How does Kyrie Irving's long-term prognosis look after knee infection? Checking in with Dr. Flynn

In wake of the news that Kyrie Irving would be undergoing season-ending knee surgery to deal with a recently discovered infection, there have been countless questions swirling about the status of the All-Star. How did Irving get this kind of infection? Is this a sign of more knee problems to come? To search for some answers, I caught up with BostonSportsJournal.com's medical expert Dr. Jessica Flynn for her insight on the situation and what comes next for Irving.

Q: Take us into the mindset of Irving's doctors. Obviously, they thought his initial procedure a couple weeks ago would help ease Irving's pain. How did they figure out that the infection was a problem and how long had he been dealing with it for?  

Dr. Flynn: I think it was a surprise to everyone that Kyrie Irving has an infected knee joint. I think that everyone was surprised that the pathology reports came back showing an infection in his knee. This is standard operating procedure for a joint — it's really important to take tissue from a joint to test it for infection whenever there is chronic pain in the knee.

His (knee) injury was in 2015. He had surgery on it and at some point early on, this infection likely occurred. It's been there, quietly causing some pain but not causing typical infection symptoms like severe pain, swelling, fevers, chills, etc. It didn't cause any of that stuff because the body was keeping this infection in check. The only real symptom he had was this pain. It's very hard to diagnose an infection of hardware because the symptoms are so vague and a lot of patients have pain after surgery, near their hardware. You really have to be looking out for it.

It sounds like his construct from the beginning was what I had expected: screws and a wire. What I can gather from this information is that the plan was likely for them to remove the wire with the hope he could play in the playoffs, if it got rid of his pain and if he was able to recover from the procedure in time. The thought may have been that if there was still pain after that procedure, they may have needed to go back in at some point and take the screws out.

The revelation that there was an infection in the knee when that happens, you have to take all the hardware out because no matter how many antibiotics you give a patient, you won't be able to kill all the little bugs in the knee. You have to take out the hardware where the bugs like to sit and hide. You have to remove it to fully clean out the knee.

Q: What is the timing of the pathology report usually after surgery to find infections? Does that usually take a few days after surgery? 

Dr. Flynn: It takes awhile. If this was a bad infection, they would have been able to tell right when they looked at the joints and from the symptoms. This is one of those quieter infections, that was very mild. They take the sample and plate it out. They have to grow the bacteria. It's a culture and it takes awhile for the culture to grow bacteria. Then, you have to identify what the bacteria is. They probably just recently got those results back.

Q: The main concern right now for a lot of people is his long-term prognosis. Is it normal for an infection like this to not be an issue long-term for an athlete, even when there is additional hardware on a knee?

Dr. Flynn: If they were taking out the screws in a normal knee with no infection, sometimes athletes can go back after six weeks or so after those screw holes fill in with bone. In this case, because the bone is compromised from the infection and because it's weakened by the infection, they want to wait four-to-five months. The other thing is there is no reason to say he's ready in a couple months. He's not going to be playing anyway. Four-to-five months is absolutely reasonable. I absolutely think he's going to be able to come back and this is not going to be a chronic problem. He's not a damaged player. I think he's going to do alright with this.

If there is an infection, once you get rid of the infection, the knee should be fine. Patients feel a lot better and they should be fine. Plus, if the hardware was causing some pain, now the hardware is gone too. It's all positive for him in the end, it's just that the timing stinks.

What could doctors have known about Kyrie's knee pain over the past couple years without going into the knee for surgery? Was there any way for them to tell he had this infection without having a procedure? 

Dr. Flynn: His symptoms were probably complicated because this is a guy who had chronic patellar tendonitis, probably a stress fracture in his knee that broke through and hardware in his knee. Those are a lot of different problems at the exact the same spot. In a patient like that, it's often complex to diagnose what the problem is. I think that's why there was a lot of back and forth about what to expect for his recovery because they didn't know what one of those things was contributing to his pain. I think, again, the infection was a surprise and it definitely wouldn't have been on the top of my list of possibilities for his pain. It's not even something I considered when I wrote about it in the past. The infection is a major surprise and who knows, maybe those other things were contributing to his pain too. Both of those things are much more common than the infection.

So there was no real way for the Celtics to get out ahead of this, right? They seemed to know surgery would be looming at some point, based on recent comments made by Danny Ainge

Dr. Flynn: He had the summer before, right? He wouldn't have been able to have surgery (to remove hardware) until 2016. Theoretically, if he was still having pain, that would have been when they would have done the surgery.

Usually, the hardware is removed a year later. I don't know if Kyrie didn't want surgery or if he was just saying, It's not that bad, let's push through it. I can't imagine him joining the Celtics and having surgery right away if the pain was unchanged. It sounds like his pain increased during the year.

Did the Celtics get lucky they caught the infection now, since it's going to let him get a clean slate moving forward without more complications?

Dr. Flynn: I think it's hard to call this situation lucky, but at the same time, I'm very happy he's having a definitive procedure to have all that hardware out. I don't think we can 100 percent say the infection is why he's having all this pain. A lot of it could be because of the hardware too. I think it'll be good for them to start with a clean slate next season. I see no reason why Gordon Hayward shouldn't be doing well by next season since he seems to be progressing nicely. There's no reason Kyrie Irving shouldn't be ready for next season either.