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THR LTHR: Near 4yr anniversary/scar suddenly swollen

Birdwing

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Everyone was great support during my recovery for both my hip replacements and I’m hoping you all can give me some insight or advice again.

I am 66 female. My LTHR was in 1/2015 anterior minimally invasive. Replacement was necessary because of severe arthritis due to previously undiagnosed DHD/Sublaxation. I was so fortunate that my recovery was text book for both left and left replacements and over these almost four years, I’ve enjoyed cycling, swimming, mountain hiking etc. I’ve been able to enjoy these in ways I’ve never been able to even in my 40’s.

About 12 days ago I developed what seemed like a “muscle knot” centered along 3/4 of the length of my left scar. It’s not an injury— I just discovered it one morning.

It started small and got larger over a 2 days. Now the scar and thigh area are perceptively swollen (usually the scar area is concave) about 4” in diameter with a definite lump filling the whole area.

It’s also red— sort of the color of a cheek slap. No real pain but just feels like a bad bruise would feel when I press on it.

Fortunately my hip feels totally fine and I can do everything I usually do activity-wise. I’m not running a fever.

My primary care doctor said “oh I think you pulled something” and recommended periodic cold packs and ibruprophen. It’s not getting worse, but it’s certainly not getting better. As I said, it’s been well over a week.

If this was anywhere else, I wouldn’t be concerned and would just let nature take its course. But because it’s right underneath the scar, I’m wondering if I should consult my hip surgeon or am I just being a little bit alarmist? Has anyone has spontaneous scar or muscle issues so long after surgery? Any thoughts are greatly appreciated and many thanks!
Birdwing
 

Layla

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Hello, Welcome back! I'm sorry it's due to a concern.
I think your best bet is to call the office of your OS and let them decide whether they want to see you through conversation / questions. Possibly you could ask if they'd look at a photo you send from your phone? Hopefully it's nothing serious but since you've had such a great recovery and been enjoying life, you want to be safe, rather than sorry.
Hoping the best for you!
@Birdwing
 
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Birdwing

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Thank you... This is what I’ve been figuring but I was sort of hoping that it was something that someone would say “oh yes... it happens.. keep tabs on it and it should go away”
I guess I’ve been trying to avoid a long trip to my surgeon and getting an appointment can be trying.
 

Eman85

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At 4 years in it would be very irresponsible for anyone to advise you to ignore it and it will go away.
 

Debru4

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Even if it ends up being nothing, I imagine it would be very hard for you to ignore it and enjoy life until you know for sure. I tend to always err on the side of caution/checking in when I have healthy concerns that I find taking up a lot of my head space. And I think most doctors understand and appreciate it. :flwrysmile:
 
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Birdwing

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Hi All,
So here’s an update on my situation since I last posted:

My GP lanced the abscess drained and prescribed doxycycline while I waited for the consult with my surgeon a week later Dec 4th. The fluid test came back negative for MRSA but other bacteria was not identified.

During the surgical consult, a complete bloodwork was drawn and hip aspiration. My surgeon said that the hip was most likely infected and referred me to a colleague for a revision consultation as my first surgeon does not do revisions.

The revision surgeon advised that unless all the test results come back pristine that there is very little chance that I can avoid revision or DAIR.

The bloodwork came back with 21.6 C-Reactive Protein and 42 ESR. The aspiration results came back inconclusive with Gram Stain Moderate WBC, no organisms found and no growth after 4 days. The revision surgeon says that the amount of fluid that was able to be drawn was somewhat low in volume and that the doxycycline probably suppressed.

I have another appointment on the 22nd to discuss next steps.

I am still feeling completely fine, no fever, no blood pressure issues, no pain, stiffness or anything different with my hip—still walking and hiking about 10-12k steps a day. All the swelling in the abscess is gone; the wound is healing well with drainage continuing. The surgeon still has me on 100mg of doxycycline daily.

I’m concerned that he is still going to recommend jumping into revision despite all the associated difficulties, possible complications, as well as the shortened longevity and limitations of a revision.

Are there alternative non-surgical protocols of close monitoring, regular testing and antibiotic treatment that I can discuss with him? I want to avoid this surgery as must as possible.

Should I be considering a second opinion?

Thanks all again for your kind help.
 
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Birdwing

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One other thing...
the x-rays of the prosthetic show that it’s in great shape. No loosening or other issues. Cementless so I have been advised that it makes revision a longer, more complicated and difficult surgery.
 

Layla

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Hi @Birdwing
Such unfortunate circumstances. I'm so sorry you have to deal with this.

If it were me, I'd take all of my records and seek a second opinion from a reputable revision specialist outside of your current surgeon's practice and not someone he's recommended. Just my opinion. I'm sure others will come along offering advice / opinions also.

Wishing you only the best as you contemplate next steps and move forward.
Please stay in touch. We're here for you.
 

Jaycey

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I’m concerned that he is still going to recommend jumping into revision despite all the associated difficulties, possible complications, as well as the shortened longevity and limitations of a revision.
A revision doesn't necessarily result in shortened longevity and limitations. And cement less does not mean a more complicated surgery. Your surgeon won't know any of this until they view the joint.

If it were me - I would get a second opinion from a revision specialist - if only to confirm that is the next option.
Are there alternative non-surgical protocols of close monitoring, regular testing and antibiotic treatment that I can discuss with him?
If there is infection present in the joint then no, monitoring isn't a safe option.

Hard decision I know. Please let us know what you decide.
 

Eman85

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Sorry to hear it turned out to be an infection. I would want a 2nd and maybe 3rd opinion. I'm sure you're not looking forward to a revision, I know I wouldn't. For what it's worth was anything mentioned about what might have brought this on? It sounds like you did everything correct and had a great recovery and didn't have any other health issues.
 

Going4fun

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I'd absolutely get a second and third opinion before committing to revision, especially given that you feel good ... and have some doubts.
 
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Birdwing

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i really have no idea how this started— no recent dental work, cuts or scrapes or bug bites. Just that a few days before the swelling started, I thought that I had pulled a muscle raking leaves. Pretty innocuous!

As of now it’s inconclusive that the infection is indeed in the hip. I’m hoping the next steps include re-doing the blood work. Can another hip aspiration be done within a few weeks of the first?
Thanks so much everyone for all your advice!
 

Mojo333

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I would like to add to the voices that advise a 2nd opinion.
Doesn't hurt to get a consensus and even a third to make sure you are not choosing to listen to the OS that most aligns with your preferred action, but what is really best.
I think you have to be off antibiotics for several weeks to get true readings on hip aspirations and you certainly don't want to be making these decisions yourself.
I hope this is a one off, but you need to get firm answers.
 

Debru4

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Right now you are lucky in that you have the gift of some time to get additional opinions, since you aren't currently in a crisis. I sure would do that if it were me.

It was great that you listened to your body and you followed up when you had the new swelling after 4 years! Good luck.
 
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Birdwing

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Hi All,
So I had my follow-up consult with the revision OS. I’m still feeling completely fine with absolutely no changes or functioning in the hip etc. The abscess wound is still draining but is healing very well.
We’ve decided that monitoring until there are any changes is the best course of action for now with w/ complete re-do of tests down the line.
I’ll stay on the doxycycline for now too and have a another follow-up in a month.
I also have a consult with his Infectious Disease/Joint Infection Specialist colleague scheduled.

I was able to also get second opinion referrals which I’ll wait on for now.
Thanks so much for the support!
Fingers crossed...
 

Mojo333

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:hi:@Birdwing
Sounds like you are doing all you can, including the specialist.

:praying: Added prayers.
 
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