What kind of mobility can I expect with an antibiotic spacer in my hip

Here's my most recent update: I'm scheduled to have my next (and hopefully last) hip surgery on Wednesday, Feb 14, when they plan to remove the antibiotic spacer and install fully-functional new hardware -- just about three months since the spacer was installed.

I had to undergo two hip aspirations a few weeks ago (where a loooong needle is used to draw fluid from the joint). During the first one, they drew some fluid but someone messed up and they weren't able to culture the sample (it was mistakenly sent for processing to a lab out of state and too much time had passed). So, they scheduled a not-very-happy me for a second aspiration but unfortunately weren't able to get any fluid that time.

According to the docs, my blood work looks good. It is frustrating to me that throughout all of this there were no successful cultures to figure out what kind of microbe was causing my infection, nor (most recently) to confirm that the infection is truly cleared out. There are only the indirect indicators from blood & lab work. My ortho tells me that during this week's surgery, samples will be taken -- and processed -- while I'm still on the operating table. If those indicate that there is still an infection, they will abort the installation of working hardware and instead re-implant another antibiotic spacer. However, he said that they have never had that occur. I guess that gives me some comfort?

But (beside having this blasted spacer in my hip and its' pain & limitations) I feel good and I have no reason to believe the infection isn't gone. I'm looking forward to this next surgery and the recovery that will come after that. I'm looking forward to putting the last six (or so) challenging months behind me -- I just can't shake this fear in the back of my mind of possibly having to go through this all again should an infection reoccur.

I'm not driving myself, but for these last few weeks, I have been going in to work at the office for three days a week (M,W,F) and using crutches. While seated at my desk, I need to get up and move around a little bit every 30 minutes or so. If I go longer, it's much more painful and harder to get things worked out and moving again. Fortunately, I have a motorized stand-up desk that I can put up or down and I'll also sometimes spend a little time standing and shifting some weight between both legs. I still cannot bear much more than 50% normal weight on my right leg.

At home, I prefer to use the walker, it's just so much more convenient. The extra activity certainly comes with additional pain. Right now, after being at work all day today, I my visibly swollen right leg elevated and an ice pack on my hip.

I'll post another update next week after my surgery. Fingers crossed.

Here's my most recent update: I'm scheduled to have my next (and hopefully last) hip surgery on Wednesday, Feb 14, when they plan to remove the antibiotic spacer and install fully-functional new hardware -- just about three months since the spacer was installed.

I had to undergo two hip aspirations a few weeks ago (where a loooong needle is used to draw fluid from the joint). During the first one, they drew some fluid but someone messed up and they weren't able to culture the sample (it was mistakenly sent for processing to a lab out of state and too much time had passed). So, they scheduled a not-very-happy me for a second aspiration but unfortunately weren't able to get any fluid that time.

According to the docs, my blood work looks good. It is frustrating to me that throughout all of this there were no successful cultures to figure out what kind of microbe was causing my infection, nor (most recently) to confirm that the infection is truly cleared out. There are only the indirect indicators from blood & lab work. My ortho tells me that during this week's surgery, samples will be taken -- and processed -- while I'm still on the operating table. If those indicate that there is still an infection, they will abort the installation of working hardware and instead re-implant another antibiotic spacer. However, he said that they have never had that occur. I guess that gives me some comfort?

But (beside having this blasted spacer in my hip and its' pain & limitations) I feel good and I have no reason to believe the infection isn't gone. I'm looking forward to this next surgery and the recovery that will come after that. I'm looking forward to putting the last six (or so) challenging months behind me -- I just can't shake this fear in the back of my mind of possibly having to go through this all again should an infection reoccur.

I'm not driving myself, but for these last few weeks, I have been going in to work at the office for three days a week (M,W,F) and using crutches. While seated at my desk, I need to get up and move around a little bit every 30 minutes or so. If I go longer, it's much more painful and harder to get things worked out and moving again. Fortunately, I have a motorized stand-up desk that I can put up or down and I'll also sometimes spend a little time standing and shifting some weight between both legs. I still cannot bear much more than 50% normal weight on my right leg.

At home, I prefer to use the walker, it's just so much more convenient. The extra activity certainly comes with additional pain. Right now, after being at work all day today, I my visibly swollen right leg elevated and an ice pack on my hip.

I'll post another update next week after my surgery. Fingers crossed.

Here's my most recent update: I'm scheduled to have my next (and hopefully last) hip surgery on Wednesday, Feb 14, when they plan to remove the antibiotic spacer and install fully-functional new hardware -- just about three months since the spacer was installed.

I had to undergo two hip aspirations a few weeks ago (where a loooong needle is used to draw fluid from the joint). During the first one, they drew some fluid but someone messed up and they weren't able to culture the sample (it was mistakenly sent for processing to a lab out of state and too much time had passed). So, they scheduled a not-very-happy me for a second aspiration but unfortunately weren't able to get any fluid that time.

According to the docs, my blood work looks good. It is frustrating to me that throughout all of this there were no successful cultures to figure out what kind of microbe was causing my infection, nor (most recently) to confirm that the infection is truly cleared out. There are only the indirect indicators from blood & lab work. My ortho tells me that during this week's surgery, samples will be taken -- and processed -- while I'm still on the operating table. If those indicate that there is still an infection, they will abort the installation of working hardware and instead re-implant another antibiotic spacer. However, he said that they have never had that occur. I guess that gives me some comfort?

But (beside having this blasted spacer in my hip and its' pain & limitations) I feel good and I have no reason to believe the infection isn't gone. I'm looking forward to this next surgery and the recovery that will come after that. I'm looking forward to putting the last six (or so) challenging months behind me -- I just can't shake this fear in the back of my mind of possibly having to go through this all again should an infection reoccur.

I'm not driving myself, but for these last few weeks, I have been going in to work at the office for three days a week (M,W,F) and using crutches. While seated at my desk, I need to get up and move around a little bit every 30 minutes or so. If I go longer, it's much more painful and harder to get things worked out and moving again. Fortunately, I have a motorized stand-up desk that I can put up or down and I'll also sometimes spend a little time standing and shifting some weight between both legs. I still cannot bear much more than 50% normal weight on my right leg.

At home, I prefer to use the walker, it's just so much more convenient. The extra activity certainly comes with additional pain. Right now, after being at work all day today, I my visibly swollen right leg elevated and an ice pack on my hip.

I'll post another update next week after my surgery. Fingers crossed.

Thanks for your well-wishes, it really meant a lot to me as I headed into this last surgery, and my anxiety was running high.

Things are going very well for me so far. I spent two nights in the hospital after my surgery on Feb 14. My surgeon said everything looked great while he was "in there" during the surgery and the rapid cultures they took during the operation showed no sign of infection. They still administered a few precautionary doses of IV antibiotic while I was in the hospital, and my ortho said they also sprinkled in some kind of slow-release/dissoving antibiotic into the joint area before closing things up.

The biggest change for me is that the joint pain of the 3 months with the spacer (the popping and grinding) is completely and immediately gone. Of course, I have some pain from the incision but that's secondary to the considerable weakness and loss of flexibility that's due to the past three months of very limited mobility. I started physical therapy this week, and will go out for that 3x a week for up to 7 weeks. I've already noticed improvement from the home exercises and the PT sessions.

I'm still using crutches or my walker, but I've also been trying to spend more time playing around with a cane over the last few days -- but, I have a bit more strength I need to regain in my right leg before I feel I can switch completely over to the cane (maybe one more week). I have no restriction on how much weight I can bear on my right leg, but it's definitely not back to "normal" yet. I can stand normally with weight ditributed evenly between left and right feet (without any pain), and can shift some more weight over to my right but I can't fully support my weight on my right leg alone as you would while trying to walk normally. It's really not an issue of pain so much as strength and not feeling stable/safe quite yet.

@janelaine and @froggy1, thank you (and others) for your support. Janelaine, I'm hoping your infection clears soon and you might be able to get your new hip. I'm so sorry that it seems to be taking so much longer for a fungal infection to clear out. Froggy1, its quite flattering to be called brave by you. After getting to know more about you and your long road to where you are today, you are truly the brave one here (but thank you). And, to be able to find humor among the challenges is a testament to your strong character and willpower. I can only begin to understand your frustration and possible disillusionment with what medicine has been able to offer you so far. But I want to sincerely say "hang in there", perhaps new technology or procedures might give you a shot at something closer to normal.

My next challenge is going to be getting off the narcotics. My pain levels are already way, way down--I could probably manage with ibuprofen now--and I've begun to significantly reduce the dose and frequency of my tramadol and oxycodone...but I've already noticed the beginning of withdrawal symptoms from just this. I've done some reading on the topic and asked my ortho for advice or possible medical help, and was very disappointed with his response. He did say I shoud talk with my normal doctor; perhaps that's the correct protocol. So, I do plan to speak with my normal doc this week and see what she may have to suggest and if we can develop a plan/schedule---but I don't think she has much experience with detox treatment (maybe I'm wrong). But again, since the orthos are the ones who prescribe so much of the pain meds, you'd think they'd devote the effort to help you get off of them. Since I'm alrerady back at work full-time, I probably need to find a 3 or 4 day weekend to carry out the initial cut-off to deal with the worst of it. I do have experience with opioid withdrawal after my first hip replacement, but that was only after 4-5 weeks of pain pills, while this time it's been about 4 months of the stuff. I remember sleeplessness was a huge problem last time so I was going to inquire about short-term sleeping medication, and I've also been reading a little about buprenorphine as something that might help lessen the withdrawal symptoms. Recreational marijuana is also legal up here in Alaska and I've had some experience with that, but that was mostly in college a few decades ago. Maybe there's no real medical way to make it meaningfully easier and I'll just need to tough it out -- which I'm fully prepared to do in the very near furure. But, any advice would be appreciated.

Moderators, is there a discussion thread on the topic here on connect.mayoclinic?

Thanks for your well-wishes, it really meant a lot to me as I headed into this last surgery, and my anxiety was running high.

Things are going very well for me so far. I spent two nights in the hospital after my surgery on Feb 14. My surgeon said everything looked great while he was "in there" during the surgery and the rapid cultures they took during the operation showed no sign of infection. They still administered a few precautionary doses of IV antibiotic while I was in the hospital, and my ortho said they also sprinkled in some kind of slow-release/dissoving antibiotic into the joint area before closing things up.

The biggest change for me is that the joint pain of the 3 months with the spacer (the popping and grinding) is completely and immediately gone. Of course, I have some pain from the incision but that's secondary to the considerable weakness and loss of flexibility that's due to the past three months of very limited mobility. I started physical therapy this week, and will go out for that 3x a week for up to 7 weeks. I've already noticed improvement from the home exercises and the PT sessions.

I'm still using crutches or my walker, but I've also been trying to spend more time playing around with a cane over the last few days -- but, I have a bit more strength I need to regain in my right leg before I feel I can switch completely over to the cane (maybe one more week). I have no restriction on how much weight I can bear on my right leg, but it's definitely not back to "normal" yet. I can stand normally with weight ditributed evenly between left and right feet (without any pain), and can shift some more weight over to my right but I can't fully support my weight on my right leg alone as you would while trying to walk normally. It's really not an issue of pain so much as strength and not feeling stable/safe quite yet.

@janelaine and @froggy1, thank you (and others) for your support. Janelaine, I'm hoping your infection clears soon and you might be able to get your new hip. I'm so sorry that it seems to be taking so much longer for a fungal infection to clear out. Froggy1, its quite flattering to be called brave by you. After getting to know more about you and your long road to where you are today, you are truly the brave one here (but thank you). And, to be able to find humor among the challenges is a testament to your strong character and willpower. I can only begin to understand your frustration and possible disillusionment with what medicine has been able to offer you so far. But I want to sincerely say "hang in there", perhaps new technology or procedures might give you a shot at something closer to normal.

My next challenge is going to be getting off the narcotics. My pain levels are already way, way down--I could probably manage with ibuprofen now--and I've begun to significantly reduce the dose and frequency of my tramadol and oxycodone...but I've already noticed the beginning of withdrawal symptoms from just this. I've done some reading on the topic and asked my ortho for advice or possible medical help, and was very disappointed with his response. He did say I shoud talk with my normal doctor; perhaps that's the correct protocol. So, I do plan to speak with my normal doc this week and see what she may have to suggest and if we can develop a plan/schedule---but I don't think she has much experience with detox treatment (maybe I'm wrong). But again, since the orthos are the ones who prescribe so much of the pain meds, you'd think they'd devote the effort to help you get off of them. Since I'm alrerady back at work full-time, I probably need to find a 3 or 4 day weekend to carry out the initial cut-off to deal with the worst of it. I do have experience with opioid withdrawal after my first hip replacement, but that was only after 4-5 weeks of pain pills, while this time it's been about 4 months of the stuff. I remember sleeplessness was a huge problem last time so I was going to inquire about short-term sleeping medication, and I've also been reading a little about buprenorphine as something that might help lessen the withdrawal symptoms. Recreational marijuana is also legal up here in Alaska and I've had some experience with that, but that was mostly in college a few decades ago. Maybe there's no real medical way to make it meaningfully easier and I'll just need to tough it out -- which I'm fully prepared to do in the very near furure. But, any advice would be appreciated.

Moderators, is there a discussion thread on the topic here on connect.mayoclinic?

Thanks for your well-wishes, it really meant a lot to me as I headed into this last surgery, and my anxiety was running high.

Things are going very well for me so far. I spent two nights in the hospital after my surgery on Feb 14. My surgeon said everything looked great while he was "in there" during the surgery and the rapid cultures they took during the operation showed no sign of infection. They still administered a few precautionary doses of IV antibiotic while I was in the hospital, and my ortho said they also sprinkled in some kind of slow-release/dissoving antibiotic into the joint area before closing things up.

The biggest change for me is that the joint pain of the 3 months with the spacer (the popping and grinding) is completely and immediately gone. Of course, I have some pain from the incision but that's secondary to the considerable weakness and loss of flexibility that's due to the past three months of very limited mobility. I started physical therapy this week, and will go out for that 3x a week for up to 7 weeks. I've already noticed improvement from the home exercises and the PT sessions.

I'm still using crutches or my walker, but I've also been trying to spend more time playing around with a cane over the last few days -- but, I have a bit more strength I need to regain in my right leg before I feel I can switch completely over to the cane (maybe one more week). I have no restriction on how much weight I can bear on my right leg, but it's definitely not back to "normal" yet. I can stand normally with weight ditributed evenly between left and right feet (without any pain), and can shift some more weight over to my right but I can't fully support my weight on my right leg alone as you would while trying to walk normally. It's really not an issue of pain so much as strength and not feeling stable/safe quite yet.

@janelaine and @froggy1, thank you (and others) for your support. Janelaine, I'm hoping your infection clears soon and you might be able to get your new hip. I'm so sorry that it seems to be taking so much longer for a fungal infection to clear out. Froggy1, its quite flattering to be called brave by you. After getting to know more about you and your long road to where you are today, you are truly the brave one here (but thank you). And, to be able to find humor among the challenges is a testament to your strong character and willpower. I can only begin to understand your frustration and possible disillusionment with what medicine has been able to offer you so far. But I want to sincerely say "hang in there", perhaps new technology or procedures might give you a shot at something closer to normal.

My next challenge is going to be getting off the narcotics. My pain levels are already way, way down--I could probably manage with ibuprofen now--and I've begun to significantly reduce the dose and frequency of my tramadol and oxycodone...but I've already noticed the beginning of withdrawal symptoms from just this. I've done some reading on the topic and asked my ortho for advice or possible medical help, and was very disappointed with his response. He did say I shoud talk with my normal doctor; perhaps that's the correct protocol. So, I do plan to speak with my normal doc this week and see what she may have to suggest and if we can develop a plan/schedule---but I don't think she has much experience with detox treatment (maybe I'm wrong). But again, since the orthos are the ones who prescribe so much of the pain meds, you'd think they'd devote the effort to help you get off of them. Since I'm alrerady back at work full-time, I probably need to find a 3 or 4 day weekend to carry out the initial cut-off to deal with the worst of it. I do have experience with opioid withdrawal after my first hip replacement, but that was only after 4-5 weeks of pain pills, while this time it's been about 4 months of the stuff. I remember sleeplessness was a huge problem last time so I was going to inquire about short-term sleeping medication, and I've also been reading a little about buprenorphine as something that might help lessen the withdrawal symptoms. Recreational marijuana is also legal up here in Alaska and I've had some experience with that, but that was mostly in college a few decades ago. Maybe there's no real medical way to make it meaningfully easier and I'll just need to tough it out -- which I'm fully prepared to do in the very near furure. But, any advice would be appreciated.

Moderators, is there a discussion thread on the topic here on connect.mayoclinic?

Okay, here's another update. It's a bit after the fact, bear with me.

So, to recap, on Feb 14 I finally got the antibiotic spacer removed after living with it for 3 months and functional hip hardware re-implanted Things were going great…I was back in physical therapy and regaining strength and mobility quickly. That’s about where we left off last time.

The dressing over the incision was hooked up to a small wound vac that I was supposed to wear for one week after being released from the hospital. Almost nothing drained from the incision into the wound vac until the day before it was supposed to come off. Then a bunch of “old” blood drained out and nearly filled the vac’s reservoir overnight. I called my ortho and they got me in right away…the drainage had stopped by then and he figured it was just a clot that had liquefied and drained. He considered putting another wound vac on with a new dressing, which I wasn’t very happy about. I was trying to get back to work and that’s not very easy if you have to drag around a bunch of post-surgical devices with their associated tubes and hoses (and this was also on a Friday afternoon and getting insurance approvals for another device wasn’t happening quickly on a Friday afternoon). Since the drainage had stopped, they re-dressed it with a bunch of gauze and tegaderm and I was to let them know if any drainage resumed.

Things went well thru the weekend until the following Tuesday (3/27) when, after a morning PT session, a bunch of new drainage occurred. Not blood this time, but a tannish fluid…and a quite a it of it, the gauze became saturated. I called and then texted a picture of the gauze to my ortho’s PA. They called me back right away, asked when I last ate anything and wanted me to come in for a “wash-out” surgery in 3 hours. Calling that a shock doesn’t really describe it…I guess the drainages I’d had were a clear sign something wasn’t right, but it’s hard to mentally prepare yourself for surgery and all that entails on such short notice.

So, I go in and do the wash-out that day and was put on IV antibiotics. I expected to stay in the hospital for another 2-3 days after surgery while they fine-tuned the antibiotics dosage. Two days later, my ortho tells me a culture they took during the wash-out was growing something but it probably would take another day until it grew enough for them to identify it. Throughout all the previous tests and cultures, they had never been able to successfully culture anything from my hip, so it was kind of a positive that they might finally know what, specifically, had been causing me all these problems.
The next evening, the ortho and my infectious disease specialist come into my hospital room to let me know the culture produced staph (not mrsa) and they were recommending yet another surgery. He said the chances success from the wash-out surgery I had just gone through and antibiotics was somewhere around 50-60%...if I agreed to one more surgery to swap out the hardware and continued antibiotics, we were told the chances of success went up to nearly 90%. I was really weary of another surgery (one week exactly after the wash-out), but the increased chances for success were pretty striking, so with my wife we decided to follow their recommendation. This was going be the 5th overall surgery on my right hip, and it would be surgery #4 since just last November, and a 3rd surgery in the span of just under 3 weeks. They made me stay in the hospital thru the weekend until the next surgery. That was a tough time; there was a lot of frustration, anger and tears.

Tomorrow marks 2 weeks since the most recent surgery (which was on 3/6). I’ve got a PICC line (again), giving myself cefazolin infusions three times a day, and taking rifampin capsules twice a day.

I’ve re-started PT once again, and I went back at work last week (6 days after surgery). It’s frustrating to have put in so much work to regain mobility just to have more surgeries kick me back down again. No more surgeries scheduled as of now; just waiting to see how this course of antibiotics goes. I need to talk with my infectious disease specialist again because I want to better understand his plans…what is he looking for in my weekly bloodwork? When does he anticipate discontinuing the antibiotics? What’s the plan after ending the antibiotics--hopefully not just “wait and see". What more can they/we do to make surer this treatment actually works?