Hip Infection 2 stage revision, hip infection

[dinsmaum]

Hello! I found Bonesmart while browsing for information about 2 stage hip revision. Found lots of medical oriented facts, but very little about personal experience until I found this site. Very helpful.

I will try to make my story concise! I had left THR in 2010, the right hip in 2012, both anterior approach. Had good recoveries. In 2013 my left hip dislocated while I was doing yoga. I really was not doing anything extreme. From then on I did well, getting stronger and fitter all along.

Then on Feb 2 of this year, it dislocated again. I was standing and talking, and it just popped out. When they saw the xrays they found a lesion on the femur, and after all kinds of testing, determined it is due to infection. I have had no symptoms, aside from elevated inflammation markers about a year ago. No pain, no fevers, sweats, chills, etc. In fact I was in the least amount of pain I have been in for years!

I am set for the first surgery on Tuesday coming up, April 19th. 6 weeks of IV antibiotics, another aspiration to see if infection is gone, and then the second surgery. I have been hitting the nutrition hard, working out carefully, listening to my preparing for surgery meditation tape.

But just to keep things exciting, on Thursday, the hip dislocated again!Again, I was standing there talking, and out it popped. Another ambulance ride from work to hospital, another reduction, so much more pain than the last time. Some of the orthopedic residents remembered me from February; I kinda feel like we are friends now, lol! So now I have a minimum weight bearing restriction, and am doing the ice and rest thing.

My questions for those of you who have gone through the 2 stage revision process:
What is that inbetween time like, between the 2 surgeries? I have read some horror stories, but is that always the case? Were you able to work at all? How much activity could you tolerate, if any? And most importantly, knowing what you know now, what can I do during that time to try to minimize loss of muscle, and what sort of things did, or would have, helped you get through that time? And, any tips for preparing for or recovering from the second surgery?

The medical journal articles have their place, but they don't help with questions like these!

Thanks in advance for any input!

 

[glynis]

Hi! All the best for your upcoming first op next week.

I had a 2-stage revision with spacer around 3 years ago. No one wants to have an infection. No one wants to need 2 further surgeries, and all the recovery time those require. BUT, I can honestly say that for me the whole procedure was not really the appalling ordeal for which it sometimes gets the rap.

I found it exhausting, mystifying (I have zilch medical knowledge, and surgeon-speak might have been Outer Mongolian for all I understood), and worrying, but I just muddled through it, and took each day as it came. Not exactly a major philosophical breakthrough for you to espouse, just a pragmatic approach which seems to work as well as any other.

You are doing exactly the right thing paying attention to your diet, and keeping as supple as possible, in the circumstances. As for a "preparedness for surgery meditation tape"... well, hey, I'm a Brit. All that sounds a bit New Age for me. But, whatever helps.

At my hospital in the UK, there are 2 different types of spacer. One allows slightly more weightbearing than the other. Do make sure you completely understand your restrictions before you leave the hospital. You will probably have to use crutches. I found these tiring, but relatively easy to use. Stairs can be a problem. I am fortunate that we have a ground floor bedroom which became my little abode for the weeks in between the 2 ops. (My husband soon christened it "glynis' pit".) Do you have stairs at home? Is there any way you could avoid them? I was not very good on the stairs with crutches, but some people seem to manage it much better than I did.

As for being able to work... My main problem was the tiredness. If you are not badly affected by that you might be able to do a couple of hours a day, but that would be pushing it, I think.

Please don't panic just yet. See how you get on. It might not be the ordeal you are dreading. And think of the success to be gained. All part of life's rich pageant!

All the best.

Glynis

 

[Jaycey]

@dinsmaum Welcome to BoneSmart. So sorry you are having to go through this! There are several members going through this same journey at the moment. If you go to the Hip Recovery area and look for the Hip Infection title in front of their thread titles you can read their stories. I'll tag a couple of members for you to chat with @keepmovin @Issa65 .

 

[dinsmaum]

Thanks for the replies. These are helpful. Glynis, your post was reassuring. Everything else I have read have been horror stories, and it is good to know it may not be. I am definitely on board with taking it one day at a time, and muddling on through. I do have stairs, and will do the come down in the morning, go up at bedtime thing. I am not going to have as much help at home as I have had in the past, so am trying to plan ahead.
I think tiredness may be an issue, as far as returning to work. I am having some fatigue just from recovering from the dislocation!
How long was it between your two surgeries for you?
And, I will look at the threads you linked, Jaycey!
Thanks again!

 

[Josephine]

What is that inbetween time like, between the 2 surgeries? Were you able to work at all? How much activity could you tolerate, if any?

It all depends which kind of spacer your surgeon uses. There are two types as Glynis said - one is made by hand at the time of surgery and is therefore somewhat rough and ready, not really designed for easy mobility. The other is a preformed prosthesis like form but therefore very expensive, but does enable better mobility.

what can I do during that time to try to minimize loss of muscle

Not a lot really as the hip will always have a degree of pain in it. You could do muscle squeezes in the thigh and buttocks but I wouldn't recommend much else.

 

[glynis]

I was told it would be 6 - 8 weeks between the 2 ops, but it was only 6. I seem to remember it was even a day or two short of the full 6, but I'm not 100% about that.

This was yet another example - of many! - of my not understanding quite what was going on. When it was first suggested that I might have an infection, like you I had no symptoms. Numerous blood tests, an aspiration, and also extremely expensive nuclear medicine, all came back either clear, or at the very most borderline. Nothing grew from any cultures. Yet still my team were confident that I did have an infection, and when my surgeon got to the coal face, as it were, he found that it was very extensive, and I needed bone grafts.

Now, here's what I'm getting at... Towards the end of the period with the spacer, further samples were taken, and again nothing grew on the cultures. But this time, everyone was confident that the infection had gone.

Am I missing something? What was the difference? That's what I don't understand.

Well, maybe you're more medically savvy than me, and will be able to hold intelligent conversations with your team, instead of sounding like a 9-year-old schoolchild. (When I first broke my hip I was on holiday in Peru, and had a hemi-arthroplasty in Lima. My lack of knowledge, coupled with the language barrier, made for some bizarre consultations. I cringe when I think of the idiotic questions I asked.)

Well, not long for you now. Have a quick look round the house. Get rid of any loose mats, or similar, and see if you can clear pathways so you'll be able to get round easily on your crutches.

Have fun!

Glynis

 

[Josephine]

I was told it would be 6 - 8 weeks between the 2 ops, but it was only 6.

I've known members keep their spacers in for a whole year! I can't recall his name but I will ask the staff and see if any of them remember him.

When it was first suggested that I might have an infection, like you I had no symptoms. Numerous blood tests, an aspiration, and also extremely expensive nuclear medicine, all came back either clear, or at the very most borderline. Nothing grew from any cultures. Yet still my team were confident that I did have an infection, and when my surgeon got to the coal face, as it were, he found that it was very extensive, and I needed bone grafts. Now, here's what I'm getting at... Towards the end of the period with the spacer, further samples were taken, and again nothing grew on the cultures. But this time, everyone was confident that the infection had gone. Am I missing something? What was the difference? That's what I don't understand.

That's a mystery to me too! But what was more of a mystery is that if they were so certain you did have an infection, why did they take so long getting around to doing something?

On the other hand, the surgeon we tend to refer all members with this problem to, Gerhard Maale in Plano TX, has a very unique and cutting edge approach to this issue. But principally, he prefers to wait for some weeks or even months to allow the immature biofilm bugs (which are largely invisible to our immune systems and antibiotics) to develop and thus become vulnerable to the Gentamycin and other heavy grade antibiotics. The bone cement used is always impregnated with Gentamycin. Read this Peri-prosthetic infection - also known as late onset infection. There are other articles in the Library which can easily be found in the Library Index.

 

[keepmovin]

Hello @dinsmaum, I am so sorry to hear about your infection and disturbed it came so many years out. So many questions go through my mind but quite frankly, I don't know if anyone can sit down and explain to us how this came to be. I suppose you may have read my thread by now, I am just finishing up my 2-stage procedure. I go in for my 4-week checkup and consult this Wednesday. You will just be getting out of surgery for your first stage.

Although everyone's experience with the spacer is unique, I think we can all agree that it is not an easy journey. I was not permitted to drive and haven't in 4 months. I was non-weight bearing with the spacer. Unfortunately, I had a lot of pain with my spacer but I don't think that is the norm. I had the spacer for 11 weeks, I received my new hip March 22, almost 4 weeks ago. I still have 30% non-weight bearing restrictions which I'm hoping will be lifted at my next visit. I am building up the strength in my leg by just doing simply thigh exercises and mild stretching. I was/am a lot like you - did a lot of yoga and hope I can resume this in the future. My muscle memory is coming back and in many ways, I'm beginning to feel like my old self. At the moment, my body seems to be extremely restless like it's saying, "enough already and let's get going!" I'm hoping this is a good sign! My ROM has returned and my leg muscle accepts the little exercises I do! I have to say, though, the muscles that got the most use have been my abs! I think I've developed a six-pack because I used them to get me around! Also, the upper body! Not everything goes to waste!

You mention you will not have help during this time, but I hope you can arrange for assistance to help with meals, food shopping, light housework, laundry, etc. You will not be up to during any of this as all your energy will be spent recovering and just getting yourself around. My husband was a blessing, but I think in the end paid for it with his health. We did this together but it took a toll on him between stress of work and worrying about me, taking over chores he hasn't done in 35 years. I arranged for home delivery for groceries which worked out well. I was able to go up and down stairs using the crutches and going slowly. This is the most exhausting so try to limit that to once or twice a day. I got around with crutches and a walker with two baskets attached to it. One was for personal items, the other, in front of the walker, was for carrying heavier things around or getting things in and out of the refrigerator.
This, out of all the improvising I had to do, was the most invaluable! Without my basket, I would not have been self sufficient!

What you do have going for you is your health and state of mind. You sound physically and mentally prepared for this. I, too was physically fit before all this and it helped immensely! I made sure and continue to make the effort to eat well - lots of protein, veggies and fruit!

Hope some of this helps! Please feel free to ask any other questions you may have. You will be in my thoughts and prayers this week. Please let us know how you make out after surgery.

Blessings,

 

[dinsmaum]

I am glad to be at the surgery-is-tomorrow day! This day will go quickly and then we will be on the way!
keepmovin: I will have some help with the things you mentioned, laundry, light housekeeping. My son lives with me, but will be gone a lot, and is no cook, for sure, lol! I am more concerned with just managing the basics in the early days. And, we won't be able to board our elderly dog this time, which is going to be challenging.
I am going to look into grocery delivery, that is a good thought. I do have a basket for my walker , and a tray, because otherwise I would be standing at the kitchen counter to eat, or drink my coffee, lol!
glynis: Your situation was a bit mysterious, yes? In my case, nothing grew from the aspiration either, but the white blood cell count, and some other infection marker I don't remember, were super high. I am so curious to see what the organism will turn out to be, as they are going to culture the prosthesis and take tissue samples as well. By the way, having such a medical emergency in a place where you don't speak the language well? Now that is intimidating! And scary!
Josephine: the article was helpful, and interesting. It will help as I discuss things with my surgeon. I don't know yet which kind of spacer I will have, so we will see.
Aside from a few last minute things today, I think I am as prepared as I am going to be.
With the two replacements, I was in so much pain all of the time, that I was actually looking forward to the surgery, and indeed, the first time walking with the walker was less painful than before the surgery! This time, I was feeling great, not in pain, and will go in to the situation that will create pain and lack of mobility. That is a little harder. But the fact is, the infection has caused enough bone loss that if this hadn't been detected, it was a matter of time until I had a fracture. So while going in feeling good, coming out feeling bad is not cool, it is almost certainly preventing a far greater problem. I am going to keep that in mind!
I am so glad I found this site, and worked up the nerve to post. It is amazing to talk to and feel supported by people who have been through this particular situation. Thank you all so much!

 

[sharonslp]

Hello fellow Michigander. Aside from the people here who have successfully endured the two-stage revision and gone on to live their lives with the benefits of a new hip, I do actually know one person well in real life who has done so. He had both hips replaced with quick and easy recoveries, and suddenly...two years later....an infection reared up. His OS, another doc in my surgeon's practice, was on it immediately and they proceeded to the spacer and antibiotic infusions. 8 weeks later (which somehow flew by, imagine that) he had the new implant put in, and once again experienced a quick and easy recovery. So with hindsight, it was just another bump in the road of life....we know all about road bumps and potholes in Michigan, do we not?

So carry that thought with you tomorrow, and in the coming weeks. Road bump....slight detour....and then back on track. I'm looking forward to hearing good results for you, dinsmaum.

Sharon

 

[glynis]

"Going in feeling good, coming out feeling bad"? Not necessarily. Sure, there is some pain and discomfort after any surgery - that's to be expected. But you are on the right road now, and that's the most important thing.

By the way, @Josephine - to clear up one of the mysteries mentioned in your post above, it really was not long between my infection being suspected and me having the revision. The time was taken up with the seemingly never-ending round of consultants appts, second opinions, going for tests, going for the results of tests, and more opinions. As I was paying for myself, I suppose I could have moved it along a bit quicker, but I always think there is wisdom in the fable of the tortoise and the hare.

All the best to Dinsmaum for tomorrow.

 

[dinsmaum]

Hey there! Yes, we do indeed know a few things about potholes, road bumps, and detours here in Michigan, don't we! I love the imagery of the speed bump, rather than the sink hole, lol!

This is great to hear, about your friend. It is helping to know that although this is new and overwhelming to me, it something quite a few people have successfully gone through, and then life goes on.

Thanks, Sharon!

 

[dinsmaum]

Thanks, Glynis, for the well wishes!
Going to keep my thoughts on the best possible outcome!

 

[Cynthia777]

@dinsmaum
I must say, you have such a wonderful mental attitude and I know this will serve you well during your upcoming surgery and recovery. I'm so sorry you've been through so much! Sending you prayers and well wishes for your journey ahead. Hugs!

PS...I found putting my coffee in a thermos to be of great help. I purchased an apron with three deep pockets and tied it to the front of my walker. It worked like a charm.
On another note, should you want to alert a member that you've mentioned them or have a question for them, put the @ sign right before their name as I've done with yours. Hope this helps.

 

[dinsmaum]

I have tried doing the @ but it doesn't turn live like the rest of yours do. I am probably missing a step?

The thermos is a great idea! I addition to being easier to tote, it can save a few trips back and forth! Thanks also for the support and well wishes!

 

[Cynthia777]

Make sure you don't put a space between the @ sign and the name of the member. Let me know if that works.

 

[keepmovin]

Hi @dinsmaum, Just wanted to send you well wishes the night before surgery. I'll be thinking of you tomorrow! You sound ready for this and because of that, you will skillfully maneuver this unexpected but temporary road block!

Warm Hugs!

 

[keepmovin]

Hi @sharonslp NJ/NY has some pretty nasty potholes we are plagued with as well - always patching things up around here!

You mentioned a friend who just went through infection and was wondering if you happen to know weather he is on long term antibiotics even after the 2-stage procedure. I hear some people remain on a low dose the rest of their lives and others do not. I will be talking with my surgeon and this is something I would like to discuss with him and the ID Dr. Also, is he still be watched and tested every few months? Just doing my research on others who have gone through this. I find some people on this site will post on their experience with infection and then go away without letting us know how they made out in the end.

Josephine has given us reading material on this which I have read and plan on discussing with my surgeon as well.
Thank you!

 

[Cynthia777]

Prayers and well wishes for your surgery tomorrow. Hugs!

 

[dinsmaum]

Thanks, everyone! I appreciate the support and warm wishes so very much!

Heading out the door shortly, so hopefully the next time you hear from me I will be on the other side of the first big hurdle!