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.

@mrfish

I finally made it home last night after a longer than exected 10 days in the hospital. The pain in the first few days following the surgery was something I could never have imagined. Fortunately, my ortho brought in a pain management specialist who inserted a pain block (nerve catheter, pump and bupivacaine) which was a huge improvement. The popping and grinding with the spacer is getting better as I move around more (on a walker), but movement is still quite difficult. For the self-administered IV antibiotics (vancomycin twice daily) I have a PICC line that runs through a vein in my right armpit, so using crutches is not allowed (or at least using a crutch on the right side).

Once I get settled in more at home I’ll post more updates. Than you everyone for your advice and guidance. This has been quite an adventure so far, and it’s still early.

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@janelaine I think you and I are just about in the same boat. I’m quite disappointed at how little mobility I have with this spacer. I knew it wouldn’t be anything close to normal but I feel my ortho wasn’t as honest (or blunt) up front with me about just how limited it would be. This morning, using a walker, it took me almost 20 minutes to get from my living room to the bathroom…a distance of about 25 feet and I was totally exhausted by the time I’d made the return trip back to my “nest” in the living room. One day at a time is right, one positive I’ve noted is that the popping/grinding from the spacer has smoothed out somewhat but I’m not able to bear hardly any weight at all on my right leg (post-op instructions said no more than 50% weight bearing, I feel like I can’t get much more than 10-15% right now).

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Well, here I am almost 3 weeks post-surgery and I’m getting around a little better with every day. I’m still using a walker 100% of the time, but I can now get from one end of my house to the other at more than a snail’s pace. Pain while walking around is getting better too, but I can definitely feel it when I haven’t stayed on schedule with my pain meds. If the meds have worn off, the pain from the spacer’s popping and grinding is much sharper as well as more pain and difficulty lifting my right leg to walk (rather than dragging/sliding it along the floor).

I have a follow up with my ortho later today and I’d appreciate other’s preferences/experience with their pain meds — particularly the shorter-term meds. (Moderators, given the sensitive nature of narcotic pain medications, feel free to delete this portion of my post if this is not allowed here.) I have been prescribed 20 mg oxycodone to be taken twiice a day (once every 12 hrs), 50mg tramadol to be taken once every 6 hours. These two seem to work quite well for pain management but depending on how active I am (or intend to be), I also need shorter term meds the help out during the day. So far, I have been given two meds to try for shorter term relief: either norco 5-325 (5mg hydrocodone w/ 325mg acetominophen) 1 tablet to every 4 to 6 hours, or roxicodone15mg 1 to 2 tabs to be taken every 4 hours as needed. I think I find the norco’s to be more effective than the short-term oxy’s, and I’m guessing this is because they also come with the acetominophen? Or is it a difference between the oxy vs. hydrocodone? I probably should go do some more reading on this subject, but what are others experiences with pain meds intended for shorter/mid term relief? Are there others meds I should be looking into and asking my Dr. about?

Thanks,
Art in AK

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@mrfish

Well, here I am almost 3 weeks post-surgery and I’m getting around a little better with every day. I’m still using a walker 100% of the time, but I can now get from one end of my house to the other at more than a snail’s pace. Pain while walking around is getting better too, but I can definitely feel it when I haven’t stayed on schedule with my pain meds. If the meds have worn off, the pain from the spacer’s popping and grinding is much sharper as well as more pain and difficulty lifting my right leg to walk (rather than dragging/sliding it along the floor).

I have a follow up with my ortho later today and I’d appreciate other’s preferences/experience with their pain meds — particularly the shorter-term meds. (Moderators, given the sensitive nature of narcotic pain medications, feel free to delete this portion of my post if this is not allowed here.) I have been prescribed 20 mg oxycodone to be taken twiice a day (once every 12 hrs), 50mg tramadol to be taken once every 6 hours. These two seem to work quite well for pain management but depending on how active I am (or intend to be), I also need shorter term meds the help out during the day. So far, I have been given two meds to try for shorter term relief: either norco 5-325 (5mg hydrocodone w/ 325mg acetominophen) 1 tablet to every 4 to 6 hours, or roxicodone15mg 1 to 2 tabs to be taken every 4 hours as needed. I think I find the norco’s to be more effective than the short-term oxy’s, and I’m guessing this is because they also come with the acetominophen? Or is it a difference between the oxy vs. hydrocodone? I probably should go do some more reading on this subject, but what are others experiences with pain meds intended for shorter/mid term relief? Are there others meds I should be looking into and asking my Dr. about?

Thanks,
Art in AK

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Today is my three weeks post-surgery. The stitches came out last week. I use a combination of the wheelchair and walker to get around. My experience with pain is similar to yours if I get off schedule with my pain melds. I haven’t taken anything stronger than 5 MG of Norco and Tylenol as needed but no more than 2000 MG a day. Norco also has Tylenol, so I have to be mindful of that. I am ultra-sensitive to the stronger narcotic pain meds so cant take them.

I am restricted to toe touch only except for hand-washing and brushing my teeth. I have had a couple of close calls with losing my balance with the Walker and ended up putting too much weight on my right leg. Apparently
I broke a small part of the spacer but my doctor wasn’t concerned

I have irritating leg cramps. Tomorrow will be my first venture out in a car. I’ve been using a cabulance for doctor appointments. Continuing to have in-home PT, OT and home nurse visits.

I see my doctor after the first of the year. He said I might be able to do more weight-bearing then which would make this much easier.

My daughter has a neighbor who had to stay in assisted living for seven weeks because of a bacterial infection as she had no one to stay with her at home. She gets her new hip next week so hang in there

And so it goes. Some days are better than others but all in all, I am blessed with a supportive family. There isn’t anything I can do to change what has happened so my goal is to accept what I can’t change and take charge of what I can.

Let us know what your doctor has to say.

Jan

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@janelaine

I am scheduled for this surgery on Tuesday of this week. I have a fungal infection but won’t know about a bacterial infectiion until they do the culture following implant of the spacer. I am told there is to be no weight-bearing on my right leg which means I will be confined to a wheelchair or walker or crutches. I’ve tried hopping around on a walker with one foot and find it very challenging. I am 78 yo. If you are fortunate enough to get rid of the infection in the first go round, I’d be doing the happy dance for you (yes, on one foot!) I would like to see that outcome for myself but don’t want to get my hopes up.

I learned on Friday that I will not be doing PT following the surgery. Maybe down the road but don’t know yet. I will be in a rehab center for what I hope is a short amount of time. Also been practicing pivoting on my good leg to chairs, the toilet, etc. and then lifting myself up on one leg. I like to think my body is developing a cell memory that will help make the transition easier. I have a regular wheelchair and a friend gave me a motorized wheelchair. I’ve used a cabulance to take me to appointments but will try getting into the car unless the pain is too much.

I have a supportive family and have done all the work to prepare myself physically, emotionally and spiritually at the recommendation of my surgeon who incidentally took some of his training at the Mayo Clinic. I will check in asap after the surgery.

Good luck to you.

Jan in Washington State

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YES! The raised toilet seat has been super helpful. In fact, I wish I would have had it back when I had my original hip surgery. My insurance wouldn’t pay for a shower chair/transfer bench that would make it easier & safer to get in and out of our tub/shower, but with my PICC line, and other wound dressings that can’t get wet I really can’t shower yet unless I use a full-body ziplock bag to keep all those other parts dry, lol. So it’s all sponge baths so far and having my wife wash my hair in the kitchen sink with the sprayer. BTW, Walgreens sells a no-rinse shampoo that works surprisingly well (not the dry shampoo spray). It must be the same stuff that’s in the shower cap-things they give you in the hospital to clean you hair.

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@janelaine

I am scheduled for this surgery on Tuesday of this week. I have a fungal infection but won’t know about a bacterial infectiion until they do the culture following implant of the spacer. I am told there is to be no weight-bearing on my right leg which means I will be confined to a wheelchair or walker or crutches. I’ve tried hopping around on a walker with one foot and find it very challenging. I am 78 yo. If you are fortunate enough to get rid of the infection in the first go round, I’d be doing the happy dance for you (yes, on one foot!) I would like to see that outcome for myself but don’t want to get my hopes up.

I learned on Friday that I will not be doing PT following the surgery. Maybe down the road but don’t know yet. I will be in a rehab center for what I hope is a short amount of time. Also been practicing pivoting on my good leg to chairs, the toilet, etc. and then lifting myself up on one leg. I like to think my body is developing a cell memory that will help make the transition easier. I have a regular wheelchair and a friend gave me a motorized wheelchair. I’ve used a cabulance to take me to appointments but will try getting into the car unless the pain is too much.

I have a supportive family and have done all the work to prepare myself physically, emotionally and spiritually at the recommendation of my surgeon who incidentally took some of his training at the Mayo Clinic. I will check in asap after the surgery.

Good luck to you.

Jan in Washington State

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I missed out on the shower cap/shampoo treat but thanks for passing the info along about the dry shampoo at Walgreens. I can see how the PICC line really complicates everything you do. I got a good giggle out of the giant Ziplock bag. My first trip by car today to see the doctor was a little more difficult and painful than what I thought but it was a treat to ride in the car and not in a cabulance. I need to get on track with my pain meds as I wait too long to take them.

One day closer to the goal line even tho I don’t know when that will be.

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@janelaine

I am scheduled for this surgery on Tuesday of this week. I have a fungal infection but won’t know about a bacterial infectiion until they do the culture following implant of the spacer. I am told there is to be no weight-bearing on my right leg which means I will be confined to a wheelchair or walker or crutches. I’ve tried hopping around on a walker with one foot and find it very challenging. I am 78 yo. If you are fortunate enough to get rid of the infection in the first go round, I’d be doing the happy dance for you (yes, on one foot!) I would like to see that outcome for myself but don’t want to get my hopes up.

I learned on Friday that I will not be doing PT following the surgery. Maybe down the road but don’t know yet. I will be in a rehab center for what I hope is a short amount of time. Also been practicing pivoting on my good leg to chairs, the toilet, etc. and then lifting myself up on one leg. I like to think my body is developing a cell memory that will help make the transition easier. I have a regular wheelchair and a friend gave me a motorized wheelchair. I’ve used a cabulance to take me to appointments but will try getting into the car unless the pain is too much.

I have a supportive family and have done all the work to prepare myself physically, emotionally and spiritually at the recommendation of my surgeon who incidentally took some of his training at the Mayo Clinic. I will check in asap after the surgery.

Good luck to you.

Jan in Washington State

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Hey to those of you who need a better way to shower without getting your PICC line wet. Go to the nearest feed store that sells horse and cow feed. There are long plastic see through gloves that vets use when they have to stick their whole arm up a horses rear. They cost around 11cents each and they work great. I would tape a wash rag around the PICC line and pull the glove about 6 inches above it and tape it to your arm. Just to be safe and sure I would fold the rest of the glove over the taped area and tape it again. You will have full use of your arm without getting water on your PICC line.I was still careful not to let water run directly on it but it solves that problem really well. Let me know how it goes……

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@janelaine

I am scheduled for this surgery on Tuesday of this week. I have a fungal infection but won’t know about a bacterial infectiion until they do the culture following implant of the spacer. I am told there is to be no weight-bearing on my right leg which means I will be confined to a wheelchair or walker or crutches. I’ve tried hopping around on a walker with one foot and find it very challenging. I am 78 yo. If you are fortunate enough to get rid of the infection in the first go round, I’d be doing the happy dance for you (yes, on one foot!) I would like to see that outcome for myself but don’t want to get my hopes up.

I learned on Friday that I will not be doing PT following the surgery. Maybe down the road but don’t know yet. I will be in a rehab center for what I hope is a short amount of time. Also been practicing pivoting on my good leg to chairs, the toilet, etc. and then lifting myself up on one leg. I like to think my body is developing a cell memory that will help make the transition easier. I have a regular wheelchair and a friend gave me a motorized wheelchair. I’ve used a cabulance to take me to appointments but will try getting into the car unless the pain is too much.

I have a supportive family and have done all the work to prepare myself physically, emotionally and spiritually at the recommendation of my surgeon who incidentally took some of his training at the Mayo Clinic. I will check in asap after the surgery.

Good luck to you.

Jan in Washington State

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Hello. I’m one of those people who always forgets to take my pain meds on time. First I set the timer on my cell phone to go off every 4 hours. Easy. Then I started having trouble remembering what I took and how much. So I made a “journal page ” on my computer. I call it Pain and medication journal. Then I typed Time- with a few spaces and below it typed Meds taken with a few spaces and typed Notes. I lined it all up. I did that 6 different times on the same page and printed it out twice. I cut it in half and taped them side by side and copied it 15 times. I cut those copies in half so I had 30 of them which I paper clipped together. At the top I write the DAY and DATE ie. Tuesday December 5th and so on for the month. I found this a lot easier than writing in a bound journal because each page is a new day. And I take notes as I’m taking my meds. For example if I wake up at 4am in horrible pain I write just that “up at 4am, terrible pain in upper hip radiating down to my foot.” Took 2 diluded, 1 Robaxin, 2 Tylenol etc. I keep the pages so I can see if a pattern is developing. Like am I waking up everyday at 4am? Was I able to sleep until 8am before the pain got too bad? This works for me because I feel like when they removed my hip joint, they took half my brain too. I just can’t remember all the meds, exercises etc. Maybe this could work for someone else having a hard time remembering meds and such. I hope so. Robin:)

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@janelaine

I am scheduled for this surgery on Tuesday of this week. I have a fungal infection but won’t know about a bacterial infectiion until they do the culture following implant of the spacer. I am told there is to be no weight-bearing on my right leg which means I will be confined to a wheelchair or walker or crutches. I’ve tried hopping around on a walker with one foot and find it very challenging. I am 78 yo. If you are fortunate enough to get rid of the infection in the first go round, I’d be doing the happy dance for you (yes, on one foot!) I would like to see that outcome for myself but don’t want to get my hopes up.

I learned on Friday that I will not be doing PT following the surgery. Maybe down the road but don’t know yet. I will be in a rehab center for what I hope is a short amount of time. Also been practicing pivoting on my good leg to chairs, the toilet, etc. and then lifting myself up on one leg. I like to think my body is developing a cell memory that will help make the transition easier. I have a regular wheelchair and a friend gave me a motorized wheelchair. I’ve used a cabulance to take me to appointments but will try getting into the car unless the pain is too much.

I have a supportive family and have done all the work to prepare myself physically, emotionally and spiritually at the recommendation of my surgeon who incidentally took some of his training at the Mayo Clinic. I will check in asap after the surgery.

Good luck to you.

Jan in Washington State

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This is a great tip @froggy1. I get the catheter for my pain block taken out this week and that’s really the last thing keeping me from showering, especially with with a trick for the PICC like you suggest here. I was thinking a washcloth under a bunch of wraps of saran wrap and then a little tape at each end would probably do the trick, too. The home-visit nurses who bring my antibiotics and clean/maintain the PICC said to keep it as dry as possible when washing up, but that keeping it totally, 100% dry isn’t really critical; just avoid significant direct water (especially submersion if you’re bathing).

I’ve done plenty of complaining about all the accessories I have had to drag along after this first of two surgeries. I was able to ditch the Active Care leg compression cuffs last week (yay!), and as I just mentioned my pain catheter/pump comes out this week. The last one I’ll still need to pack around for a while is a wound vac. When my joint infection finally presented itself in an obvious fashion, it was as a series of growing abscesses that pushed out via a fistula (channel) from the joint and directly through the scar from my first (anterior) THR surgery. When they did this last surgery to remove the THR and place the spacer, they also did considerable debridement of that wound which resulted in quite a large “crater” on the front of my leg. This wound gets its’ dressing changed twice a week. It’s packed with porous sponge, then covered with a tegaderm-like film and then a tube over the top that goes to a smallish (maybe 10″x6″x2″) vacuum pump. It has been fascinating watching how quickly this has helped this large & deep wound close itself up. I’ve clearly got some more time to stay attached to this one…but at least I can see a significant value to having to pack it along with me everywhere I go.

Has anyone else had to use one of these for wound care?

I guess some doctors like to continue their use through some of the epidermal (skin) formation, while others just remove it once the wound has closed enough and let the scar tissue/skin form on its own? I’m not soo sure about that one, though. It’s on my list of things to talk to my ortho about during our next follow-up.

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5-week update: I met with my infectious disease specialist two days ago and he said that if my bloodwork from this week (drawn yesterday) looks good, he expected to take me offf the antibiotics on Dec 26 (what a great Christmas present!!) Then, it’ll be a matter of waiting anywhere from 3-6 weeks before the next surgery to make sure the infection doesn’t come back. He said infectious disease docs usually prefer to wait a little longer than the orthopedic surgeons for the re-implantation — the extra time, in his opinion, gives more confidence that the infection is gone. I also happen to have a follow up appointment with my ortho on Dec 26, so we’ll see what he has to say. I definitely want to do as much as I can to make sure I don’t have to go through all of this again, so I’d be okay with waiting a little longer before the new THR. At least once I’m off the IV antibiotics, I’ll have the PICC line removed will be able to start using crutches instead of a walker. My pain is still problematic, but reasonably under control with meds, and my mobility is still very limited.

Jan @janelaine how are things going for you?

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Hello – I’ve been thinking about you and wondering how you are doing. Good news from your infectious disease doc that the PICC line gets to come out.
And I agree that waiting a bit longer at this point makes sense – we do not want to go through this again. I don’t have an appointment to see my infectious disease doctor yet but do see my ortho doc on January 4 with lab work done next week. I was told they go a “little” longer with fungal infections because they are so hard to get rid of so I don’t know what that means other than every day puts me closer to the goal of THR. Pain is problematic for me as well plus sitting so much causes problems in and of itself. Haven’t been able to find a comfy cushion. I don’t do well on pain meds so use Tylenol sparingly. I might get the go-ahead to use more weight-bearing so I can use the walker more, I totally understand about limited mobility and the precautions we have to take just like having a THR. Sometimes I just want to get up and walk! This definitely challenges my patience. It is very difficult to have to rely on others for help with almost everything.

Wishing you a happy holiday season, My family put up a tree and decorated so we are looking quite festive around here.

Stay in touch – I will check in after January 4. Let me know what your ortho doc has to say.

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So sorry for your pain and follow up need for surgery. While I’m thoroughly uninformed of but intrigued by an antibiotic spacer, I have concerns that you seem to have not broached with your surgeon, or a/some of his-her patients that have had this insertion. You might also choose to get a second medical opinion, which is totally reasonable, to grow your information and comfort zone with the decision you’ve made.
I’ve had too many surgeries, including an anterior cervical spine fusion and did a huge amount of research, posed a lot of questions to my surgeon until I felt sure that what was scheduled was in my best interest, all things considered.
You deserve to have every question or concern addressed and if you want feedback from someone who has experienced the procedure, ask your Dr for referrals.
Ask for what you want! Good luck!

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Thank you for your suggestions, @shenriq. I did quite a bit of online research about treatment options once my infection was diagnosed, as well as speaking with my infectious disease specialist. There are a lot of medical journal articles online that looked at this, and it seemed quite clear that non-surgical treatment (antibiotics only) was really only an option if the infection is discovered and treatments began within just a few days of the onset…otherwise, surgical revision is required to address the infection. There were a number of journal articles, particularly from the UK, where they compared single-stage and two-stage revisions for infected hip implants. From what I saw, the two-stage (two surgeries and the antibiotic spacer) had significantly better success rates than just a single surgery to swap out hardware.

As far as mobility, and as my ortho explained, that really varies from patient to patient. For me, it’s now been 8 weeks since they removed the infected joint and implanted the spacer and I’m still needing to use a walker or crutches to get around. I’ve briefly tried using just a cane, but that still puts too much weight (and pain) on my right leg. For the most part, there’s no pain when I’m not moving around, but movement is slow and still always comes with some degree of pain. When I’m at home, it seems the walker is just more convenient than crutches most of the time. Fortunately, I have a job that allows me the opportunity to do some work from home/electonically but I’ve been wanting to get out of the house. So this week I began going into work for 4-5 hours a day and using crutches to get around when there. I’ve been having my wife or son drive me…I’m in no condition to be driving a vehicle for two reasons: my right leg doesn’t have the strength or agility to safely control the gas/brake pedals and I’m also still taking narcotic pain meds. While I’ve been able to reduce the amount of meds I’ve been taking, there is no doubt my judgement and reaction times are still compromised to some degree (especially with our icy roads).

But, after just two days of going into the office, I’ve had a little swelling return and my joint is much more stiff and painful than it had been before. So, I’m home resting it today. Maybe I’ll get a little more mobility if I just keep at it, but I think this is most likely as good as it’s going to get until I get a functioning hip joint re-implanted. Next week, I think I’ll try going into the office every other day (MWF) and see if that works better.

On Friday this week, they will draw out (aspirate) and culture some fluid from my hip joint to make sure the infection is/remains clear. My re-implantation surgery is scheduled for Feb 14, if everything contiues to look good. It’s frustrating that it’s still more than a month away (and will be almost exactly 3 months from the first surgery)…but as I mentioned before, longer waits before re-implantation should hopefully provide some more assurance that the infection is truly gone.

@janelaine, I hope you’re doing well. Is your second surgery on the calendar yet?

Best,
Art in AK

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