tutati
new member
Has any one had a two stage revision with a spacer? My father had his old prosthesis removed and a spacer with antibiotic beads put July 3,2008. He is in severe pain. This is far worse than we were led to believe. He is 86.
hip revision with spacer
- Thread starter tutati
- Start date
- Status
westexas
graduate
Hi Tutati,
I am sorry about your father being in so much pain. Just hang on and Josephine, our resident nurse will be on soon. She will definetely be able to help you with this.
I will be thinking of your dad.....Patty
I am sorry about your father being in so much pain. Just hang on and Josephine, our resident nurse will be on soon. She will definetely be able to help you with this.
I will be thinking of your dad.....Patty
United KingdomHis hip was infected, right? That is a most unpleasant method of treatment and very painful. He has my sympathies.
What has to be done is for all metal wear to be removed until the infection has been eradicated. This can take months. But in order to preserve the joint space, something has to be put in there to keep it open and ready for the new prosthesis when the time is right. Generally they just use a large plug of bone cement impregnated with Gentamycin. The beads will have been put into the femoral shaft to deal with the infection deep in the bone there. The antibiotic will leech out over a period of months.
When the time is right, they will remove the plug and the beads and insert a new hip prosthesis.
In the meantime, there is a lot of abnormal movement and instability in the hip which is what is causing the pain.
Hope this information has been of some help.
What has to be done is for all metal wear to be removed until the infection has been eradicated. This can take months. But in order to preserve the joint space, something has to be put in there to keep it open and ready for the new prosthesis when the time is right. Generally they just use a large plug of bone cement impregnated with Gentamycin. The beads will have been put into the femoral shaft to deal with the infection deep in the bone there. The antibiotic will leech out over a period of months.
When the time is right, they will remove the plug and the beads and insert a new hip prosthesis.
In the meantime, there is a lot of abnormal movement and instability in the hip which is what is causing the pain.
Hope this information has been of some help.
tutati
new member
Thank you for the info. Yes he did have an infection. How much mobility can we expect him to have with the spacer? We expected him to be up and around in four or five days. At this point we are worried he will never walk again. The antibiotics are making him sick. He can't keep any food down and is very depressed.
There's no soft way of saying it ... mobility will be severely restricted until he gets his new hip in. And yes, the quantity of severe antibiotics he has to take will make him nauseous, even to the point of being sick. They are almost as strong as the cytotoxic drugs used for cancer (chemotherapy) which also makes a person sick as a toad. Perhaps if he talks with his OS they could shuffle them around so he has some relief from time to time.
Sorry couldn't come up with better news. They should have told you all this.
Sorry couldn't come up with better news. They should have told you all this.
tutati
new member
I agree we should have been told. I went with him to his appointment and asked specifically what the recovery was going to be like. The O.S. said he would be up the day after surgery and ready to go home in three to four days. I asked about getting him set up for a care facility for rehab like the first time and he indicated that probably wouldn't be necessary. I told him my mother was not able to help him and he said Dad wouldn't need help he would be able to take care of himself. I'm thinking we need a new surgeon.
dcdowden
junior member
Sorry to hear about your Dad's situation. My Dad had the same thing happen last year. My Dad is 83 and he broke his hip and had a partial hip replacement the year before. He developed severe pain and they decided to put in the socket replacement part as well. But when they went in, they found that the stem was infected and had to remove everything and put in the spacer with antibiotics. They also put him on IV antibiotics. He did not do very well after the surgery - couldn't eat anything for a week - and stayed in the hospital for about 10 days.
He then spent the next 6 weeks in a nursing home rehab facility where he got the IV antibiotics and PT twice a day. At first he couldn't do much at PT. But they eventually were able to get him to use a walker with partial weight bearing on the leg with the spacer. I'm sure there are lots of variations in exactly what they put in for the spacer. I was told that they fashioned a spacer ball out of bone cement, so he could put some weight on the hip. After the IV ended, he came home for a few weeks. They arranged for a hospital bed at home and some home health care assistance (Medicare doesn't pay for the custodial care unfortunately) to help my mother take care of him. He had to be off the antibiotics for about 3 weeks before they did the tests to determine that the infection had cleared. It was almost 3 months from the surgery where they found the infection until the surgery where they put in the full revision hip replacement. In my father's case, he had lost so much bone from the earlier surgeries as well as from osteoporosis, that they had to put in a plate and wrapped wires around his femur to hold it together.
After the surgery, he was very restricted on weight bearing for 6 weeks, so he had to go back to a nursing home rehab facility. His scar extends well down his leg - maybe 18 inches. I know it was a very long and mentally depressing process for my Dad, but from everything I've read the two stage revision is the Gold Standard procedure for dealing with an infection. My Dad is home now and able to walk with a cane, but he is still very weak from not being able to use his legs for so long. He also still complains of some pain, but he is also diabetic and they suspect diabetic neuropathy may be contributing to that.
Good Luck - the hardest thing for us was to try to keep up my Dad's spirits when he was stuck in the nursing home. He was much happier when he got to go home. So if your Dad can go home with at home nursing care and PT, that would be great. Of course it really depends on how well he can get around.
Doug
He then spent the next 6 weeks in a nursing home rehab facility where he got the IV antibiotics and PT twice a day. At first he couldn't do much at PT. But they eventually were able to get him to use a walker with partial weight bearing on the leg with the spacer. I'm sure there are lots of variations in exactly what they put in for the spacer. I was told that they fashioned a spacer ball out of bone cement, so he could put some weight on the hip. After the IV ended, he came home for a few weeks. They arranged for a hospital bed at home and some home health care assistance (Medicare doesn't pay for the custodial care unfortunately) to help my mother take care of him. He had to be off the antibiotics for about 3 weeks before they did the tests to determine that the infection had cleared. It was almost 3 months from the surgery where they found the infection until the surgery where they put in the full revision hip replacement. In my father's case, he had lost so much bone from the earlier surgeries as well as from osteoporosis, that they had to put in a plate and wrapped wires around his femur to hold it together.
After the surgery, he was very restricted on weight bearing for 6 weeks, so he had to go back to a nursing home rehab facility. His scar extends well down his leg - maybe 18 inches. I know it was a very long and mentally depressing process for my Dad, but from everything I've read the two stage revision is the Gold Standard procedure for dealing with an infection. My Dad is home now and able to walk with a cane, but he is still very weak from not being able to use his legs for so long. He also still complains of some pain, but he is also diabetic and they suspect diabetic neuropathy may be contributing to that.
Good Luck - the hardest thing for us was to try to keep up my Dad's spirits when he was stuck in the nursing home. He was much happier when he got to go home. So if your Dad can go home with at home nursing care and PT, that would be great. Of course it really depends on how well he can get around.
Doug
dcdowden
junior member
Sorry to hear about your Dad's situation. My Dad had the same thing happen last year. My Dad is 83 and he broke his hip and had a partial hip replacement the year before. He developed severe pain and they decided to put in the socket replacement part as well. But when they went in, they found that the stem was infected and had to remove everything and put in the spacer with antibiotics. They also put him on IV antibiotics. He did not do very well after the surgery - couldn't eat anything for a week - and stayed in the hospital for about 10 days.
He then spent the next 6 weeks in a nursing home rehab facility where he got the IV antibiotics and PT twice a day. At first he couldn't do much at PT. But they eventually were able to get him to use a walker with partial weight bearing on the leg with the spacer. I'm sure there are lots of variations in exactly what they put in for the spacer. I was told that they fashioned a spacer ball out of bone cement, so he could put some weight on the hip. After the IV ended, he came home for a few weeks. They arranged for a hospital bed at home and some home health care assistance (Medicare doesn't pay for the custodial care unfortunately) to help my mother take care of him. He had to be off the antibiotics for about 3 weeks before they did the tests to determine that the infection had cleared. It was almost 3 months from the surgery where they found the infection until the surgery where they put in the full revision hip replacement. In my father's case, he had lost so much bone from the earlier surgeries as well as from osteoporosis, that they had to put in a plate and wrapped wires around his femur to hold it together.
After the surgery, he was very restricted on weight bearing for 6 weeks, so he had to go back to a nursing home rehab facility. His scar extends well down his leg - maybe 18 inches. I know it was a very long and mentally depressing process for my Dad, but from everything I've read the two stage revision is the Gold Standard procedure for dealing with an infection. My Dad is home now and able to walk with a cane, but he is still very weak from not being able to use his legs for so long. He also still complains of some pain, but he is also diabetic and they suspect diabetic neuropathy may be contributing to that.
Good Luck - the hardest thing for us was to try to keep up my Dad's spirits when he was stuck in the nursing home. He was much happier when he got to go home. So if your Dad can go home with at home nursing care and PT, that would be great. Of course it really depends on how well he can get around.
Doug
He then spent the next 6 weeks in a nursing home rehab facility where he got the IV antibiotics and PT twice a day. At first he couldn't do much at PT. But they eventually were able to get him to use a walker with partial weight bearing on the leg with the spacer. I'm sure there are lots of variations in exactly what they put in for the spacer. I was told that they fashioned a spacer ball out of bone cement, so he could put some weight on the hip. After the IV ended, he came home for a few weeks. They arranged for a hospital bed at home and some home health care assistance (Medicare doesn't pay for the custodial care unfortunately) to help my mother take care of him. He had to be off the antibiotics for about 3 weeks before they did the tests to determine that the infection had cleared. It was almost 3 months from the surgery where they found the infection until the surgery where they put in the full revision hip replacement. In my father's case, he had lost so much bone from the earlier surgeries as well as from osteoporosis, that they had to put in a plate and wrapped wires around his femur to hold it together.
After the surgery, he was very restricted on weight bearing for 6 weeks, so he had to go back to a nursing home rehab facility. His scar extends well down his leg - maybe 18 inches. I know it was a very long and mentally depressing process for my Dad, but from everything I've read the two stage revision is the Gold Standard procedure for dealing with an infection. My Dad is home now and able to walk with a cane, but he is still very weak from not being able to use his legs for so long. He also still complains of some pain, but he is also diabetic and they suspect diabetic neuropathy may be contributing to that.
Good Luck - the hardest thing for us was to try to keep up my Dad's spirits when he was stuck in the nursing home. He was much happier when he got to go home. So if your Dad can go home with at home nursing care and PT, that would be great. Of course it really depends on how well he can get around.
Doug
tutati
new member
Dad is doing better, he is still in a wheel chair but is in less pain. He has completed his six weeks of antibiotics and the wound care specialist has given him the go ahead for his new hip. The O.S. wants to wait another six weeks to put in the new hip. Dad wants it now. Is there any medical reason not to go ahead now?
To be honest, the longer you wait, the better as it gives more of a chance for the infection to be GONE! Last thing you want is to go on this merry-g-round again.
- Status
BoneSmart #1 Best Blog
Staff online
-
PumpkinStaff member since March 26, 2015 -
sistersinhimStaff member since March 20, 2017
