THR 2.3 years later developed Tendonitis

[AviationGeek777]

Did an MRI and CT scan finally on the 9th of Sept. The issue goes away for 2-3 weeks after the doctors poke it with a needle and i take antibiotics. It then comes back again. There is still some fluid left, after they drained it the first time and that is causing all this.

IMPRESSION: A left total hip arthroplasty has been performed. As expected there is considerable metallic artifact from the prosthesis metal artifact reduction sequences was utilized and there is some significant diagnostic information obtained:

Moderate left hip joint effusion with a large fluid collection extending from the posterior aspect of the left hip coursing along the surgical scar/tract extending through the gluteal musculature, through the subcutaneous soft tissues to start deformity of the skin. No abnormal collection measures 7 x 1.5 x 1.5 cm greatest dimension. This follows the signal intensity as simple fluid however the sterility of the fluid is uncertain.

No gross periprosthetic erosive change or fracture

 

[golfer67]

So are the doctors checking the fluid for infection? Something has to be causing the buildup of fluid I would insist that they analyze the fluid and find out what is wrong.

Golfer67

 

[AviationGeek777]

So are the doctors checking the fluid for infection? Something has to be causing the buildup of fluid I would insist that they analyze the fluid and find out what is wrong.

Golfer67

No they didn't check the fluid for infection, when they first drained it. Clear yellow fluid came out and they instantly said it's joint fluid and it didn't have any puss or any signs of infection in it. I also don't have temperature, hip pain, any other symptoms that could be results of an infection. If it was infection i would have gotten worse during these 6 months. I will tell them to take a sample this time around when i see them on the 27th. I don't know if they are going to drain it with a needle, or they are going to open up the scar and remove it via surgery. The first collection of fluid was on surface level, this one seems to be deep under the skin/muscles. The reason it could be happening is, because of inflammation/arthritis. I just got the test results today, so i have to see the surgeon so they can explain why it's happening and how they are going to drain the fluid.

 

[golfer67]

Yes be sure to have them analyze the fluid sounds like something is wrong.

Golfer67

 

[Jamie]

Sometimes an infection isn't visible to the eye and you may not always have symptoms like a fever. That's why it's usually a good idea to culture the fluid any time it's drawn. The fluid needs to be cultured for several days to see if anything grows. So be sure to ask for this type of test on whatever is drawn out at your next visit with the surgeon.

I suggest you write down all your questions and concerns so that you don't forget anything. Also, if you can take someone in the appointment with you, that's always a good idea. An extra set of ears helps to recall everything that's said.

 

[AviationGeek777]

Saw the surgeon again today. He viewed the MRI and CT scan results with me, I also did another x ray just in case. He told me that, he wants me to do another MRI in 6 months time. He wants to see if the fluid get bigger, if it does he said he will have to remove it via surgery. He told me not to worry about it, and that it's not infected. And he also told me the reason this is happening is that for some reason the stitches at the bottom of my scar didn't dissolve ( that's why they cut it open previously to remove the stitches and cleaned it up with iodoform) My body reacted to said stitches and I guess the fluid resulted from the inflammation. He told me if I get any severe symptoms or any discharge from the scar, I should see him immediately. He suspects that my body will absorb the fluids on it's own. He told me he doesn't want to remove it now, because there is a risk of infection from that surgery. If the fluid remains the same or gets bigger he will remove it completely.

 

[Jamie]

Thanks for the feedback from your appointment. This certainly is not something we see very often but your surgeon's description of what has occurred makes sense to me. I think his approach is the right one. It's never good to open a a joint up unless absolutely necessary because of the risk of infection. Stay watchful and know that our bodies are very good at doing things like getting rid of excess fluid. You were wise to get this checked out and I'm glad to hear it's just a small blip in your recovery.

 

[AviationGeek777]

Update: I Saw the doctors assistant on the 13th of this month, they did the usual x ray which looked fine. At the time my scar was swollen and he drained it and it was blood no other fluids. He then put a gauze on the area and told me to come back the next day to see the doctor that did the surgery. So I go the next day, doctor comes and asks questions that seemed weird to me. He was asking me if the swollen wound opened on its own, I said never and told him his assistant did it yesterday, he also didn't know i did an MRI months before. Seems like they don't communicate with each other. Either way, he grabs another syringe and pokes the scar multiple times (WITHOUT ANY COLD SPRAY OR LOCAL ANESTHETIC) He then collects small amounts of blood. He then proceeds to cut up my scar tissue with the end of the syringe (WITHOUT ANY LOCAL ANESTHETIC) The pain was too much I almost passed out and my leg was shaking, blood on the ground a horrible mess. He then sticks a q-tip with iodine on it and cleans it up, puts a gauze on the wound he created and tells me to change it once or twice a day. He prescribes me strong antibiotics, and then tells me he can't do ANYTHING ABOUT MY SITUATION what? He told me he is going to send me to a specialist where they can help my problem. I literally wasted almost 2 years going to that place so they can at the end tell me to go somewhere else? After countless of times telling them to send the fluids to culture them, and countless of times of them treating me like some kind of lab rat without any pain receptors, I am done. I thought that after they do another MRI they would most likely remove the fluid deep inside my hip that is in a pouch. I am hoping the second opinion doctor knows what's going on with me and actually helps me. Here is the wound he created with the end of the syringe.

 

[Jamie]

Wow.....what an awful story! I don't blame you for being upset with this treatment by your surgeon. You are very wise to move on. However, please take the recommended "specialist" with a grain of salt. You may want to see both this person and someone you pick. This fluid needs to be cultured and you may still need to see an infectious disease doctor. But it's best to find a new surgeon and start with him.

 

[CricketHip]

I agree, what a horrible story! Maybe it's time to speak with your PCP and get referred to an Infectious Disease Specialist? When my husband was struggling with several health conditions his PCP asked to be updated on every step.. he said it was his responsibility to assess what the specialists were doing and intervene when needed, which makes sense, doesn't it? So, maybe your PCP can give you some much needed help.
Please bring someone with you who will help advocate for you.. we all need support when dealing with health issues.
Your treatment from your surgeon was downright cruel. I don't understand why he would want to treat you like that, the only excuse would be that he was so preoccupied with your mysterious incision that he "forgot" there was a human being attached to it! Inexcusable, regardless.

Please keep us posted, so sorry you are dealing with this for over 2 years!

 

[golfer67]

WOW! You must get to a new doctor or better yet try to find a center that only does joints. I had to go to a joint only practice to get my problem solved. Try to find a practice that only does joints and that has no affiliation with your original doctor.



Golfer67

 

[Elf1]

@AviationGeek777 oh my, what awful treatment! I definitely agree about taking this new "specialist" with a grain of salt and looking for a group that just deals in joints like @golfer67 suggested.

After my gallbladder operation and removal of staples my incision came open. I went to our military hospital ER and was being examined by the Officer on Duty. In walks this Colonel who must have been unhappy that he had to do rounds on a Saturday.

He proceeded to poke and prod my stomach around the incision. He grabbed a huge Qtip like we cleaned weapons with and jammed it in my incision. I almost shot off the table head first and that man has no idea how lucky he is that I didn't kick him in the head. That made me see stars but what they did to you makes that look like a walk in the park! So sorry you've been treated so badly.

 

[Layla]

I’m so sorry for the treatment you’ve endured. It is awful. Please keep us posted on your situation. We do care.
@AviationGeek777

 

[AviationGeek777]

Update: Saw 3rd Orthopedic Surgeon yesterday. Original surgeon sent me to a surgeon who only does hand surgeries I don't know why. I told him to send me to another orthopedic doctor who does hip surgeries. The new doctor looked at my wound, which the scar has been compromised, because of previous openings/cleanings. The liquid that comes out is clearish yellow fluid, doesn't have any smell to it and doesn't look like a pus. Still don't have temperatures/chills and don't have single ounce of pain that hip. He looked at my medical records and looked at the MRI results that i took 1 year ago. He told me that, I am a weird case, because of no pain symptoms. He told me the "liquid" has seeped from the skin to the hip. He thinks it's an infection. He gave me bloodwork to do, also gave me dentist list that i have to do. He wants to do aspiration of the hip, to check what kind of infection it is. He reccommened two stage revision. He told me they might have to break the femur to remove the implant which is very painful. And he also told me since I am short and skinny the new hip is going to be bigger with a higher chance of dislocations.

I still want to do another MRI, because to be honest the MRI pictures showed me looked like different persons MRI. I remember mine being a pocket of fluid not a fluid that is running from the skin to the hip like a river. I am 50/50 wether it's infection or some other kind of fluid. The no pain, no chills, no temperature, no pus, makes me rethink everything. Seems like they want to rush me into surgery. I am 30 years old and this is a huge decision that might as well ruin my quality of life.

Should I see another doctor to confirm that it's infection? I will do the blood work to see if it shows anything. And before hip aspiration, I might see another doctor.

Has there been a case of false diagnosis? What if the lab work and the aspiration results show up negative? I don't want to rush into surgery. But the doctor wants to do it quickly. Since I have no pain or discomfort and the wound is draining he told me there is no chance of going septic.

Any advices would be helpful. This is a lot to take in and I am quite sad and depressed. I have had this issue for almost 2 years, but I haven't noticed worsening symptoms.

 

[djklaugh]

@AviationGeek777 From what you wrote it sounds to me like this surgeon is proposing 2 or 3 separate procedures - 1- the aspiration of the hip (drawing off fluid from the hip to see if there is infection there) this commonly is done via a laparoscopic procedure which is not full open the hip and 2- IF there is infection in the hip, then do the revision which might be a 2 part surgery. I think you need to clarify this with the surgeon. The aspiration would definitely show if there is an infection as the fluid collected would be sent to the lab for analysis and that would answer the question of infection. The lab would grow out any germ and see if it responds to antibiotics. There are many different types of germs, most of which can be successfully treated with medications. Alas there are a few that are resistant to currently available antibiotics.

At some point this surgeon probably will have you get another MRI - most likely right before revision surgery if that is necessary. But it probably is not really needed at this point (again clarify with the surgeon) I don't think you need to see yet another surgeon -- this one seems to know what he is doing and has a specific plan to address your problems. But that is always up to you!

 

[AviationGeek777]

He wants to send the sample from aspiration to another state, would that have an effect on the sample? I will do the blood test tomorrow, but want to see another surgeon before the aspiration. If the second opinion says the same thing, I will do the aspiration.

 

[Pumpkin]

Sending the aspiration to another state should be the same as doing it locally.
Probably he is sending to a speciality lab to ID a possible pathogen.

You can seek a second opinion about the aspiration, likely any surgeon you see is going to want to take a sample.
Usually a sample is taken with a needle aspiration using fluoroscopy to be sure they are in the right place to obtain a sample.

Keep is posted on how you are doing,
Chris

 

[djklaugh]

@AviationGeek777 If the surgeon wants to send sample to a special lab they have procedures to make sure the sample is preserved and that lab tests will give best information available. I goofed about the aspiration though -- those are usually done by a guided needle procedure - no cutting at all.

 

[golfer67]

Sending the sample to another state is not a problem don’t worry about that. If the sample comes back positive then you need to get the revision done as soon as you can. It will be a long drawn out process as they will need to take all the old hip parts out and put in a temporary hip joint made out of antibiotic material and then do a complete new hip replacement after that. I know this is a hard pill to take but if you have an infection then that is simply what it will take to fix it, Good luck.



Golfer67

 

[danelady]

@AviationGeek777
WOW WOW WOW! I am truly sorry for what you have been going through for so long and at such a young age! This past year has showed me just what a lot of the drs think about us....but I have to stop writing before I go off on a tangent about that. Let's get you healed and healthy so you can put this behind you.