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What kind of mobility can I expect with an antibiotic spacer in my hip
Joint Replacements | Last Active: Nov 27 10:18am | Replies (283)Comment receiving replies
My situation is not unlike many of those that I have read in this forum. With that being said I am looking for some specific answers that I have yet to receive from my surgeon. First, my situation is that I have gone through 11 surgeries. On the orthopedic side I have had a knee replaced, both hips replaced and a joint on a big toe replaced. All of the replacements are made of surgical grade titanium. In addition I've had 4 spinal fusions so I am fused from the L1 thru the L5. My problems started in the spring of 2018 with 2 staph bacteria's and MRSA. It is not known at this time where I picked up the bacteria. They tell me it could have laid dormant in my left hip since 2007 but this can't be verified.
In the early part of last summer they put me in the hospital for a week and sent me home with a PICC line for another 6 weeks of antibiotics. Cultures showed everything was good by August 1st. By mid-October I became delusional, delirious and despondent (the 3 D's as I call them). They rechecked my blood with cultures and found massive amounts of staff and MRSA. They checked my hardware in my back and found it to be positive as well. My only option was to have all the hardware removed. I spent 2 months in the hospital and another 2 weeks in a rehab center. I came home right at Christmas this past year.
My rehab at home went well as I was relearning how to walk but by the end of February I started to get pains in my left hip. 2 doctors told me it was probably bursitis from all the PT I was doing. Wrong! My infectious disease doctor did more cultures and I had an aspiration done on the hip. By early April my back was now getting sore. What I have been told now is that my left prosthetic hip and my psoas muscles are now infected with the same bacteria as I had before. They say my only option is to have the left rip replaced and drains put in. The 1st surgeon I saw said he would only do a 2-stage replacement with a cement, antibiotic-laden spacer. The length of this spacer being in my hip is still not known. My surgeon won't even consider a 1-stage replacement because of the MRSA. The 1st of the stages is scheduled on July 11th. I do have an appt. with a much older, and hopefully more experienced surgeon from the same group towards the end of this month to get a second opinion to see if he might consider the less-invasion 1-stage replacement.
The questions I am putting out here are 1) Does anyone have any personal information on the success rate of the 1-stage replacement? Studies I've found on the internet show only a slightly less success rate for the 1-stage replacement. 2) I am obviously not new to surgeries but I am new to this 2-stage procedure. Just how bad is it? 3) Will I be able to get around the house on my own, I.E. going to the bathroom and going up stairs with the spacer in my hip?
My infectious disease Dr. says that the staph and MRSA bacteria that is in my body is a very mutated and antibiotic resistent strain and is going to be very hard to irradicate thoroughly and completely. He also says the likelihood of it ending up back in the same hip or any of the other 3 prostetic joints is not only possilbe but at this time is probable. This is despite the replacement of my left hip, being on Vancomycin both in the hosital and going home with a PICC line and even being on an oral antibiotic for the rest of my life. My problems with this are seemingly endless.
Hopefully someone can answer a few of my questions and can offer some pertinent advise. Many thanks to all who respond!
Replies to "My situation is not unlike many of those that I have read in this forum. With..."
Hi Briank. My name is Lin. I'm so sorry you are going through this too. I have had a staph infection on my hip replacement and underwent a 2 stage replacement. I can feel your frustration at having antibiotics only for the infection to return because the same happened to me.
My understanding of this type of infection is this can occur any time around the time of original surgery, or after dental work ie root canals or even other types of surgery. If bacteria gets in, the hardware is susceptible. Once bacteria gets onto the bio plates of the device no amount of antibiotics will cure this, only infection in the surrounding tissue will be treated. Once the antibiotics are stopped the bio plates will re-infect the bodies tissue. This is why they have to remove the prosthesis.
My surgeon wanted to do the 2 stage method with a hope he could eradicate the infection completly before he implanted the new one. I had read about the one stage but he wouldn't consider this feeling the 2 stage was gold standard.
I think mobility after is according to your surgeons preference. I was lucky I could 50% weight bear but it was a couple of months before I could climb stairs.following help from my physio.
I'm a year in (5/6/18) but now feeling very well, my blood work is good and I'm hopeful this will be the end. I hope you find the answers you want and wish you well.
Lin
Gosh, things have been busy since I last visited!
@briank1958 I am sorry to hear of your journey through this. I had MRSA then E-Coli. I understand MRSA lives on the skin and my Infectious Doctor told me E-Coli lives in everyone's stomach and tends to be attracted by 'interlopers' in the body, ie, protheses. I son't know about other infections ... and it seems neither to the specialists ... it is one of those mysteries!
I have no personal knowledge of 1 Stage Revision but I have read they are not as successful as 2 Stage. I believe this is because the body needs time following a debridement/washout before new hardware is put back in being treated with antibiotics.
I had a THR in December 2014 and a TKR in March 2018. When my Surgeon went in to do a hip revision in October 2018 infection was discovered. He debrided, implanted a Spacer and I was on antibiotics for nearly 5 months. I was on no weight bearing as I have Osteoporosis, Through all my problems I lost over 50lbs and was down to 112lbs with muscle atrophy. I had a 5cm/2in shortness of the leg and it was difficult even with a walker. In March just past I had my 2nd Stage Revision, a larger ball and a 30cm stem installed reducing the LLD. I was house/bedbound for 18 months and am now learning to walk again, migrating from walker to elbow crutches. Yesterday I received news my blood levels are within;limits and I don't have to see my Surgeon for three months ... unless I feel I need to.
The whole thing about this journey is to keep positive.
@skidly, wow you cram in a lot in a short period of time, don't you? I am not a medical expert ... but 8 ops, 5 replacements and 4 spacers in 18 months is mind boggling and it would seem to me that not enough time was given in between for the infections to clear your system so they promptly attached themselves to the new hardware. Just my opinion. After my Spacer was placed I had blood tests every two weeks till I was clear (from October to February) then I had to have two clear readings before Stage 2 would be done. What country are you in? I am in Portugal.
@linjane "My infection has returned (yet) since I've had my spacer. So far I'm in the 85%. The infections were before the 2 stage." ?????
Izabel
@briank1958, welcome. My 2-stage revision wasn't successful, but I think the main reason it failed was because they didn't have a positive culture to know, specifically, what kind of bug was causing the infection. My understanding is that 1-stage revisions and washouts are most successful if they catch the infection very early (my ortho was talking in terms of just a few days to a week as "early"). Another thing that I'd recommend if you go the 2-stage route is to try to keep the spacer in for as long as you can to increase your chances of success. I had mine in for three months and it was taken out just as soon as my blood numbers came down and the surgery could be scheduled. I think it might have been better to have more time with the numbers down and staying down before the 2nd stage. I was miserable with the spacer and couldn't wait to get it out and I let that override the recommendations of others to try to hang in there a little longer.
My mobility with the spacer was very limited. I could only get with a walker and stairs were a real challenge (but do-able). Showers needed a bench/chair and help. There is a tremendous amount of popping and grinding in the joint which is painful and unsettling in the beginning, but does improve somewhat. I was only able to sleep on my back (a reclining chair worked the best and was where I slept most of the time).
It wasn't until after my failed 2nd stage revision and then a wash-out that they finally were able to culture which strain of staph was causing my infection. I haven't been able to regain my full range of motion, but it's pretty close to full use of my hip (90%). I think all the scar tissue from the surgeries is what limits full flexibility.
It's been a year (today!) since I completed the last of my antibiotic meds. There were some real low lows along the way, but I'm feeling good.
Jan '22 I just found this with my registration to Mayo connect. Is this very old news and BrianK is now doing well? Can I ask - which MAYO was involved with these various MRSA compromised spinal fusion surgeries? I have very similar circumstances but want to know more before I write an epistle on the topic. NPB in NC
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Hi @briank1958 - Welcome to Connect! I'm so glad you posted. I wish so much I could help answer your questions but I've only had two knee replacements - which is plenty! I just can't imagine all you have been through with your extensive surgeries and MRSA. My heart is aching for you. I'm going to tag some people who I believe have had hip replacements in case they have some insight on your issues: @beatricefay, @mariemotte, @laura1956 and @scottb32. Meantime, from reading your description I am beyond impressed at how proactive you are being in managing your situation. Hopefully, we can get a conversation started here that might help answer some of your questions and give you some peace of mind. Can I ask if you are doing anything at all that is just fun or relaxing for you? I haven't been through what you have but sometimes when things get too hard, I just have to stop and do some quilting, or watch a movie or get acupuncture. I hope you have something that helps steady you.