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Hip Infection* Anyone have a Prostalac® implant?

Genevive

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As you'll see from my signature, I had a THR, DAIR (debridement, antibiotics and implant retention) procedure for infected joint and a Revision within 2 months in 2019. I still have pain in and around my right hip, although not the sharp pain I used to get in my groin - it's more like deep aches in the buttock and thigh. My Left Hip & both knees are poor - Osteoarthritis.

I take painkillers daily and this takes the edge off and allows me to get on with my life, but still with a fair amount of pain - I can walk 2-3 miles, but with crutches and regular stops to sit for a few minutes.

I'd like to get off the pain killers (Zomorph and Oramorph for breakthrough pain) but it's not happening.

There's a physiotherapist with a fairly good reputation, offering Shockwave Therapy - does anyone have any experience of this with regards to Hip pain?

Elizabeth.
 

Celle

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Hello @Genevive - and :welome:

I'm sorry you're still having pain from your hip.
I had to look up the procedures you've had, as the abbreviation "DAIR" is not one we see a lot here on BoneSmart, and nor is the KIWI Prostalac implant mentioned much.

Please can you tell us where you had your surgery, and who your surgeon was?

From what I understand, you still have the KIWI antibiotic spacer in place. Is that right?
The KIWI is made of antibiotic-laced bone cement. Although I have read of people having it left in place, I believe the normal procedure is to remove it once all indications of infection have gone, and replace it with new replacement hardware.

Are you still being followed up for monitoring of joint infection? I hope so.
If not, I think you should ask for further testing. Then, if infection signs are negative, have the spacer removed and new replacement hardware installed.

I have never heard of an antibiotic spacer being left in as a permanent solution and I think the spacer is the cause of your pain.

With new replacement hardware, it should be possible for you to be in less pain and more mobile.

I would be inclined to pursue this course, rather than trying Shockwave therapy that has variable results.

At any rate, you need to see your surgeon again (or a new surgeon), and discuss your options.

PS: I've put your surgery information in your regular signature, so you won't need to repeat it every time you make a post.
 

Celle

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Hi again, @Genevive ,
I've been doing some research about the Prostalac system and it appears that it is not intended to be used as a permanent implant, but rather as a treatment prior to replacing a hip joint prosthesis, once the joint is free of infection.

From this website (by DePUY)
http://www.bizwan.com/_mydoc/depuy/hiptech/DPY_Prostalac-Hip_Surgical_Technique_0612-60-500.pdf

"To prevent complications in the two-stage approach, the Prosthesis of Antibiotic-Loaded Acrylic Cement, or the Prostalac®(prost-allik) Hip Temporary ProsthesisSystem, was developed to function temporarily as a total hip replacement (THR). It was also designed as a carrier device for local delivery of antibiotic drugs within the periprosthetic space following surgery for the explantation of an infected total hip prosthesis. This implant system acts as an articulating spacer with a structure and function similar to the traditional total hip arthroplasty components and has a proven high success rate (90-95 percent) for eradicating infection. The Prostalac hip provides a means for limited mobility of the patient following excision arthroplasty surgery, eliminating the need for traction and reducing the chances of muscle atrophy, stiffness or bone loss. The Prostalac hip is designed to remain in situ for approximately three months after which a second surgery is performed for implantation of a permanent THR prosthesis. The design of this device requires that it be protected from the stresses associated with full weight bearing throughout the three-month implantation period."

Now that your left knee and hip have developed osteoarthritis, your gait has probably altered and this is putting further stress on the Prostalac implant.

I'm sorry to say this, but I think you are going to need further surgery, to replace the Prostalac system with a permanent prosthesis, and eventually to replace your left hip and knee.

You really do need to see an orthopaedic surgeon.
 
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Genevive

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Hello Celle,
many thanks for your responses & the time you spent on researching this for me.

I can't find a date for the article, other than the trademark (?) 2004... but I did find another article from 2019 where a gentleman had one for 6 years? I'm unable to post the link here (apparently I need 5 posts to post a link) The title of the article is

Retention of prosthetic articulating spacer after infected hip arthroplasty as a semipermanent implant: A case report

I have had my bloods monitored regularly - the last time was 25th September 2020 (CRP:2 ESR:10 - both in an acceptable range?) I'm now on the "annual review" list.

I think your advice to see my surgeon again is correct, but I'd be interested to know if any of the other members of BONESMART have this in place? Would it help to change my subject line?

Many thanks for your help - very much appreciated. Elizabeth.
 

Jaycey

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@Genevive I've changed the title of your thread so that our members can reply if they have had the Prostalac implant. I can't think of anyone who has had this. What is your surgeon's plan moving forward?
 
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Genevive

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Hello Jacey, many thanks for that super quick response and action!

As far as I'm aware, he's just planning on doing an annual review... think I need to try and make an appointment (!) and have a proper conversation with him about where I go from here...

many thanks, Elizabeth.
 

helenium

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Hello @Genevive,
I remembered reading something about this before. CobyBlack hasn't updated his thread since last May, but you could try contacting him to see if he would come back and talk to you. Best wishes.
 

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