Hip Infection Infection, dislocation, revisions, & life beyond

[Patticake]

You are such an inspiration. Your courage, positive attitude, and concern for others is amazing.

 

[dickinson]

glad to hear you're on the upswing @Vetgirl . happy belated birthday. it should be a great year of health and happiness.

 

[Vetgirl]

Thank you for your comments everyone. I don't feel courageous but I do try be positive. Sometimes you have to work at it. There is always someone else worse off than me, and this really helps me to keep it all in perspective.

@mystikfairy61 I'm so glad your out and about and enjoying the Y

Well yesterday I visited with the professor of Microbiology and it was an interesting and also scary visit. It's bit detailed so please bear with me if you are interested. I do try to keep a detailed account of these types of things as a reference to anyone else who may have to go through this as I found the information I wanted to know when this all happened sketchy at best.v

So Prof said that my bug was a very difficult one to get rid of because it is very 'sticky' and produces a good amount of sludge. He said, before looking at my bloods, that he wouldn't expect a big reduction in CPR markers this early on. He talked a lot about Golden staf (staf aureus) which is a coagulase positive bug which means it produces little sludge. My bug, staf ludgenesis thinks it is golden staf by the way it does reproduce etc but is a coagulase negative bug. The coagulase negative bugs produce a lot of sludge.

He would prefer the OS removed the implants and not put anything at all in whilst the ABX do their work, in these infection cases. He said there is a risk that the bug can still hang around in the spacer. He said all the OS always tell him that if they don't put a spacer in, it makes it too hard to put the THR back in. He had a chuckle and said that he doesn't really know if any of them have tried it without the spacer. It's just a thing they all tend to do.

He would like me to continue on the ABX as it is well tolerated, easy to take and one of the safest drugs around. He thinks that I shouldn't come off the ABX next week. He prefers that the new THR goes in when my bloods are stable and that I continue on the ABX until about four months after the new hip goes in and the bone has started to attach to the replacement.

The reason for this? With the bug I have, it is:

• Difficult to eradicate
• Not super aggressive like staf aureus (golden staf)
• It tends to bubble away slowly and can for years and then raise its ugly head again
• Even a short time off the ABX like the 2 weeks suggested can allow it to reoccur, although symptoms may not show for years
• If even a little bit of it isn't eradicated it may cause the implant to not bond well to the bone

By staying on the ABX longer and keeping the spacer in, it is allowing my body to really fight the infection.

It was really interesting that he said, ABX do not cure infections as widely believed but actually get the infection under control to allow your bodies phagocytes to be able to get rid of the infection itself. These phagocytes
Eat up the infection. I think of them as like little PACMAN..like the game (just the image that came to my mind!!!)

The good news is that my blood CRP levels are nearly back to normal and though not normal they are staying consistent which is good. The bad news is that I may never get rid of this bug. It may lay dormant and reappear years later or it can happen again with the new implant.

He said that infection only happens to 2% of surgeries and the bug i have most likely lives on my own skin and was Introduced from my skin or someone else's via cannulas which are in place for anaesthetic, IV drugs, fluids etc. I told him how I got pedantic about the nurses disinfecting my cannula before putting anything into it and he said that was 100% correct. I am to think about anything going into that cannula in terms of germs,as going straight to my implant!!!! He said it was impossible to make skin sterile unless it went into an autoclave which of course is impossible and I know this anyway, from vet nursing.

The idea was to get anything foreign like catheters and cannula s out as soon as possible after surgery, as they are all gateways to infection and to my hip. He said he nearly got mobbed, when he gave a talk to a room full of Aneathesist's on the topic of whether the surgeons Introduced infection to the patient or whether the aneathesist did. Ouch, touchy subject obviously!!!!

The worst case scenario for me is that the infection keeps coming back and that I can have no hip implant but would have the girdlestone procedure. Another scenario is that I may have to take low grade ABX for the rest of my life. I'm not even thinking about these...we asked the questions!!! And we got the answers!!!!

One final thing he said was that many OS base their technique for these type of things from papers that other OS write on the subject. Quite often these percentages are incorrect as many patients who do get infections tend to go to a different surgeon as they say they are not going back to the one that did this to them!!! LOL but not really.

Both Wayne and I are really glad we have all this information and now we can have a good discussion with my OS when we go on Wednesday 30th (same day as @fulafoto and @Sue629 have their THR....don't panic....all this is rare!!!!). We are thinking that maybe I keep the spacer in for a bit longer and see if my bloods can come back to normal and then maybe not go off the ABX at all. Lots to think about...but as I said we are glad to have the information and both my prof and OS work together which is good too.

I would be interested to hear what @Josephine has to say

Today in Australia we remember our fallen war heroes on Anzac Day.....all the men and women who gave their lives so that we can live in freedom as we do. My BIL is a commando and has lost many friends in Afghanistan in the last few years. He has often had to carry their bodies out of the action and willingly stood guard over them before they could be sent home to their families and be buried, as is the tradition.

Please take a moment to think of the sacrifices that these men and women and their families make for us.

Have a great weekend....(if you haven't left this very long post yet!!!!)

 

[miaow27]

Sally- fantastic post. It sounds like between your surgeon and the micro biology prof , you are well looked after and they know what they are doing AND involving you in the process. So interesting to learn how different bugs behave. Also about cannulas and catheters- eeek!
Thank you for sharing. I hope you feel ok after what must have been a ling day yesterday.
I will remember Australia's heroes today definitely.
With very best wishes and kind thoughts to you Sally,
Gill

Sent from my GT-I8160 using Tapatalk 2

 

[fulafoto]

Thanks so much for all that information Sally - it really is very, very informative and a wonderful reference for anyone who has an infection.
I will echo your sentiments regarding ANZAC Day with the words from the Ode of Remembrance;
"Age shall not weary them, nor the years condemn. At the going down of the sun and in the morning. We will remember them."

 

[calikat]

Thank you for detailed information Sally. It's very interesting. Knowledge is power even if some of it can be daunting/disappointing. It will be interesting to hear what your OS says.

 

[Dmcfad2]

Wow. Sally, you are dealing with so much! I don't even know what to say. I commend you for staying so positive in the face of all of this. It is quite a bit to deal with.

It does sound like they have a plan and I pray that everything works out, as it sounds like you have a lot to go through! Keep up the good fight. You are such a sweet person and I enjoy reading your posts.

I have been to Australia twice and just love it. I didn't know about Anzac Day. My husband is a Vietnam vet and we live in a military town, so I am always thinking about what they go through. I am so grateful to all our vets for their service and sacrifice!

 

[younghippie]

Sally, you are so kind to reference your journey for others. That was very informative. You are in my thoughts and prayers. I hope you will have peace with the decisions before you. God bless.

 

[Josephine]

He would prefer the OS removed the implants and not put anything at all in whilst the ABX do their work. He said there is a risk that the bug can still hang around in the spacer.

I wouldn't be so sure about that. The spacers are impregnated with Gentamycin and are therefore an important part of the chemotherapy.

He had a chuckle and said that he doesn't really know if any of them have tried it without the spacer. It's just a thing they all tend to do.

bShows what he knows! Of course we've tried it without and all the ligaments and muscles contracted so we couldn't get the new hip in! That's why spacers were invented!

staf aureus

Not to be pedantic, Sally, but that's spelled staph as in staphylococcus.

ABX do not cure infections as widely believed but actually get the infection under control to allow your bodies phagocytes to be able to get rid of the infection itself.

Well he's right about that!

He said that infection only happens to 2% of surgeries and the bug i have most likely lives on my own skin and was Introduced from my skin or someone else's via cannulas which are in place for anaesthetic, IV drugs, fluids etc.

But he's most likely wrong about that! I have always suspected that your infection was laid down during the surgery but that's much more likely due to issues directly associated with the surgery such as a breach of the sterile field, breach of good practice such as members of the surgical team containing hair properly, not being careful about touching things outside the sterile field, wearing face masks under the nose, using improperly sterilized instruments, drapes and etc., or contaminating instruments, swabs and such during the procedure. All this involves items and hands that go into the wound. The other things he mentioned are highly unlikely to result in an early infection like yours.

The worst case scenario for me is that the infection keeps coming back and that I can have no hip implant but would have the girdlestone procedure.

A Girdlestone is not the end of the world, Sally. Before THRs were invented it was actually the treatment of choice for arthritic hips and people managed very well with them. Where I was then was in an agricultural area and many of our patients were farming people. And they went back to their jobs!

 

[Vetgirl]

Thanks @Josephine I always value your input

That's really scary to think that my infection was caused during surgery by those things considering I am going in with the same team each time!!!! Eeek. Actually when you think about the bugs and the possibilities...the mind boggles!!!!

I was wondering what you thought, about going off the ABX to see if infection markers rise vs keeping spacer in longer and not going off ABX. You have so much experience In This area, I value your opinion.

I tend to agree with you about the spacer too.....I was just reporting what he said. I forgot about the ABX being in there too. Does the bone start to grow into the spacer like it does with an implant???

Staf/ staph.....I was wondering how to put it...thanks

 

[cripl34]

Happy Birthday Sally, thank you for the kind words on my thread. I'll jump over there in a minute and respond to your questions and then perhaps I can come back over here or something....lol

 

[Josephine]

That's really scary to think that my infection was caused during surgery by those things considering I am going in with the same team each time!!!! Eeek.

Well, will you be with the same team? In my experience, the staff rotates in shifts and theatres so unless it's a very small hospital, that's unlikely. You'd have the same surgeons and that's about it.

I was wondering what you thought, about going off the ABX to see if infection markers rise vs keeping spacer in longer and not going off ABX.

I think you need both. The slow release gentamycin isn't as strong a dose as the oral or IV stuff, it's just delivered at the seat of the infection but slowly.

Does the bone start to grow into the spacer like it does with an implant???

No, not at all. The metal implants have a covering of a semi-porous material called hydroxyapatite which consists of calcium and phosphorous which promotes osseointegration between itself and the bone.


Hey, it was your birthday last Saturday?

 

[MajorHeidi]

@Vetgirl Wow Sally, this is a very informative post for your infection state of affairs.
Now I have a better idea of how this is expected to work.
Let us all cheer for your phagocytes to be strong, powerful PACMEN!
Go Phagocytes!

 

[Vetgirl]

Thanks @Josephine for your wisdom and my birthday wishes

I probably didn't make myself clear enough....what I was asking was what were your thoughts on going off the oral ABX for 2 weeks to see if my CRP levels rise whilst I still have the spacer in vs staying on the oral ABX and keeping the spacer In a little longer to give my body more of a chance to fight the infection and get my CRP markers back to normal. The prof suggests not going off ABX at all until about 4 months after new implant goes in.

I ask all this, In regards to the professors comments, that by stopping the ABX for even 2 weeks it can allow the bug to grow again, even minutely. He prefers staying on ABX and not going off them at all. My OS was saying to go off the ABX for 2 weeks or so to see if the CRP levels go up, before putting implant back in

This is what I am interested in your comments on....I'm a bit tired today ...so I hope I make sense because I really value your input on this......thanks

 

[Poppet]

Hi Sally, is your OS and Prof consulting with each other - seems to me they need to get on the same page and work as a team - just a thought hon x

 

[Vetgirl]

Yes they are @Poppet The OS wanted me to meet with the professor and we will talk about this all next week.

I was just interested in what Josephine thought about the 2 different options....but I do t think I'm explaining myself well enough?

 

[Poppet]

Oh good

Yes you are explaining yourself - no worries there honey Let's get Jo's opinion.

 

[Josephine]

I probably didn't make myself clear enough....what I was asking was what were your thoughts on going off the oral ABX for 2 weeks to see if my CRP levels rise

Yes you did and I said not to. That you need both. However, it's just my opinion and it's not the b-all and end-all of it if your surgeon wants to do that trial. There's no exact science on this and often these guys have to play it by ear somewhat.

 

[Vetgirl]

Thanks @Josephine

 

[Josephine]