9yr old hip has loosened - revision required

[prairienut]

@Going4fun, It turns out there is a way through the HSS patient portal to direct questions to your surgeon via email. I have sent these two questions in through that method. They commit to respond within 3 business days. It's about time the medical community embraced electronic communications. Otherwise, you're stuck playing telephone tag or scheduling another expensive and inconvenient appointment for even a relatively simple question. I'll post here again when I hear back. In the meantime, I am trying to be kind to my poor THR leg. Looking forward to Jan. 3 (I think).

 

[Josephine]

On his computer screen he showed me how he would size an implant for my unoperated leg, then he dragged that image over to the right leg, flipped it and lined it up with the implant I have.

Gosh, that took me right back to my youth when we first started using acetate templates to assess the size of the implant. Professor John Charnley started that in the UK and made it a policy to always do that for every hip!

 

[prairienut]

I just returned from a full day of pre-op testing at Hospital for Special Susrgery. They took blood for the panel of tests first thing in the morning and by the afternoon, I could read the results on my HSS account. Now that is progress in medical records and reporting! No signs of infection, metabolic numbers are normal. All looks good for the Jan. 3 hip revision, although it will take 4-5 days to get the culture results from the hip aspiration. I was dreading the aspiration but they use Novocaine so it wasn't as bad as I expected. Still NOT FUN. I have a bottle of pre-surgical Ensure to drink three hours prior to my arrival time for surgery. They have found that people do better post surgery with this shot of easily absorbed carbs and fluid ahead of time as opposed to strict fasting. I am ready for this. Getting tired of stumping around with crutches!

 

[Jaycey]

These pre-op assessments can be exhausting. Glad it's all done and dusted! Bring on January 3rd!

 

[prairienut]

Not quite dusted. Turns out I had to re-do the PT-DNR blood test as the first try was possibly incorrect. I sure hope this try falls within the proper range. Never had an issue with clotting or bleeding so I have to think it will be OK. Won't have results until Monday of course. I do get impatient, but I don't want anything to spoil the Jan. 3 revision date!

 

[Going4fun]

@prairienut, glad to hear the hss preop process is humming along, even if they brought you back for a repeat test. Hey, did you ever get some answers to your questions about the cramps in the hip ... and about the LLD leading to trips and awkward walking (if I remember correctly)?

 

[prairienut]

Going4fun, luckily, I was able to do the repeat blood test here in my hometown which is a 2-hour drive from HSS.

No, I did not get an answer back yet on whether LLD could be causing stumbling or what was causing the twinges of pain at night. Will have to prompt the OS office on Monday.

I mentioned the night twinges at the anesthesia consult yesterday. She didn't have any quick and easy answer either. I also asked her about the shivering legs post surgery. She said those could be a result of the anesthesia and may or may not happen again. She said I should mention it the day of surgery to whoever the anesthesiologist is, and they will address it as needed.

Got a call from the social worker today to be sure I have what I need when I get home as I am not recommended for inpatient rehab. For the first 2 weeks at home, a visiting nurse will check the suture a couple of times, and out-patient PT will be 2-3 times per week.

 

[Mojo333]

Glad this is happening soon.
Hope your holiday is full of comfort and joy!:tree:

 

[prairienut]

Now this is seriously impressive. I had blood drawn here in my hometown at 4 PM yesterday. Just now, about 18 hours after the draw, the results have been posted on my HSS account, and the PT-INR test is within normal range. Yay! This is when technology is at it's best, giving you quick access to important information. So far, so good for Jan. 3.

I have a question for you revision hippies out there. Will I be able to tolerate a 2-hour car ride on the 2nd post-surgery day? It will be in a van with smooth suspension and a seat back that reclines. I knew this would be the price to pay for having the surgery in NYC. Still happy about the decision. The attention to detail at HSS has been unrelenting.

 

[Jaycey]

Will I be able to tolerate a 2-hour car ride on the 2nd post-surgery day?

It may be tough but if you stop at least once to get out and stretch you may find it helpful. Lots of pillows, icepacks for icing and elevate in the back seat if that's possible.

 

[prairienut]

I'm planning ahead for recovery needs. What product is recommended for the icing? Should I get a supply of the gel-packs so I can alternate them? What size is best? Is just the operated area iced or the entire leg? Forty minutes sounds like a long time to ice. Do you use a cloth in between the ice pack and skin to prevent frost bite? I do remember having a "log leg" for some number of weeks after my THR, so I know I will need to "elevate, ice, and rest" for this revision recovery.

 

[prairienut]

Just got the test results for the synovial fluid analysis from the aspiration. The WBC is 1000 when the reference range is 1-200. The RBC is 16,000 when the reference range is <=2000. I read that the elevated counts are a result of inflammation and/or infection. Still don't have the culture back. Should have that by mid-week. I REALLY hope it does not mean an infection. None of my other bloodwork shows signs of infection, but my OS says there can be "hidden" infection which does not show up in the blood tests. My heart sank when I saw these high numbers. Everything else was within range. Can anyone out there tell me more about the meaning of these tests? How likely is it an infection vs. inflammation from a wobbly prosthesis?

 

[alexthecat]

@Josephine would be the person to advise you on your results.

You are in my thoughts. I don't know if you remember me, but I remember you. You were already recovered back when I had my THR. I appreciated your friendliness and support. I wish you well.

 

[Going4fun]

@prairienut, you'll definitely be able to go for a 2-hour ride after the surgery. People endure travel longer than that to go to HSS! They travel from across the world ... from across the country ...

On the ice packs, the discharge nurses will cover all of that ... and the hospital will have ice packs you can take with you ... and you can tell them (the nurses) before surgery and the morning of intake about your car ride two days later ... There's nothing in the slightest out of the ordinary in your situation as a patient. Just tell the folks at HSS what you need, what you're worried about ... and it's their job to hook you up. Just be blunt about your pain before discharge. You should NOT be in pain when you leave or a day later.

Typically someone from your hospital will check in with you a day after surgery ... maybe two days after surgery. You have to speak up because we all need different meds and dosages of pain meds, muscle relaxants, narcotics and so on. So if they haven't given you enough, you ask for more ... so that you aren't in pain. Pain treatment after hip replacement is therapeutic on multiple levels because patients will not walk and get mobile if they are in pain ... and if they don't walk and move, their recovery is slowed and they have an increased risk of a clot.

I was hurting a little as the nurse was giving me discharge directions. I finally told her, hey, this pain is starting to bother me. She gave me whatever, maybe more oxy. I was out of pain ...

On my day of discharge I went from the hospital to lunch with my sister and a friend at a restaurant. I was on the walker and had an easy time. Not everyone has as easy a time as I did, but my result wasn't atypical either. Between discharge and arriving home, maybe three hours. We didn't rush the lunch!

My sister came from out of town ... and maybe three days after surgery ... we went driving through the city to give her a tour. A buddy of mine was driving ... I had my walker in the trunk. I sat up front. The pain meds were doing their job. We stopped and ate at a restaurant. Spent a whole afternoon out ... in and out of the car. I don't remember anything uncomfortable about the ride--literally. Now your mileage will vary of course. You're having a revision.

 

[prairienut]

I am getting quite anxious. I called the OS office today but didn't hear back. He's a busy guy I'm sure and may be waiting for the culture results before contacting me. The elevated WBC in my synovial fluid has me worried that I have a periprosthetic infection in which case I am facing two surgeries, not one. This changes my whole outlook for 2019 and what I will be able to do and when. I'm trying to be patient and awaiting the call from my OS, but it is very hard to distract myself from the negative thoughts. All the other blood tests look within range. Does anyone have any insight into these results?

 

[Josephine]

What two surgeries are you facing? I'm afraid I don't understand that.

 

[prairienut]

I am worried if there is indeed a periprosthetic infection (high WBC count in synovial fluid) they will have to first implant an antibiotic spacer then later, when the infection is cleared, they would go in a second time to implant the final prosthesis.

The OS should call by midweek or at least by the end of the week with his verdict. I believe he is holding off until he sees the results of the synovial fluid culture which takes some time. The usual blood tests for infection are within the reference ranges, so if it is an infection, it is a "hidden" one. I am anxiously awaiting the call from the OS. The waiting is hard for me.

 

[Going4fun]

@prairienut, oh the wait must be agonizing. Hang in there.

 

[prairienut]

No word from the OS yet on whether he thinks there is an infection around my wobbly prosthesis. I did get a promising test result -- my serum interleukin-6 level is below the threshold for indicating infection. This test is apparently very sensitive and specific for periprosthetic infections. So that gives me some hope while I am waiting for an official assessment from my OS. I have been getting very painful twinges in my THR hip, especially at night when I get occasional muscle cramps (ouch) and in the morning when I get sharp pain as I am getting up and starting my day. My hope is that these problems will melt away once a properly sized femoral implant is tapped (pounded?) into place.

Two weeks to go! I am ordering the assistive devices that are not covered by insurance so they are waiting for me when I get home. Also, setting up the downstairs bedroom with everything I'll need.

 

[Mojo333]

for bloodwork.
Hopefully all will be set for a new hip with no hiccups!

Hope your day is sweet!