Hip Infection* 1 week post Birmingham Hip Resurfacing

[gregnado]

Just wanted to post my experience as I read many, many posts leading up to my surgery (and had the normal panic that almost had me cancel). Hopefully this helps as one night, reading some posts (along with aching in my hip) convinced me to proceed.

Background: 49 years old, pretty active in general but a tennis player primarily, left hip arthritis that 3 different doctors all told me needed surgery at some point. Ended up using Dr. Stephen Smith in Atlanta who was absolutely awesome and has done Birmingham hips for a long time (and a friend had both of his done by Dr. Smith). Starting ~3 months prior to surgery, I did as much pre-hab as I could and lost about 10 pounds (I was not really overweight before the surgery but the 10 pounds was good to lose)

Day 0
Surgery: Operation was Nov 5th, I had a spinal and profolol which worked great - I remember them getting me on my side and then waking up in recovery. Stayed in the hospital 1 night as my surgery wasn't over until probably 2:30pm. They did get me up on the walker that night a bit, was of course stiff and sore, my left leg mostly felt like it was 3,000 pounds and was hard to move. Around midnight I felt pretty bad (shaky, pain) and was due for pain meds which helped - that was probably my worst point in recovery.

Day 1:
Following day in hospital had group PT and the exercises were fine - they were sore, but felt like I could do more than they asked. Came home on a Friday and was just really low on energy, needed to nap (and I am not a napper), painful getting up or sitting down. Stayed on pain meds as well as tylenol / ibuprofen.

Day 2:
This was another day I felt bad at night, which has been a pattern - just felt chilly and achey. Moved as needed (~hourly) but not much. Was on a walker exclusively.

Day 3:
Tried to go off pain meds for this night which did not work and was a bad idea. Woke up and felt chilly, took my temp and had a 99.6 fever. Spoke to case manager and this was normal but something to watch and continue doing breathing exercises. This was the only time I had a small fever. Moving continued as before, not much, just up to bathroom or to get a drink or stretch.

Day 4:
In home PT started which was good. Moved similar to prior days, continued on pain meds but only before bed now. Have cotninued to just feel "blah", didn't really want to read or watch TV much as I didn't feel like concentrating.

Day 5:
In home PT again. This is the day I felt I kinda turned the corner and could tell I felt more "normal". Still would get tired after doing exercises, but off pain meds now, moving well and stopped using the walker except to go to the bathroom at night, switched to a single crutch and feel I move more normally with it.

Days 6-7:
More exercises have been added to PT, dressing looks good, still get a little tired at times but definitely feel like the day 5 / 6 was a positive turning point. Took a short walk outside each of these days and felt a bit sore after but still good.

Other points:
I have had no issue with appetite the whole time. I have been taking HMB, calcium, L-glutamine and L-cytosine after reading some studies on their benefit in recovery (also took these in pre-hab up until 2 weeks before surgery). Have been off work a week and a half now and will start work (from home, all computer work) on day 10. I expect to be ok but assuming I will tire out with too many consecutive meetings.

 

[Layla]

Welcome to BoneSmart and recovery. Thanks for joining us. You’re doing well at only eight days post op!

Please take it slow though because I’d hate to see you sideline the progress you’ve made so far. Tiring easily in these early weeks is normal. See the article on Energy Drain in the Recovery Guidelines below. The body uses energy to heal first not leaving much for anything else so I hope you’re able to nap if you’re feeling tired since the best healing takes place while we’re sleeping.

As far as meetings go you may tire out and find your concentration isn’t quite up to par. We normally recommend a phased return to work, but working from a computer at home isn’t as draining as getting up, preparing for work and traveling to your destination. One word of caution, when you return to work, it’s been mentioned here often that your work colleagues expect that if your back...You Are Back and ready to perform as usual, so please keep that in mind and proceed accordingly.

Thanks for sharing your progress here. I’m sure those following behind you will appreciate reading about your first week of recovery.

Happy healing...hope you have a nice weekend!


Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for THRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask the at each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Jaycey]

@gregnado Welcome to the other side of surgery. How is your recovery going? Please update when you can.

 

[gregnado]

Update at week 3:

Thanks for the response. I am definitely not pushing too much, a couple of days I could tell I was just up too much and needed to sit and then following day take an easy day. Hip is doing well, only use a single crutch sparingly (when outside for walks or when I notice a limp or hitch when walking). Did the stairs with alternating legs around week 2 holding on and have down some very light stationary bike exercise, feel like my strength is coming back but still stiff. Still have swelling, hip still feels a little unstable (figuring it will be like this for months as it strengthens). I am scheduled for my follow up visit in a week and will see how I am doing then.

My primary issue is sleep - I have had 3-4 nights total since the surgery where I went to bed and slept all night, most nights I am up several times. Just never was a back sleeper and while not in pain at all, just uncomfortable at night and want to roll over or toss. Going to try melatonin this week. I don't want to take pain meds just for sleep so have been avoiding that as I don't have any pain at this point.

One other thing - I use a Fitbit and noticed from the surgery date for about 2+ weeks, all of my biometrics went the wrong way. Resting heart rate is normally 58-62 and just went up every day until it was at 79. Heart rate variability dropped from ~40 to down under 20. I didn't find much in studies except post surgery, many people get tachycardia (elevated heart rate) but it only says for a few days. My theory, wondering if this is correct, is you lose blood during surgery... your body prioritizes blood flow to organs and not extremities which leaves you cold (I was freezing most of the time after surgery)... your heart works harder to warm you up. At a little over 2 weeks, my resting heart rate started recovering and dropped down to 69 but still has some to go.

 

[Jaycey]

@gregnado Unfortunately sleep problems are a part of this recovery. Read the article about it (posted above). Nap when you can. At your followup ask your surgeon if you can sleep your non-op side with a pillow between your legs.

Many of our members complain about being cold after surgery. The operating theatre is kept on the cool side. I was so cold post LTHR my teeth hurt from chattering. I was in a heated blanket turned up full blast for hours.

Your body is traumatised during surgery. It is fighting to repair the damage. That and the drugs both during and after the op can effect heart rate. All temporary.

 

[Layla]

Well, it’s been two months since your resurfacing. Wondering how you’re doing?
Hopefully your sleep has improved and you’re comfortable with your recovery at this point.
We‘d love to hear from you when you have time. Wishing you only the best to you as you continue gaining strength and stability.
Happy 2021!
@gregnado

 

[gregnado]

I had my hip resurfacing done 11/5 and was rehabbing very well until Christmas day when I got a fever and extreme pain in the groin. Also the wound was warm to touch and increased red splotches around it. Over the holiday weekend I was on the phone with the on call nurse, we scheduled an appt with my ortho (actually the PA) on Monday morning and was direct admitted back to the hospital. From there, immediately on antibiotics and had surgery on Wed to wash the joint. Cultures came back staph aureus (the susceptible version, not MRSA) and came home Friday evening and on IV antibiotics for 6 weeks.

Although I was feeling good from a hip strength perspective, I am now looking back and wondering if I and the doctor missed signs of an infection. Some questions:
- I had some red splotchiness around the wound all along, they said it was normal which I accepted. These red splotches definitely got worse as other symptoms came, but there were some present all along. Is some red splotchiness around the incision normal?
- I am in good shape and put about 5 pounds on immediately post surgery which I assumed was fluid retention and swelling. This weight came stayed through the 7 weeks post-op and wondering if this was a sign of holding fluid / infection? I am now watching my weight post the second surgery.
- And final, I did not have blood work post op - is this normal? I am of course now getting weekly labs.

 

[ljpviper]

Sorry to hear about your infection. Glad they saved the resurfacing components with the washout.

I had bloodwork six weeks after my hip resurfacing. From what I have read, the infections can start from the initial surgery and not manifest until a weeks later. Unless you had major dental work or a serious wound that you did not care for, it would be difficult for an infection to develop so soon after. I don't recall my wound having too much splothchiness. I did have some.

As for the swelling mine went down pretty quick, I have more swelling from the anterior hip replacement I recently had compared to the resurfacing, but it was posterior.. Everyone heels different, so I swelling is a variable.

Good luck,

Larry

 

[Layla]

Hello,
I‘m so sorry to read of your experience with infection and that you questioning whether your concerns were dismissed. I guess it reinforces the need to be more persistent when feeling something isn’t quite right, or your not satisfied with the answers you’re receiving. With that said, it’s difficult because we assume we can trust our medical professionals. As far as red splotches, I believe it would have concerned me also since you'll find below signs of possible infection -

Some common signs of infection are:
Fever
Unusual or increasing pain
The incision is hot to the touch
A change in the size of the incision
A change in the odor of the discharge
A yellow or green discharge that is increasing
Redness or hardening of the surrounding area
Excessive bleeding that has soaked through the incision

I don’t know that you can relate the five pound weight gain post op to infection because it’s my understanding they pump you full of fluids pre and post op, but I also believe we lose that water weight fairly quickly.

To the best of my recollection I did not have blood work post op, nor have I read here that blood draws are normal protocol immediately following hip surgery.

In an effort to update your signature I’ll add December 30, 2020 to reflect the date of the washout procedure. Please let us know only if that’s inaccurate.

I believe this second thread will be combined with your original recovery thread and a prefix of Hip Infection added. Please stay in touch. We’re here for support as you journey through this.

I hope your weekend is a peaceful one.
@gregnado

 

[Celle]

Hello @gregnado

I'm sorry to hear that you have an infection and I hope that the washout has done the trick, to get rid of the infection.


You'll notice that I have merged your two threads together as it's best if members in recovery only have one thread.
This is because:

• That way, you have all your information in one place. This makes it easier for others to go back and review your history before providing advice.
• If you start new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

Please keep all your questions and updates on this thread. We won't miss your new question as, between us, the staff read all new posts each day.
If you need an urgent response to a question, tag a member of staff.
Tagging other members and answering tags

If you prefer a different thread title, just post what you want and we'll get it changed for you.

Here are the instructions on finding your thread, How can I find my threads and posts?

A helpful hint - Many members have found it useful to bookmark their thread so they don't lose it.

Best wishes,
Celle

 

[gregnado]

Thanks all for the replies. I forgot to mention in my post above that I haver NOT had dental work since March, so it wouldn't be from that.

I did have a follow up appt 4 weeks post op and the red splotches were there but they weren't concerned. Now I'm regretting not pushing that more.

 

[Layla]

Hello @gregnado
It‘s been one month since your washout. Wondering how you’ve been over the past three weeks since we last heard from you? Hopefully you’re doing well. We’d love to hear from you as time allows.
Wishing you all the best.

 

[gregnado]

Doing better, it took around 2-2.5 weeks to feel better, just had little energy and weakness in leg. Last ~2 weeks I have definitely felt better. Hip feels structurally good, but had a lot of weakness, as an example, laying on back I could not lift my leg straight up until last weekend (found out they took out a decent amount of tissue in the debridement surgery so it just needed to heal). Weekly ID doctor blood tests and still have post surgery anemia but infection markers just fell back within range (CRP as example).

Reading studies, it seems like a lot of failures (reinfection) occurs around 6 weeks out so will see.

 

[Mojo333]

Hi @gregnado
Glad to hear you are seeing improvements and feeling better.

Hip feels structurally good, but had a lot of weakness, as an example, laying on back I could not lift my leg straight up until last weekend (found out they took out a decent amount of tissue in the debridement surgery so it just needed to heal).

The weakness is most certainly temporary and there's plenty of time to do this after more healing has happened.
Might want to do your simple exercises while standing and holding onto something for stability vs laying down.

When you are laying down on and try to lift the leg, you are lifting the WHOLE weight of the leg against gravity. Not just the hip, not just the thigh but the knee, calf and foot as well. And since each leg is approximately 1/3 of your total body weight, that's a big ask for traumatized soft tissue.
Hope today is a good day.