1. < Joint Replacements

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

Posted by mrfish @mrfish, Nov 3, 2017

About 11 months ago, I had a total (right) hip replacement. No injuries led me to the decision to undergo that, just arthritic pain that had become gradually worse over 20+ years. Several months after the surgery, I developed an infection at the joint but it took a while to get that properly diagnosed. So, in less than two weeks I'll undergo the first of the two surgeries/stages to elminate the infection and replace the implant. I've read that the antibiotic spacer I'll have for 2-3 months will provide "limited mobility" but I'm struggling with what that really means. I'd apperciate any further information I can get from others who have undergone this same procedure. I expect 2-3 days of hospitalization following the surgery and IV antibiotic infusions several times a day (self-administered).

I'm an (otherwise) healthy 48yo male and I was very happy with how quickly I was able to bounce back from the original hip replacment. I'm sure there will be a week or so of recovery from the surgery itself -- but after that am I going to be mostly home-bound for the interim, or is driving myself and working in an office setting (on a limited schedule) a possibility? What other aspects are there to living for a with a hip spacer?

Thank you in advance for your help on this,
Art in Alaska.

Interested in more discussions like this? Go to the Joint Replacements Support Group.

izabel | @izabel | May 13, 2019
In reply to @linjane "Hi All thought I had posted an update to my current issues, but cant find it..." + (show)
@linjane

Hi All thought I had posted an update to my current issues, but cant find it so will do again.

After my hip was replaced last October my surgeon had to fit a plate and wires to fix a non healing fracture, caused by a very difficult removal of my hip last June.

Just before I went on holiday end of March I had a very violent movement, like I'd been shot in my leg whilst bending forward. As I could walk I deemed my holiday was much needed and therefore more important!!! Unfortunatly a week into my holiday I suddenly got extreme pain and was unable to weight bear. This settled but then became an intermittent problem. Xray on return to the UK showed that I had snapped the wires securing the plate which was now moving around causing problems with my sciatic nerve.

The wires had snapped and the plate had smashed my femur on rebound after breaking, resulting in a periprosthetic fracture. So I returned to theatre my 7th OP in 2 1/2 years, 5 in 2 years on that hip! The plate and wires removed and the # repaired with tape.

I'm pleased to say that after 48 hours I was walking better that I've walked in years with very little pain, I also feel taller!!!!! Cultures were taken at the op and I havn't heard yet about the prolonged culture but at 48 hours were negative. Hopefully it is all finally behind me. Clips out tomorrow and seeing consultant on Wednesday. Wish me luck as we all know you get very apprehensive beforehand.

Lin

Jump to this post

@linjane My dear Lin, my thoughts are with you and am sending positive vibes for culture results and consultation. You really must stop this op nonsense ... it's not good for the mental wellbeing! I will catch up later in the week when my visitor has gone home.

Myself, I am progressing well. Thankfully the foot is returning to normal and I attempt to make one new progress per day ... what will that be today I wonder???? I continue to pedal 20 minutes daily. I have been out to lunch four times in 8 days which is amazing getting out in the sunshine for hours absorbing that Vitamin D but sitting in the shade. I have pottered in the garden weeding the pots and planters sitting in the wheelchair.

The strong medications/antibiotics I have been on have caused dental problems, teeth discolouration and teeth breaking off. I have an appointment next Monday with a Dental Surgeon to remove some roots ... not looking forward to that. This dental clinic is part of the private hospital I was in so has all my history.

Wishing everyone well and hope you are getting some sunshine wherever you are.

Izabel xx

REPLY
Debbra Williams, Alumna Mentor | @debbraw | May 13, 2019
In reply to @linjane "Hi All thought I had posted an update to my current issues, but cant find it..." + (show)
@linjane

Hi All thought I had posted an update to my current issues, but cant find it so will do again.

After my hip was replaced last October my surgeon had to fit a plate and wires to fix a non healing fracture, caused by a very difficult removal of my hip last June.

Just before I went on holiday end of March I had a very violent movement, like I'd been shot in my leg whilst bending forward. As I could walk I deemed my holiday was much needed and therefore more important!!! Unfortunatly a week into my holiday I suddenly got extreme pain and was unable to weight bear. This settled but then became an intermittent problem. Xray on return to the UK showed that I had snapped the wires securing the plate which was now moving around causing problems with my sciatic nerve.

The wires had snapped and the plate had smashed my femur on rebound after breaking, resulting in a periprosthetic fracture. So I returned to theatre my 7th OP in 2 1/2 years, 5 in 2 years on that hip! The plate and wires removed and the # repaired with tape.

I'm pleased to say that after 48 hours I was walking better that I've walked in years with very little pain, I also feel taller!!!!! Cultures were taken at the op and I havn't heard yet about the prolonged culture but at 48 hours were negative. Hopefully it is all finally behind me. Clips out tomorrow and seeing consultant on Wednesday. Wish me luck as we all know you get very apprehensive beforehand.

Lin

Jump to this post

@linjane - Wow. I am so sorry for what you have been through with that hip. It must have been totally frightening to find that the wires had snapped on the plate. But I'm happy to hear your good outcome so far. I'm wishing you the best on getting the clips out and seeing the consultant. Also, hoping with you that the cultures all stay good! Please let us know how things go on Wednesday.

REPLY
briank1958 | @briank1958 | May 31, 2019

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!

REPLY
5 replies
Debbra Williams, Alumna Mentor | @debbraw | May 31, 2019
In reply to @briank1958 "My situation is not unlike many of those that I have read in this forum. With..." + (show)
@briank1958

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!

Jump to this post

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.

REPLY
1 reply
linjane | @linjane | Jun 1, 2019
In reply to @briank1958 "My situation is not unlike many of those that I have read in this forum. With..." + (show)
@briank1958

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!

Jump to this post

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

REPLY
briank1958 | @briank1958 | Jun 3, 2019

Hi Lin, thank you very much for your reply. My surgeon also refused to do the 1-stage procedure stating that because of my MRSA, and not necessarily the 2 staph bacteria's I also have; he thought this was the best way to go. But also, my surgeon admitted to never have done the 1 stage procedure before. He's only done the 2-stage despite hearing great things about the 1-stage from other surgeons and seeing posted results on the internet where they have done many studies comparing the 2. I currently have an appt. with another Dr. in his group who is 60 years old and has much more experience and possibly has performed the 1-stage procedure. I can't imagine this is going to be any tougher than the full knee replacement I had 13 years ago. To me, it was the worst operation I have had. Many thanks for your input. Be and stay well and healthy. Brian

REPLY
briank1958 | @briank1958 | Jun 3, 2019
In reply to @debbraw "Hi @briank1958 - Welcome to Connect! I'm so glad you posted. I wish so much I..." + (show)
@debbraw

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.

Jump to this post

Debra, Many thanks for the reply and positive comments. As you can imagine I have the greatest respect for anyone who has gone through a total knee replacement! I had my rt. knee done 13 years ago (to date the toughest surgery I have ever had) and at that time I was told I was down to 20% of my cartilage in my left knee. My surgeon for the knee, Dr. Colisemo of UC Orthopedics here in Cincinnati, was theorizing after the surgery which knee would give out or need replacing first (he was telling me this as knee replacements typically have just a 20 year life span). My left knee has been a little achy over the last couple of years but it is nothing like the rt. when I was "bone on bone". As time has moved on I find myself questioning more and more. In my more youthful days when I never questioned much of anything and played just about every contact sport you can imagine it never occurred to me what the long-term effects to my body might I be causing. Now at 61 I look back at those 20 or so years and think just how "young, dumb, naïve and stupid" I was. As I have plenty of time to sit around now and ponder I find myself being much more "proactive" as you put it. As I consider myself maybe a little more than just average in intelligence, which might not have always been the case, I have a great thirst for knowledge, especially when it comes to what is going to happen to me. As far as hobbies or interests are concerned I'm afraid quilting really isn't my thing right now but in my pre-teenage years I will admit to making potholders and peddling them to relatives and around the neighborhood! LOL I haven't mentioned that I also have moderate to severe RA on top of everything else but right now Humira is holding that affliction at bay. The Humira is a double-edge sword. On one hand it arrests the progression of the RA but on the other hand it might have had an influence on my body not fighting the staph bacteria which I have succumbed! Back in February I bought into a hobby I was all set to involve myself in. Of course it has now been put on hold as I can't go walking through the woods and fields swinging a metal detector back forth and go digging up the riches it detects. Some day I will achieve that goal! I was brought up to never, ever give up! I do enjoy watching the current champion on Jeopardy ($2,500,00 and some change) and anything about Ancient Aliens or about UFO's as I am a believer (much to my wife's chagrin)! I guess I'm secretly hoping that alien technology will magically fix all the things wrong with my body that our current mankind technology can't figure out!!! Thanks for asking.

REPLY
1 reply
Debbra Williams, Alumna Mentor | @debbraw | Jun 4, 2019
In reply to @briank1958 "Debra, Many thanks for the reply and positive comments. As you can imagine I have the..." + (show)
@briank1958

Debra, Many thanks for the reply and positive comments. As you can imagine I have the greatest respect for anyone who has gone through a total knee replacement! I had my rt. knee done 13 years ago (to date the toughest surgery I have ever had) and at that time I was told I was down to 20% of my cartilage in my left knee. My surgeon for the knee, Dr. Colisemo of UC Orthopedics here in Cincinnati, was theorizing after the surgery which knee would give out or need replacing first (he was telling me this as knee replacements typically have just a 20 year life span). My left knee has been a little achy over the last couple of years but it is nothing like the rt. when I was "bone on bone". As time has moved on I find myself questioning more and more. In my more youthful days when I never questioned much of anything and played just about every contact sport you can imagine it never occurred to me what the long-term effects to my body might I be causing. Now at 61 I look back at those 20 or so years and think just how "young, dumb, naïve and stupid" I was. As I have plenty of time to sit around now and ponder I find myself being much more "proactive" as you put it. As I consider myself maybe a little more than just average in intelligence, which might not have always been the case, I have a great thirst for knowledge, especially when it comes to what is going to happen to me. As far as hobbies or interests are concerned I'm afraid quilting really isn't my thing right now but in my pre-teenage years I will admit to making potholders and peddling them to relatives and around the neighborhood! LOL I haven't mentioned that I also have moderate to severe RA on top of everything else but right now Humira is holding that affliction at bay. The Humira is a double-edge sword. On one hand it arrests the progression of the RA but on the other hand it might have had an influence on my body not fighting the staph bacteria which I have succumbed! Back in February I bought into a hobby I was all set to involve myself in. Of course it has now been put on hold as I can't go walking through the woods and fields swinging a metal detector back forth and go digging up the riches it detects. Some day I will achieve that goal! I was brought up to never, ever give up! I do enjoy watching the current champion on Jeopardy ($2,500,00 and some change) and anything about Ancient Aliens or about UFO's as I am a believer (much to my wife's chagrin)! I guess I'm secretly hoping that alien technology will magically fix all the things wrong with my body that our current mankind technology can't figure out!!! Thanks for asking.

Jump to this post

Hey @briank1958 - I like your TV choices and your confidence in alien technology. I could use some advances myself from time to time! I'm wishing you the best when you talk to the other, older doctor in the group. When is your appointment? Will you keep us posted?

REPLY
briank1958 | @briank1958 | Jun 5, 2019

That other appointment with the head of the department, a 60 year old surgeon, is on 6/26. Both surgeons are extremely qualified but the older gentlemen has been around the block a few more times. As I am trying to gain a little more perspective on both flavors of the surgery I guess my end goal is to feel better about the 2-stage process and get a little more than a hint of living with the spacer for 4 to 8 weeks. Quite frankly, reading everyone's posts is a little scary. Not from the idea of living with the spacer but that, in their case, the infection keeps coming back. Yikes!!! From what I have read there is a 15% chance that will happen, even under the best of circumstances. Many thanks for all your kind words and the huge amount of confidence you have thrusted upon me. Of course I will keep you posted! Brian

REPLY
2 replies
linjane | @linjane | Jun 5, 2019
In reply to @briank1958 "That other appointment with the head of the department, a 60 year old surgeon, is on..." + (show)
@briank1958

That other appointment with the head of the department, a 60 year old surgeon, is on 6/26. Both surgeons are extremely qualified but the older gentlemen has been around the block a few more times. As I am trying to gain a little more perspective on both flavors of the surgery I guess my end goal is to feel better about the 2-stage process and get a little more than a hint of living with the spacer for 4 to 8 weeks. Quite frankly, reading everyone's posts is a little scary. Not from the idea of living with the spacer but that, in their case, the infection keeps coming back. Yikes!!! From what I have read there is a 15% chance that will happen, even under the best of circumstances. Many thanks for all your kind words and the huge amount of confidence you have thrusted upon me. Of course I will keep you posted! Brian

Jump to this post

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. 85% is good odds be positive Brian and good luck hopefully it will be the same for you.
Lin x

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