Reconstruction for THR - Any Advice or Experiences to Share?

Posted by LA Hipster @lahipster, Jan 9, 2023

My trusted orthopedic surgeon humbly admitted he did not feel up to the task of performing my THR for the third time after an infection had him remove my first and second THRs. After a 3 month course of antibiotics (Zerbaxa) the infection has been eradicated, but my surgeon was afraid to remove my temporary spacer due to a fracture that happened somewhere along the way. In removing my last implant he told me quite a bit of bone stuck to it, compromising the bone density of my femur.

He recommended me to a surgeon outside of my HMO specializing in reconstruction and orthopedic oncology. I'll be seeing this specialist for a consultation and for what I hope will be another hip replacement. Has anyone ever had this type of procedure or have experience with specialists in orthopedic oncology and bone reconstruction for hip replacement? I would like to know what questions I should be asking and if I am eligible for a THR, what my results and recovery might look like.

Currently I'm 9 months in with the temporary spacer, and it's been painful and challenging. I can transfer to a commode and in and out of a car, but I need help getting in and out of bed. Fortunately at least some of my home is wheelchair accessible so I can be independent during the day. Many of you have experienced this and you know how one can get discouraged from this situation. I was fortunate enough to be able to take an early retirement and I'm hoping for the best to be able to walk and climb stairs again.

This forum has really been a game changer for me. It's so uplifting to hear of our experiences and tips and tricks for making the most of where we are!

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

@lahipster Hello, I've been looking through the hip replacement discussions here, to see if anyone else has gone forward with a new replacement after infection.

From reading your posts, it looks like you have participated in most of those related threads.

I am glad to see you are being referred to a specialist in reconstruction. My cousin has been through the process twice like you, but due to other medical issues will spend the rest of her life without a hip or a spacer.

Also, have you consulted with an infectious disease specialist who deals specifically with implant infections? It seems fact that you have been infected twice in the same joint would make most doctors reluctant to try again.

Have you considered a consult with Mayo, or another large ortho facility that uses a team approach to treating difficult and unusual situations?
Sue

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@sueinmn

@lahipster Hello, I've been looking through the hip replacement discussions here, to see if anyone else has gone forward with a new replacement after infection.

From reading your posts, it looks like you have participated in most of those related threads.

I am glad to see you are being referred to a specialist in reconstruction. My cousin has been through the process twice like you, but due to other medical issues will spend the rest of her life without a hip or a spacer.

Also, have you consulted with an infectious disease specialist who deals specifically with implant infections? It seems fact that you have been infected twice in the same joint would make most doctors reluctant to try again.

Have you considered a consult with Mayo, or another large ortho facility that uses a team approach to treating difficult and unusual situations?
Sue

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I had a consultation with a surgical team at Cedars-Sinai hospital here in Los Angeles, thanks to the hard work of my team at Kaiser Los Angeles who approved the procedure. The surgeon and the team I met at my visit are confident they can restore my femur and move forward with one of three procedures described to me, all of which seemed like great news. The surgeon's last words to me were "we're going to get you out of that wheelchair". At this point nothing encourages me more than to hear I'll be able to stand up and take some steps on my own.

Tomorrow I am going in for blood tests and a hip aspiration to to check for infection. Based on my prior experiences with infection, I haven't had any of the symptoms I had before and am hoping that my infection has been eradicated. If that's the case - surgery will move forward.

Just a heads up to anyone else with an HMO or insurance - stay active in the outside approval process. It seems like I made phone calls and sent emails daily between my HMO and the outside agency. The approval process takes time and my medical team wasn't always familiar with the process. I downloaded my medical record and had my diagnostic imaging sent to the new surgeon as soon as I could - that was a time saver. We've heard it before - be your own advocate. Everyone has been helpful along the way - the process just needs some pushing along. Stay tuned.

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I finally made it home after what became a nearly nine week stay at the hospital. Along the way another infection was averted, parts replaced and other non-joint related issues were found and some addressed.

I had a "clean out" along the way, and now I'm on Invanz for the next month. I haven't had PT outside the hospital yet, so I'm taking supervised walks around the house with my walker. There is hardly any pain, and my leg lengths seem perfectly even.

What I wasn't prepared for was how quickly I became deconditioned in the hospital. Fortunately being back home has done wonders. Nowhere to go but up from here.

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@lahipster

I finally made it home after what became a nearly nine week stay at the hospital. Along the way another infection was averted, parts replaced and other non-joint related issues were found and some addressed.

I had a "clean out" along the way, and now I'm on Invanz for the next month. I haven't had PT outside the hospital yet, so I'm taking supervised walks around the house with my walker. There is hardly any pain, and my leg lengths seem perfectly even.

What I wasn't prepared for was how quickly I became deconditioned in the hospital. Fortunately being back home has done wonders. Nowhere to go but up from here.

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Wow! You'll have to fill in some details here - I was wondering what you were up to. And yes, deconditioning is fast - glad you're on the way back. Take it slow, and share how you are doing please?
Sue

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@lahipster

I finally made it home after what became a nearly nine week stay at the hospital. Along the way another infection was averted, parts replaced and other non-joint related issues were found and some addressed.

I had a "clean out" along the way, and now I'm on Invanz for the next month. I haven't had PT outside the hospital yet, so I'm taking supervised walks around the house with my walker. There is hardly any pain, and my leg lengths seem perfectly even.

What I wasn't prepared for was how quickly I became deconditioned in the hospital. Fortunately being back home has done wonders. Nowhere to go but up from here.

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Congratulations....sounds like you have been through the worst of it! Wishing you continued success with your new joint! ....Cindy

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@sueinmn

Wow! You'll have to fill in some details here - I was wondering what you were up to. And yes, deconditioning is fast - glad you're on the way back. Take it slow, and share how you are doing please?
Sue

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Along the way the doctor suspected another infection, so I had a debridement and some of the pieces of my implant were replaced - he even gave me the ones he removed! There was that, and then some shortness of breath complicating recovery from what turns out to be aortic stenosis from radiotherapy I had years ago to treat Hodgkin lymphoma. The stenosis lead to a buildup of fluid which was making me feel weaker than I already was at the hospital, and I learned first hand about thoracentesis, when the fluid is removed.
There were some other administrative snags that also prolonged my stay, including waiting for approval to go to acute physical therapy rehab, which wasn't approved, but just as well because I think I'll make better progress being at home.

I am getting around much better with my walker but it's still a long road ahead, and Sue, I certainly will heed your advice to take it slow. For now I'm waiting for PT as part of my home care which is also in an administrative process right now. All the pieces seem to be in place for me to get my independence back - to say nothing of getting my wife's life back to her as she has been my rock and support all along the way.

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@lahipster

Along the way the doctor suspected another infection, so I had a debridement and some of the pieces of my implant were replaced - he even gave me the ones he removed! There was that, and then some shortness of breath complicating recovery from what turns out to be aortic stenosis from radiotherapy I had years ago to treat Hodgkin lymphoma. The stenosis lead to a buildup of fluid which was making me feel weaker than I already was at the hospital, and I learned first hand about thoracentesis, when the fluid is removed.
There were some other administrative snags that also prolonged my stay, including waiting for approval to go to acute physical therapy rehab, which wasn't approved, but just as well because I think I'll make better progress being at home.

I am getting around much better with my walker but it's still a long road ahead, and Sue, I certainly will heed your advice to take it slow. For now I'm waiting for PT as part of my home care which is also in an administrative process right now. All the pieces seem to be in place for me to get my independence back - to say nothing of getting my wife's life back to her as she has been my rock and support all along the way.

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Hang in there - how wonderful that you have your wife helping you - recovery is so much smoother with someone at your side.
My friend did acute in-patient rehab after a femur fracture/hip replacement in December - says she probably would have made better progress at home, but my husband & I were away, so she had no one to turn to for the day-to-day help.
My revisions recoveries were slow - I think the body hates the repeated assault. Keep us updated on your progress.
Sue

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Hello Sue,

I hope I'm not being intrusive, but I am confused. What do you mean when you write " my cousin will spend the rest of her life without a hip or a spacer" ? How does one live without a hip? Did her revision fail?
Thank you.

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@katrine

Hello Sue,

I hope I'm not being intrusive, but I am confused. What do you mean when you write " my cousin will spend the rest of her life without a hip or a spacer" ? How does one live without a hip? Did her revision fail?
Thank you.

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Both the original surgery and all subsequent efforts failed to eradicate the systemic MRSA infection she had. It was acquired as a hospital employee (strain matched to her place of employment), but apparently dormant until it attacked after surgery. It go so bad it damaged tissue and bone, so no possibility for a revision. There is apparently no way to eradicate it - it popped up again after dental surgery, and she had to have dentures instead of the planned implants.

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@sueinmn

Both the original surgery and all subsequent efforts failed to eradicate the systemic MRSA infection she had. It was acquired as a hospital employee (strain matched to her place of employment), but apparently dormant until it attacked after surgery. It go so bad it damaged tissue and bone, so no possibility for a revision. There is apparently no way to eradicate it - it popped up again after dental surgery, and she had to have dentures instead of the planned implants.

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I'm so sorry to hear of these difficulties. Thank you for the explanation.
My best wishes.

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