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[REVISION THR] Artificial joint infection

dav2stage

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Age 47 male born 1970 over weight. Diagnosed with ankylosing spondolitis 1984. Diagnosed with diabetes type 2 in 2015. First left hip replacement due to cartlidge degeneration in 1986 at age 16. In1989 I shattered steel hip up through my pelvic bone while wrestling. Pelvis was reconstructed with metal plates an screws and cadaver bone. In 1992 the pelvic reconstruction came lose. It was reconstructed again with metal plates and screws and coral. 2011 I fell off ladder and shattered top half my femur. It was repaired with metal plates and wires and a new hip was cemented in place. This was done at cedars sinai in Los Angeles. 4 months after surgery their was a small portion of scar that did not heal and became infected. Immediately surgeon opened me up and made sure there was no infection deep enough to reach prosthesis or hardware. E cleaned infection and closed me back up. No problems until 2015 when a portion of scar opened again and there was son drainage. It quickly healed and did not appear for about 5 months then healed. Then opened again in beginning of 2017 and would not heal. There was more discharge from the wound. It was a clear slightly milky color with no infection smell but would not heal. July 2017 I went to ortho surgeon. He stated that the sinus tract went all the wY to prosthesis. He figured this out by putting long tip into open wound. He stated I needed a two stage surgery immediately and set me up to have surgery the next week. He took 1 X-ray but never tested my blood for signs of infection and did not do an aspiration. He saw the severity of my femur repair and did warn me that when they removed the cemented prosthesis it could cause more damage which may make the final repair very difficult if there was not enough femur left for the prosthesis to slide into. I asked about any possible treatment for the infection that we could try before the surgery since repair after might be so difficult. Could we try and fight infection before moving directly to surgery. I was told no I had to hve surgery ASAP. Even though the components were not lose an I was not feeling any pain in hip and was walking fine he stated surgery was only option. At this time he never did any testing of the drainage or blood test or a hip aspiration beforehand to possibly see extent of infection. August 2017 I had first stage of two stage surgery. They implanted antibiotic spacers non weight bearing. When removing the hip prosthesis he did extensive damage to my already damaged femur. My femur is now shattered to just above my knee. I was on pic line for six weeks after surgery then oral antibiotics for two weeks. Nothing since. Still waiting to make sure infection is cleared before reconstruction. I have been told I willl need a full femoral prosthesis due to damage when hip prosthesis was removed. I have been bed ridden for six months at this point. I recently was reading a paper titled "Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America". In this paper it seemed to go through the process a doctor should follow when confronted with my situation and it does not seem to me as he was anywhere near following protocol. Can a doctor let me know if what he did with rushing me for surgery without any testing was normal or okay. By the way this last surgery was done at a county hospital. Here is a link to the paper. I just feel the surgeon rushed me into the surgery without looking at any other options first. It I sad to say but he has a god complex and he can never admit to making a mistake which scares me a bit. I just want to make sure he did what he should have or if he should have done more or tried more before putting me on table and cutting me up. I feel as though he is medically negligent. Am I right?

https://academic.oup.com/cid/article/56/1/e1/415705
 

Layla

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Hi @dav2stage
I'm very sorry for your longsuffering. You've been on quite the journey.
Your story is pretty complex and it would be best if our Nurse Director, @Josephine
read your history and weighed in on all. I've tagged her for you but she's in the U.K.
so please check back in the event she has questions.

Also wondering if you could list your surgeries and the reason for each in a column,
so they can be added as your signature.
Warm wishes for comfort and peace moving forward!
 

Pumpkln

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@day2stage
You have been through a lot with your hip.
Yes, you can get a second opinion, it is your right.
Recommend you seek a second opinion for your THR, from a surgeon specializing in Revisions, they have the education and background to determine what is happening with troubled hips. Look for a surgeon specializing in complex joint reconstruction or revisions. You will also want to be sure they have extensive experience with infection. They should have no relationship with your present OS, not even golf buddies.

If you are in/near Texas Gerhard Maale MD, in Fort Worth has extensive experience with infections.
 
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dav2stage

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Thanks for the responses. I am working on a fourth opinion at this point. It is difficult to find a dr with the skills needed that also takes county insurance. I am waiting to get approval to see a doctor that is a ortho oncologist and deals with major loss of bones and reconstruction.

Honestly I am a bit worries but more then my worry I feel bad for my wife. She is so good to me. Even with the hell she goes through working and taking care of me since I am bedridden right now I know it's exhausting.

Layla I hope this is what you meant. Ty for your help.

Surgeries
1986 thr left leg due to ankylosing spondolitis

1989 Pelvic Reconstruction using plates and screws and cadaver bone due to my artificial hip being slammed up through my pelvic bone while wrestling

1992 Pelvic reconstruction did not hold. It was redone this time with plates and screws and pieces of coral that were pressure fit into the needed areas. Since coral is also living bone it grew together with my own existing bone very well.

2007. 10 ft fall off ladder onto cement. Femur was shattered. Was put back together with wire and metal plates. Artificial hip was replace with new one which was cemented into ten repaired femur.

2nd surgery dour months later to clean out infection. Was not extensive thank goodness.

2009 motorcycle accident. Car made right turn at intersection. And I did superman over good. Fractured spine. No surgery.

2017 first stage of 2 stage surgery due to artificial joint infection. Removed hardware and replace with antibiotic spacers. Currently awaiting second stage of process.
 

koala78

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I’m waiting for new implant too as part of two stage revision. No spacer this time. Did this two stage back in 2013-14 for previous infection. 10 hip surgeries as an adult - 7 on left hip; 3 on right.
 

stronggal

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Wow!!! Dav2stage. You are a strong man! I can believe what you have been thru, many similar things happened to me. I' in the US, buy you have to seek counsel. I think you mentioned hospitals here in America? Try to keep us informed, I'm going a situation myself steaing from almost 4 years ago. You must follow your gut feelings! You know when something is not right. DONT give up. Thx for sharing. I pray for you to get the right doctor to help you.
Koala, unbelievable how many surgeries you have had...all by the same surgeon?
 
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Layla

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Hi @dav2stage
Your story, as well as the stories of the two who commented above are heartbreaking. @stronggal
I'm sorry for the suffering each of you has experienced. Prayers for resolution and brighter days for you all.
@koala78
 

clodaghcov

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I so feel for you and all you are going through, it feels never ending doesn't it. My history is not the same but it has certainly been similar. I have just had my 2nd stage hip in after having infection and a spacer since August for the 2nd time. My first spacer I had was agony with 4ins shortening, I can still remember the pain, the 2nd onr in August was much more comfy but it dislocated a little while before really it was time for my hip to go in. however it is in.

I can only hope for better things for you I think you do need reconstructive surgeon and a very specialist hospital. when our bodies have had so much treatment it must be a huge challenge to the surgeons to do their best for you.

I have had wonderful treatment here in England over the last 30 odd years and its only thanks to them I am walking---I so hope the same for you, keep positive, don't think too many what ifs, it really will eat you alive.xxxx
 
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dav2stage

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Hello, it has been quite a while since I have posted on this site. I am hoping someone can help me out with this question.

I currently have antibiotic spacers in my left hip and femoral area. Non weight bearing for the last two years or so. Had to have everything removed due to infection. I need to get a total knee replacement done on my right knee before having my hip surgery on my left side. I had an aspiration done at USC last week and have the results. I tried my best looking them up online to try to find the normal ranges but was not very successful. I see the doctor for the review of the results late next week but am inpatient. My life has been on hold for over two years waiting to move forward and these results will let me know whether it is going to happen or not. I understand 100 percent that any info I receive in this forum re my results should just be taken as an opinion and not as fact until Dr verifies but I am hoping someone has had experience in reading the aspiration results and can let me know if they think there is any infection.

Specimen Type: Wound Culture
Result: NO GROWTH
Report Status: Preliminary
Collected Date: Jul 02, 2019, 10:55 a.m.
Additional Information: No Growth at 2 Days

BODY FLUID ANALYSIS
BF TYPE: left hip
TOTAL VOLUME BODY FLUID: 2.5ml
APPEARANCE BF: cloudy
COLOR BF: pink
WBC BF: 1261 cells/mcL
RBC BF: 12000 cells/mcL

BODY FLUID DIFFERENTIAL
Total cells counted BF: 100 cells
Neutrophil BF: 75%
Lymphocyte BF: 23%
Monocyte BF: 2%

Any opinions on whether these results are still showing infection or not or are inconclusive would be a great help.

Thank you
David
 

Jaycey

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@dav2stage you will notice that I have merged your two threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread. If you would like a new thread title just give a shout.

I'll tag our medical expert @Josephine to see if she has any input on your test results.
 

Josephine

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I'm afraid I cannot give you an opinion on your lab results as I never learned about lab results. Sorry.
 

Mojo333

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:wave:
Such a long recovery
I'm not sure if @clodaghcov or member who has dealt with infection would have any insight.
I see the No Growth part so that must make you feel encouraged...
I hope that you are able to get on with your other surgeries and that this is all good news:fingersx:
 

clodaghcov

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@dav2stage I so feel for you, being at one with my spacer for the last year, It certainly gives us challenges. I seemed to spend a great deal of time worrying about my blood tests,but i havnt a clue what yours mean,will your consultant not give you proper results and explanations,i think we try to understand more than we can truly can. I am curious why your knee needs replacing first. Ihave my bloods done every month and go slightly dizzy waiting for the results and praying all is still well. My oposit knee needed replacing before i ever had this infection but the surgeon will wait until this time next year to do my hip so its just upward and onward,I really hope your results are good and they can get on with it for you.xx
 

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