’s risk of developing PJI sits at 0.5 per cent. However, with a revision surgery, that risk increases to 10 per cent. Unfortunately, these infections can be difficult to detect, and there is still very little known about what causes them to develop.  

"Issa didn’t present as an infection that was easy to diagnose,” says Dr. Wolfstadt. “But, when we sent for some of the more high-level, next-generation sequencing, that’s when it was finally revealed that Issa had an infection in the knee. That was most certainly what was causing his pain all along.”

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 "I'm with you. We're going to beat this together.”

But finding the infection was just the first step in what would be a long road to recovery. For many patients, this can be one of the most difficult periods of their treatment. They’re undergoing chemotherapy-like treatment, dealing with the uncertainty of whether the treatment will be effective, and still living with significant pain.

“My knee couldn’t bend, it was swollen and I couldn’t move,” says Issa. “It was affecting me inside now, mentally and everything else. I have a big support system at home, but there were days when I locked myself in my room. I was crying, like, ‘what am I going to do?’”

But, those moments, the level of compassionate care that Dr. Wolfstadt was able to provide, made all the difference.  

“I’ve met a lot of doctors in my life,” says Issa. “But no one ever listened to me the way he did. He always kept telling me, ‘We’re going to find the solution for this. I’m with you. We’ll beat this together.’ He gave me a little bit of hope.”  

Once the infection was confirmed, the orthopaedics team leapt into action. Issa underwent a two‑stage revision procedure. First, they removed the affected implant and replaced it with a temporary one and high doses of antibiotics. Then after a six-week course of intravenous antibiotics and careful monitoring, a second surgery to put in a new joint replacement was performed.  

Issa recalls waking up from that surgery and already feeling a wash of relief. The pain was finally gone.

“Now, I feel great,” says Issa. “I’m walking everywhere, I’m able to do my training at the gym. Without Jesse, I wouldn’t be doing what I’m doing today.”

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Improving complex orthopaedic care through research and compassion

While Dr. Wolfstadt is honoured to have played a role in helping Issa find relief from pain and return to a pre-surgery level of mobility, he knows that there are many more patients like him who will face a similarly difficult road to recovery.  

“These are the cases that keep us up at night,” says Dr. Wolfstadt. ““There’s a high rate of undiagnosed depression and anxiety in many of these patients. They’ve had a joint replacement thinking they’re going to get their life back, and now they’re going through this long, onerous recovery.”

As the Granovsky Gluskin Chair in Complex Orthopaedic Reconstruction, Dr. Wolfstadt is committed to conducting research that contributes to better outcomes for patients like Issa. He’s contributing to global research aimed at reducing infection rates and improving outcomes for patients with PJI. He’s also leading research focused on integrating mental health and multidisciplinary supports into recovery, recognizing the emotional toll of prolonged and complex surgical journeys.  

“Recognizing the mental health aspect and understanding how much of a burden this has on patients will help us take a more multi-disciplinary approach to the management of their care,” he says.

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Orthopaedic leadership is fuelled by philanthropy

The boundary-pushing surgical care offered by Sinai Health’s orthopaedics team would not be possible without the support of our generous community. Your support fuels world-leading research, makes it possible to purchase leading-edge surgical tools and to invest in training the next generation of surgical leaders.  

Bur most importantly, every donation helps ensure more patients like Issa receive expert, compassionate care when they need it most. Make a donation today.