Hip Infection* 2 Back-to-Back Infections, Different Bacteria

[Hippie2020]

I am a 51 year old female in the United States. I have included the back-story of my hip history below, but I have some questions about the infections I have been fighting.

I had my right hip replaced February 5th, 2020. Recovery was going very well, but on May 13th, I went from having a normal day to not being able to walk by the afternoon. I hit a fever of 103° F and my hip was splotchy and red (about the size of a basketball) and hot to the touch. I went to the ortho 2 days later (his first available appointment). They admitted me to the hospital, and I had a 1-stage revision surgery done the next day. The surgeon took out all the acetabular components, did a debridgement, and left in the femoral stem. The bacteria was strep B, and I was sent home to do once-a-day IV ceftriaxone. After 3 weeks, I had a reaction to ceftriaxone - 103 fever and rash. My antibiotic was then changed to ertapenem, which I tolerated much better. I was on IV antibiotics for a total of 8 weeks, then went on amoxicillin oral. I was having yeast infections and digestive issues so I was switched to clindamycin. My CBC, CRP, and Sed Rate blood tests were being monitored and were showing mostly positive results.

After a plane ride and a lot of walking through airports on October 3rd, my right hip was very painful again, but not to the point of needing a cane. It was once again splotchy red and hot to the touch. On October 4th, I went to the emergency room, was admitted to the hospital, and had surgery the next day. This time, the entire prosthesis was removed and a spacer was put in. The bacteria was enterococcus faecalis and is now being treated with a 24/7 IV pump of ampicillin. Because of a setback, likely a hematoma, my time on the ampicillin was increased for a total of 8 weeks. I am tentatively scheduled for a THA the first week in January.

Several questions I have:
1. How common is it to have 2 infections that close together that are from different bacteria?
2. How much weight can you put on a spacer? I am overweight - how much does that factor in?
3. Because of all the antibiotics, I am concerned about 2 things: resistance to antibiotics in the future, and what effects the antibiotics are having on my gut. I am taking probiotics, but how long will it take for my gut to recover, and what will happen down the road when I get a bacterial infection from something else?
4. What are some exercises I can do other than the traditional hip replacement post op ones, especially aerobic? I am putting on weight, and that is not helping my recovery.
5. What are my chances of getting another infection in my right hip again?
6. When placing the femoral component of the spacer, the surgeon was unable to retrieve a Steinmann pin that had been used. It is now lodged in the lower part of my femur, just below the narrowing of the bone. Does anyone have experience with something like this? Obviously, the surgeon is going to try to get it out again, but how worried should I be if he has to leave it in?

Back story: I started having left hip pain in 2016. My chiropractor took an xray and said I had some arthritis starting, but it wasn't major. As the pain worsened, I visited an orthopedic surgeon's PA, who said I had a torn labrum and recommended that I have arthroscopy to fix it. I went to a different orthopedic surgeon for a second opinion and they said that there was enough cartilage loss noted that it was likely that I would need to get the hip replaced, and the arthroscopy would maybe just help short term. I went through injections and PT then visited a 3rd ortho because I wasn't getting any relief. The standard xrays showed cartilage loss, but not bone-on-bone. It wasn't until that surgeon ordered a "true lateral" image instead of a frog leg that he could see the true extent of the cartilage loss and it was bone-on-bone.

I was cleared for hip replacement in 2018 but then started having extreme pain in my right hip, which also showed a torn labrum. Another ortho in the practice performed a right hip arthroscopy in January, 2019 to repair the labrum to facilitate an easier recovery for my left hip replacement. My left hip was replaced 3 months later, in March.

During recovery for the left hip replacement, my right hip began to get more and more painful. Once again, it was a "true lateral" xray that showed I had the same pattern of cartilage loss in the right hip as I had in the left. I once again did PT and injections for the right hip before getting it replaced the beginning of February, 2020.

I'm sorry this post is so long. I am struggling finding people to talk to about what I am going through and would truly appreciate any feedback. Thank you for your help!!

 

[Pumpkln]

@Hippie2020
Welcome to BoneSmart, glad you joined us!
You can find other members who have had hip infections, by following this link. Hip Infection

1. How common is it to have 2 infections that close together that are from different bacteria?

It is not common, but you will find other members who have had more than one infection, click on the link I gave you for a list of members with infections to read their stories.
I am going to tag @PegGar16 to come and talk to you.

2. Your surgeons should have given the guidelines for wt bearing on your spacer.

3. Because of all the antibiotics, I am concerned about 2 things: resistance to antibiotics in the future, and what effects the antibiotics are having on my gut. I am taking probiotics, but how long will it take for my gut to recover, and what will happen down the road when I get a bacterial infection from something else?

The best person to ask is your infection doctor. You can all eat foods with a lot of probiotics, such as fermented sauerkraut, yogurt with live cultures, kefer, and others in the refrigerator compartment in your grocery store.

4. What are some exercises I can do other than the traditional hip replacement post op ones, especially aerobic? I am putting on weight, and that is not helping my recovery.

You can ask about using an upper cycle for aerobic exercise.

5. What are my chances of getting another infection in my right hip again?

With the two stage revision, you chance of reinfection will be lower than it was after the washout and partial revision in May.

6. When placing the femoral component of the spacer, the surgeon was unable to retrieve a Steinmann pin that had been used. It is now lodged in the lower part of my femur, just below the narrowing of the bone. Does anyone have experience with something like this? Obviously, the surgeon is going to try to get it out again, but how worried should I be if he has to leave it in?

He should be able to get this out, your surgeon is the best person to ask.

Sorry I cannot answer all of your questions, some of our members with a similar experience may be able to help.

 

[Pumpkln]

I have posted a signature for you with your surgery dates, please check them to be sure I have the correct information.
Just post what you would like in your thread and a moderator will update your signature.

While recovery from an infections/revision is different from a primary TKR, you will find most of the articles helpful for your current recovery.

Here are the Hip Recovery Guidelines, the articles are short and will not take long to read.

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:

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rest​

elevate​

ice​

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

3. Do what you want to do BUT

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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

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BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

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Activity progression for THRs​

6. Access these pages on the website

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Oral And Intravenous Pain Medications​

Wound Care In Hospital​

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 the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[PegGar16]

Hi @Hippie2020! Sorry it took a couple of days to get on here. I have been slammed with work and wasn't paying attention to my personal email. My infection was with the knee but it hit me like you on my second round. Everything was going fine and then I woke up one morning with a fever and red swollen knee. I felt like I had the flu. I get bursitis in my hips and think that pain is miserable, I can't imagine replacements and a revision. I can't move anything without pulling on the hip.
I can't answer many of your questions......I had 2 different spacers put in. The first one I could bend somewhat and put some weight on it while the second one was no bending or weight. So that would be a question for your doctor. I didn't have a lot of pain with either of them just a weird feeling like chalk rubbing together.
I had the same type of infection both times and lots of antibiotics...remember the yogurt/probiotics. They seemed to help me.
Having the infection is miserable and seems to take forever to clear. It is so important to make sure it is completely gone before putting in the knew prosthetic. I know there are some that have to take antibiotics for life but I don't have to. They do like keep an eye on me. Any excessive swelling/fluid or pain they bring me in to drain it and test for infection. So far so good.

 

[Layla]

Hello @Hippie2020
How are you doing since we last heard from you? I hope the medical professionals you’re dealing with were apply to supply answers to any questions you still had after your original post here. Hopefully you are feeling optimistic these days.
Please know we’re here for you. Wishing you comfort and perfect healing.