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@jbro

I'm catching up on reading all the postings in this discussion. I hope you are still free of infection since your false alarm episode that occurred approximately 3 months after your last IV antibiotics treatment. Today is the first day of my 3-month observation period in which I need to be free of infection for the doctors to say I am clear of an MRSA infection of the tissue near the incision (that hopefully never attached to my prosthesis) following my September THR. Yesterday I finished my 6 weeks of daily antibiotic infusions, which began with my October debridement surgery.
If my infection returns, then I will have to travel a path similar to yours, but my surgeon mentioned 2-stage rather than 1-stage for a 2nd THR. Apparently your surgeon gave you the option for 1-stage. Can I ask you to comment on that again?
Also, did the subject of a "salvage" procedure (resection arthroplasty, or "Girdlestone") ever come up as the most successful way to eradicate infection, albeit with functional outcomes that do not compare well with a successful THR?
Thank you for your time.

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Replies to "I'm catching up on reading all the postings in this discussion. I hope you are still..."

Hi Jbro. My debridement was Nov 2017 with 6 weeks of oral antibiotics. However within 2 weeks of stopping I was very flulike with all the red flags for prosthesis infection. The only option for me in the UK was 2 stage hip replacement with the antibiotic spacer. I had this in June ( things move slowly with the nhs) I beleave this is gold standard treatment. Don't think I would have been happy with girdlestone surely that's last resort. Seen my consultant today all is going well and can start weight bearing in 2 weeks. We have also been given the go ahead to book a holiday, very much needed. I hope your debridement is successful and you don't have to go down this path. If you do it's just a case of putting your life on hold and getting through it. Good luck.
Lin

@jbro sorry for not replying sooner to your questions. I'm still doing well, even after the false alarm.
When my infection first presented (after the first THR), I first became suspicious something was wrong because I began to lose strength and range of motion (things I had regained through PT after the THR). The first infection wasn’t clinically obvious until it actually showed as large abcess coming out through the surgical scar but that was probably another 6 weeks past what I felt were the initial concerns I had relayed to my Ortho and his PA.
Through all of this, I had often asked about more rigorous testing. But, to put it into perspective, my infectious disease doc (who I really trust) helped me understand it from his perspective: blood work is only indicative of "something:" going on, and it could be anything from a cold/flu or a stubbed toe to an infection at the joint. He was very hesitant to order a joint aspiration because there’s a risk of actually introducing an infection when it may not have otherwise been present.
I think the biggest problem with my infection was the fact that they weren’t able to get a positive culture for anything until after the 2-stage process. Vancomycin is a powerful and broad spectrum antibiotic and while it effectively suppressed my infection, it apparently wasn’t quite right to eliminate what I had. I think they only offered the single-stage revisions after that knowing that the infection was “almost” gone, rather than something that had been there for a while and was most likely attached to the hardware.
My infectious disease doc would never give me a good answer when I asked him about how long until I could relax. “The longer, the better” is all I got. But I think once you make it 3-6 months out, you’ve made it past the infection you had. However, with this hardware, the risk of infection from a new source is always a possibility. Heck, dental cleanings introduce a potential risk of infection to our THR’s but there doesn’t seem to be anything conclusive in the literature about whether those should be treated with antibiotics as a preventative measure (from what I’ve seen).
Wishing you the very best,
Art.