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.

I appreciate your sharing more of the details of your situation and regret not being able to provide more information or support. The complexity of your hip is extremely curious, but I’m sending you good wishes and every success with journey, going forward.
I had an afterthought, since you mentioned having done a lot of research. I’ve learned quite a lot of information on a variety of subjects, from the National Institutes of Health. They are a repository of research and information, that the public has access to, that they will mail to you. I hope this helps.
Best wishes and lots of luck, for a successful healing and full usage, without pain.
Good luck to you!

REPLY

Time for an update on how I’m doing.On November 4, 2017 I had a spacer put in my right hip due to a fungal infection. I saw my ortho doc last week The lab work shows the infection levels are coming down which is great news. I see him again in six weeks to see where my lab results are. IF the infection is gone, I will have a four week drug=free holiday. If nothing shows up at the end of the four weeks, I can schedule my THR. That’s a big IF as the fungal infection is hard to get rid of so I’m just doing this one day at a time. I did get permission to do 50% weight bearing on my right leg so that means I can use a rolling walker and get around much better.

Happy New Year to all of you who are on this journey. Thanks for your support.
janelaie

REPLY
@mrfish

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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Thanks for your update. I’m having the same issues with pain. I am delighted to be using the walker and put 59% weight on my right leg, even though I feel like I’m using some muscles that are tight and sore. I save my pain meds until bedtime so I can sleep. Let us know what the aspiration and culture show – hopefully no infection so you can proceed with surgery on Valentine’s Day. What a sweet gift that would be. I have been out of the house several times, primarily for appointments but did sneak in a visit to Costco using one of their carts.

Jan in WA

REPLY

Here’s my most recent update: I’m scheduled to have my next (and hopefully last) hip surgery on Wednesday, Feb 14, when they plan to remove the antibiotic spacer and install fully-functional new hardware — just about three months since the spacer was installed.

I had to undergo two hip aspirations a few weeks ago (where a loooong needle is used to draw fluid from the joint). During the first one, they drew some fluid but someone messed up and they weren’t able to culture the sample (it was mistakenly sent for processing to a lab out of state and too much time had passed). So, they scheduled a not-very-happy me for a second aspiration but unfortunately weren’t able to get any fluid that time.

According to the docs, my blood work looks good. It is frustrating to me that throughout all of this there were no successful cultures to figure out what kind of microbe was causing my infection, nor (most recently) to confirm that the infection is truly cleared out. There are only the indirect indicators from blood & lab work. My ortho tells me that during this week’s surgery, samples will be taken — and processed — while I’m still on the operating table. If those indicate that there is still an infection, they will abort the installation of working hardware and instead re-implant another antibiotic spacer. However, he said that they have never had that occur. I guess that gives me some comfort?

But (beside having this blasted spacer in my hip and its’ pain & limitations) I feel good and I have no reason to believe the infection isn’t gone. I’m looking forward to this next surgery and the recovery that will come after that. I’m looking forward to putting the last six (or so) challenging months behind me — I just can’t shake this fear in the back of my mind of possibly having to go through this all again should an infection reoccur.

I’m not driving myself, but for these last few weeks, I have been going in to work at the office for three days a week (M,W,F) and using crutches. While seated at my desk, I need to get up and move around a little bit every 30 minutes or so. If I go longer, it’s much more painful and harder to get things worked out and moving again. Fortunately, I have a motorized stand-up desk that I can put up or down and I’ll also sometimes spend a little time standing and shifting some weight between both legs. I still cannot bear much more than 50% normal weight on my right leg.

At home, I prefer to use the walker, it’s just so much more convenient. The extra activity certainly comes with additional pain. Right now, after being at work all day today, I my visibly swollen right leg elevated and an ice pack on my hip.

I’ll post another update next week after my surgery. Fingers crossed.

REPLY
@mrfish

Here’s my most recent update: I’m scheduled to have my next (and hopefully last) hip surgery on Wednesday, Feb 14, when they plan to remove the antibiotic spacer and install fully-functional new hardware — just about three months since the spacer was installed.

I had to undergo two hip aspirations a few weeks ago (where a loooong needle is used to draw fluid from the joint). During the first one, they drew some fluid but someone messed up and they weren’t able to culture the sample (it was mistakenly sent for processing to a lab out of state and too much time had passed). So, they scheduled a not-very-happy me for a second aspiration but unfortunately weren’t able to get any fluid that time.

According to the docs, my blood work looks good. It is frustrating to me that throughout all of this there were no successful cultures to figure out what kind of microbe was causing my infection, nor (most recently) to confirm that the infection is truly cleared out. There are only the indirect indicators from blood & lab work. My ortho tells me that during this week’s surgery, samples will be taken — and processed — while I’m still on the operating table. If those indicate that there is still an infection, they will abort the installation of working hardware and instead re-implant another antibiotic spacer. However, he said that they have never had that occur. I guess that gives me some comfort?

But (beside having this blasted spacer in my hip and its’ pain & limitations) I feel good and I have no reason to believe the infection isn’t gone. I’m looking forward to this next surgery and the recovery that will come after that. I’m looking forward to putting the last six (or so) challenging months behind me — I just can’t shake this fear in the back of my mind of possibly having to go through this all again should an infection reoccur.

I’m not driving myself, but for these last few weeks, I have been going in to work at the office for three days a week (M,W,F) and using crutches. While seated at my desk, I need to get up and move around a little bit every 30 minutes or so. If I go longer, it’s much more painful and harder to get things worked out and moving again. Fortunately, I have a motorized stand-up desk that I can put up or down and I’ll also sometimes spend a little time standing and shifting some weight between both legs. I still cannot bear much more than 50% normal weight on my right leg.

At home, I prefer to use the walker, it’s just so much more convenient. The extra activity certainly comes with additional pain. Right now, after being at work all day today, I my visibly swollen right leg elevated and an ice pack on my hip.

I’ll post another update next week after my surgery. Fingers crossed.

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Mr.Fish. You are very, very brave. I will be praying for your infection to be looooong gone and to NEVER come back. I say you’re brave because I’ve chosen to not undergo another surgery (which would have been a 2 stage and new PICC lines after each stage “just in case”) For me 4 surgeries and 2 staph infections was all I could do. Also, in between dislocation 2 and re-vision of the liner in my pelvis, I had breast cancer surgery. They removed a lump from my breast and 3 lymph nodes from my arm pit (to check if it had spread, and it did not) and a week later I had the revision where I caught the first staph infection. While I was home with the first PICC line, Nurses started calling me telling me they wanted me to do radiation. I passed. Just didn’t have it in me. I did enough research on radiation to make an informed decision and I’ve been talking to people about CBDs, which is derived from marijuana. Not quite there yet either. But at my 6 month mammogram I was cancer free so I’m keeping my fingers crossed:) The end of February will be my 1 year mark of having that hip joint removed. It’s a process getting used to but I’m doing quite well. Everyday is different (they just had to add another inch to the bottom of my left shoe, so now I’m at around 3 inches shorter on that side.) Sitting too long, driving too long and walking too much will probably always be an issue. The good news is I’ve only fallen once in the last 4 months! And it was more like a trip and fall. (stepping into the shower I forgot to grab the safety bar, tried to step in with my right foot first, bad move, it left all my weight on the wrong side and on top of that I didn’t lift my leg up high enough and stubbed all my toes before not so gracefully going down.) It’s a good thing that I can laugh at myself, because it was a laugh or cry moment and I chose to laugh. Plus my dog was standing behind me when I got up looking at me like “not again, would you just get up”? Enough yakking about me. Think good thoughts, take some deep breaths and think of your favorite person or place before they sedate you. I’ve been told that if the last thing you picture before going under is something pleasant, you’ll wake up thinking that same thought and you’ll feel fine. It worked for me 5 times!! You’re gonna do great. I’m always available to talk and or listen if you need to…. Robin

REPLY
@mrfish

Here’s my most recent update: I’m scheduled to have my next (and hopefully last) hip surgery on Wednesday, Feb 14, when they plan to remove the antibiotic spacer and install fully-functional new hardware — just about three months since the spacer was installed.

I had to undergo two hip aspirations a few weeks ago (where a loooong needle is used to draw fluid from the joint). During the first one, they drew some fluid but someone messed up and they weren’t able to culture the sample (it was mistakenly sent for processing to a lab out of state and too much time had passed). So, they scheduled a not-very-happy me for a second aspiration but unfortunately weren’t able to get any fluid that time.

According to the docs, my blood work looks good. It is frustrating to me that throughout all of this there were no successful cultures to figure out what kind of microbe was causing my infection, nor (most recently) to confirm that the infection is truly cleared out. There are only the indirect indicators from blood & lab work. My ortho tells me that during this week’s surgery, samples will be taken — and processed — while I’m still on the operating table. If those indicate that there is still an infection, they will abort the installation of working hardware and instead re-implant another antibiotic spacer. However, he said that they have never had that occur. I guess that gives me some comfort?

But (beside having this blasted spacer in my hip and its’ pain & limitations) I feel good and I have no reason to believe the infection isn’t gone. I’m looking forward to this next surgery and the recovery that will come after that. I’m looking forward to putting the last six (or so) challenging months behind me — I just can’t shake this fear in the back of my mind of possibly having to go through this all again should an infection reoccur.

I’m not driving myself, but for these last few weeks, I have been going in to work at the office for three days a week (M,W,F) and using crutches. While seated at my desk, I need to get up and move around a little bit every 30 minutes or so. If I go longer, it’s much more painful and harder to get things worked out and moving again. Fortunately, I have a motorized stand-up desk that I can put up or down and I’ll also sometimes spend a little time standing and shifting some weight between both legs. I still cannot bear much more than 50% normal weight on my right leg.

At home, I prefer to use the walker, it’s just so much more convenient. The extra activity certainly comes with additional pain. Right now, after being at work all day today, I my visibly swollen right leg elevated and an ice pack on my hip.

I’ll post another update next week after my surgery. Fingers crossed.

Jump to this post

Thanks for getting us current on your upcoming surgery.. I can relate to much of what you have to say about the spacer and pain and limitations and the lingering fear that you might have to go through this again. This is a challenging journey. I see my ortho doc on Thursday to see what my lab work is. I’m not expecting the fungal infection to be gone but hoping the numbers are coming down. I know my THR is somewhere in my future but don’t know when. Wishing you a totally successful surgery and recovery. Stay in touch and let us know how you are doing.

REPLY
@mrfish

Here’s my most recent update: I’m scheduled to have my next (and hopefully last) hip surgery on Wednesday, Feb 14, when they plan to remove the antibiotic spacer and install fully-functional new hardware — just about three months since the spacer was installed.

I had to undergo two hip aspirations a few weeks ago (where a loooong needle is used to draw fluid from the joint). During the first one, they drew some fluid but someone messed up and they weren’t able to culture the sample (it was mistakenly sent for processing to a lab out of state and too much time had passed). So, they scheduled a not-very-happy me for a second aspiration but unfortunately weren’t able to get any fluid that time.

According to the docs, my blood work looks good. It is frustrating to me that throughout all of this there were no successful cultures to figure out what kind of microbe was causing my infection, nor (most recently) to confirm that the infection is truly cleared out. There are only the indirect indicators from blood & lab work. My ortho tells me that during this week’s surgery, samples will be taken — and processed — while I’m still on the operating table. If those indicate that there is still an infection, they will abort the installation of working hardware and instead re-implant another antibiotic spacer. However, he said that they have never had that occur. I guess that gives me some comfort?

But (beside having this blasted spacer in my hip and its’ pain & limitations) I feel good and I have no reason to believe the infection isn’t gone. I’m looking forward to this next surgery and the recovery that will come after that. I’m looking forward to putting the last six (or so) challenging months behind me — I just can’t shake this fear in the back of my mind of possibly having to go through this all again should an infection reoccur.

I’m not driving myself, but for these last few weeks, I have been going in to work at the office for three days a week (M,W,F) and using crutches. While seated at my desk, I need to get up and move around a little bit every 30 minutes or so. If I go longer, it’s much more painful and harder to get things worked out and moving again. Fortunately, I have a motorized stand-up desk that I can put up or down and I’ll also sometimes spend a little time standing and shifting some weight between both legs. I still cannot bear much more than 50% normal weight on my right leg.

At home, I prefer to use the walker, it’s just so much more convenient. The extra activity certainly comes with additional pain. Right now, after being at work all day today, I my visibly swollen right leg elevated and an ice pack on my hip.

I’ll post another update next week after my surgery. Fingers crossed.

Jump to this post

Froggy1 – you are an inspiration to have gone through so much and still have a sense of humor. Sounds like you have accepted your condition and are coping quite well under the circumstances. You are very brave! Wishing you the best!

REPLY

Thanks for your well-wishes, it really meant a lot to me as I headed into this last surgery, and my anxiety was running high.

Things are going very well for me so far. I spent two nights in the hospital after my surgery on Feb 14. My surgeon said everything looked great while he was "in there" during the surgery and the rapid cultures they took during the operation showed no sign of infection. They still administered a few precautionary doses of IV antibiotic while I was in the hospital, and my ortho said they also sprinkled in some kind of slow-release/dissoving antibiotic into the joint area before closing things up.

The biggest change for me is that the joint pain of the 3 months with the spacer (the popping and grinding) is completely and immediately gone. Of course, I have some pain from the incision but that's secondary to the considerable weakness and loss of flexibility that's due to the past three months of very limited mobility. I started physical therapy this week, and will go out for that 3x a week for up to 7 weeks. I've already noticed improvement from the home exercises and the PT sessions.

I'm still using crutches or my walker, but I've also been trying to spend more time playing around with a cane over the last few days — but, I have a bit more strength I need to regain in my right leg before I feel I can switch completely over to the cane (maybe one more week). I have no restriction on how much weight I can bear on my right leg, but it's definitely not back to "normal" yet. I can stand normally with weight ditributed evenly between left and right feet (without any pain), and can shift some more weight over to my right but I can't fully support my weight on my right leg alone as you would while trying to walk normally. It's really not an issue of pain so much as strength and not feeling stable/safe quite yet.

@janelaine and @froggy1, thank you (and others) for your support. Janelaine, I'm hoping your infection clears soon and you might be able to get your new hip. I'm so sorry that it seems to be taking so much longer for a fungal infection to clear out. Froggy1, its quite flattering to be called brave by you. After getting to know more about you and your long road to where you are today, you are truly the brave one here (but thank you). And, to be able to find humor among the challenges is a testament to your strong character and willpower. I can only begin to understand your frustration and possible disillusionment with what medicine has been able to offer you so far. But I want to sincerely say "hang in there", perhaps new technology or procedures might give you a shot at something closer to normal.

My next challenge is going to be getting off the narcotics. My pain levels are already way, way down–I could probably manage with ibuprofen now–and I've begun to significantly reduce the dose and frequency of my tramadol and oxycodone…but I've already noticed the beginning of withdrawal symptoms from just this. I've done some reading on the topic and asked my ortho for advice or possible medical help, and was very disappointed with his response. He did say I shoud talk with my normal doctor; perhaps that's the correct protocol. So, I do plan to speak with my normal doc this week and see what she may have to suggest and if we can develop a plan/schedule—but I don't think she has much experience with detox treatment (maybe I'm wrong). But again, since the orthos are the ones who prescribe so much of the pain meds, you'd think they'd devote the effort to help you get off of them. Since I'm alrerady back at work full-time, I probably need to find a 3 or 4 day weekend to carry out the initial cut-off to deal with the worst of it. I do have experience with opioid withdrawal after my first hip replacement, but that was only after 4-5 weeks of pain pills, while this time it's been about 4 months of the stuff. I remember sleeplessness was a huge problem last time so I was going to inquire about short-term sleeping medication, and I've also been reading a little about buprenorphine as something that might help lessen the withdrawal symptoms. Recreational marijuana is also legal up here in Alaska and I've had some experience with that, but that was mostly in college a few decades ago. Maybe there's no real medical way to make it meaningfully easier and I'll just need to tough it out — which I'm fully prepared to do in the very near furure. But, any advice would be appreciated.

Moderators, is there a discussion thread on the topic here on connect.mayoclinic?

REPLY
@mrfish

Thanks for your well-wishes, it really meant a lot to me as I headed into this last surgery, and my anxiety was running high.

Things are going very well for me so far. I spent two nights in the hospital after my surgery on Feb 14. My surgeon said everything looked great while he was "in there" during the surgery and the rapid cultures they took during the operation showed no sign of infection. They still administered a few precautionary doses of IV antibiotic while I was in the hospital, and my ortho said they also sprinkled in some kind of slow-release/dissoving antibiotic into the joint area before closing things up.

The biggest change for me is that the joint pain of the 3 months with the spacer (the popping and grinding) is completely and immediately gone. Of course, I have some pain from the incision but that's secondary to the considerable weakness and loss of flexibility that's due to the past three months of very limited mobility. I started physical therapy this week, and will go out for that 3x a week for up to 7 weeks. I've already noticed improvement from the home exercises and the PT sessions.

I'm still using crutches or my walker, but I've also been trying to spend more time playing around with a cane over the last few days — but, I have a bit more strength I need to regain in my right leg before I feel I can switch completely over to the cane (maybe one more week). I have no restriction on how much weight I can bear on my right leg, but it's definitely not back to "normal" yet. I can stand normally with weight ditributed evenly between left and right feet (without any pain), and can shift some more weight over to my right but I can't fully support my weight on my right leg alone as you would while trying to walk normally. It's really not an issue of pain so much as strength and not feeling stable/safe quite yet.

@janelaine and @froggy1, thank you (and others) for your support. Janelaine, I'm hoping your infection clears soon and you might be able to get your new hip. I'm so sorry that it seems to be taking so much longer for a fungal infection to clear out. Froggy1, its quite flattering to be called brave by you. After getting to know more about you and your long road to where you are today, you are truly the brave one here (but thank you). And, to be able to find humor among the challenges is a testament to your strong character and willpower. I can only begin to understand your frustration and possible disillusionment with what medicine has been able to offer you so far. But I want to sincerely say "hang in there", perhaps new technology or procedures might give you a shot at something closer to normal.

My next challenge is going to be getting off the narcotics. My pain levels are already way, way down–I could probably manage with ibuprofen now–and I've begun to significantly reduce the dose and frequency of my tramadol and oxycodone…but I've already noticed the beginning of withdrawal symptoms from just this. I've done some reading on the topic and asked my ortho for advice or possible medical help, and was very disappointed with his response. He did say I shoud talk with my normal doctor; perhaps that's the correct protocol. So, I do plan to speak with my normal doc this week and see what she may have to suggest and if we can develop a plan/schedule—but I don't think she has much experience with detox treatment (maybe I'm wrong). But again, since the orthos are the ones who prescribe so much of the pain meds, you'd think they'd devote the effort to help you get off of them. Since I'm alrerady back at work full-time, I probably need to find a 3 or 4 day weekend to carry out the initial cut-off to deal with the worst of it. I do have experience with opioid withdrawal after my first hip replacement, but that was only after 4-5 weeks of pain pills, while this time it's been about 4 months of the stuff. I remember sleeplessness was a huge problem last time so I was going to inquire about short-term sleeping medication, and I've also been reading a little about buprenorphine as something that might help lessen the withdrawal symptoms. Recreational marijuana is also legal up here in Alaska and I've had some experience with that, but that was mostly in college a few decades ago. Maybe there's no real medical way to make it meaningfully easier and I'll just need to tough it out — which I'm fully prepared to do in the very near furure. But, any advice would be appreciated.

Moderators, is there a discussion thread on the topic here on connect.mayoclinic?

Jump to this post

Hi, @mrfish — glad to hear things are going well for you so far.

You'd asked about threads on withdrawing from pain meds. You might want to check out these two:

http://mayocl.in/2ENZ66U (on withdrawing from fentanyl and oxycodone)

http://mayocl.in/2EQHzLA (on withdrawing from morphine)

REPLY
@mrfish

Thanks for your well-wishes, it really meant a lot to me as I headed into this last surgery, and my anxiety was running high.

Things are going very well for me so far. I spent two nights in the hospital after my surgery on Feb 14. My surgeon said everything looked great while he was "in there" during the surgery and the rapid cultures they took during the operation showed no sign of infection. They still administered a few precautionary doses of IV antibiotic while I was in the hospital, and my ortho said they also sprinkled in some kind of slow-release/dissoving antibiotic into the joint area before closing things up.

The biggest change for me is that the joint pain of the 3 months with the spacer (the popping and grinding) is completely and immediately gone. Of course, I have some pain from the incision but that's secondary to the considerable weakness and loss of flexibility that's due to the past three months of very limited mobility. I started physical therapy this week, and will go out for that 3x a week for up to 7 weeks. I've already noticed improvement from the home exercises and the PT sessions.

I'm still using crutches or my walker, but I've also been trying to spend more time playing around with a cane over the last few days — but, I have a bit more strength I need to regain in my right leg before I feel I can switch completely over to the cane (maybe one more week). I have no restriction on how much weight I can bear on my right leg, but it's definitely not back to "normal" yet. I can stand normally with weight ditributed evenly between left and right feet (without any pain), and can shift some more weight over to my right but I can't fully support my weight on my right leg alone as you would while trying to walk normally. It's really not an issue of pain so much as strength and not feeling stable/safe quite yet.

@janelaine and @froggy1, thank you (and others) for your support. Janelaine, I'm hoping your infection clears soon and you might be able to get your new hip. I'm so sorry that it seems to be taking so much longer for a fungal infection to clear out. Froggy1, its quite flattering to be called brave by you. After getting to know more about you and your long road to where you are today, you are truly the brave one here (but thank you). And, to be able to find humor among the challenges is a testament to your strong character and willpower. I can only begin to understand your frustration and possible disillusionment with what medicine has been able to offer you so far. But I want to sincerely say "hang in there", perhaps new technology or procedures might give you a shot at something closer to normal.

My next challenge is going to be getting off the narcotics. My pain levels are already way, way down–I could probably manage with ibuprofen now–and I've begun to significantly reduce the dose and frequency of my tramadol and oxycodone…but I've already noticed the beginning of withdrawal symptoms from just this. I've done some reading on the topic and asked my ortho for advice or possible medical help, and was very disappointed with his response. He did say I shoud talk with my normal doctor; perhaps that's the correct protocol. So, I do plan to speak with my normal doc this week and see what she may have to suggest and if we can develop a plan/schedule—but I don't think she has much experience with detox treatment (maybe I'm wrong). But again, since the orthos are the ones who prescribe so much of the pain meds, you'd think they'd devote the effort to help you get off of them. Since I'm alrerady back at work full-time, I probably need to find a 3 or 4 day weekend to carry out the initial cut-off to deal with the worst of it. I do have experience with opioid withdrawal after my first hip replacement, but that was only after 4-5 weeks of pain pills, while this time it's been about 4 months of the stuff. I remember sleeplessness was a huge problem last time so I was going to inquire about short-term sleeping medication, and I've also been reading a little about buprenorphine as something that might help lessen the withdrawal symptoms. Recreational marijuana is also legal up here in Alaska and I've had some experience with that, but that was mostly in college a few decades ago. Maybe there's no real medical way to make it meaningfully easier and I'll just need to tough it out — which I'm fully prepared to do in the very near furure. But, any advice would be appreciated.

Moderators, is there a discussion thread on the topic here on connect.mayoclinic?

Jump to this post

thank you, @lisalucier!

REPLY
@mrfish

Thanks for your well-wishes, it really meant a lot to me as I headed into this last surgery, and my anxiety was running high.

Things are going very well for me so far. I spent two nights in the hospital after my surgery on Feb 14. My surgeon said everything looked great while he was "in there" during the surgery and the rapid cultures they took during the operation showed no sign of infection. They still administered a few precautionary doses of IV antibiotic while I was in the hospital, and my ortho said they also sprinkled in some kind of slow-release/dissoving antibiotic into the joint area before closing things up.

The biggest change for me is that the joint pain of the 3 months with the spacer (the popping and grinding) is completely and immediately gone. Of course, I have some pain from the incision but that's secondary to the considerable weakness and loss of flexibility that's due to the past three months of very limited mobility. I started physical therapy this week, and will go out for that 3x a week for up to 7 weeks. I've already noticed improvement from the home exercises and the PT sessions.

I'm still using crutches or my walker, but I've also been trying to spend more time playing around with a cane over the last few days — but, I have a bit more strength I need to regain in my right leg before I feel I can switch completely over to the cane (maybe one more week). I have no restriction on how much weight I can bear on my right leg, but it's definitely not back to "normal" yet. I can stand normally with weight ditributed evenly between left and right feet (without any pain), and can shift some more weight over to my right but I can't fully support my weight on my right leg alone as you would while trying to walk normally. It's really not an issue of pain so much as strength and not feeling stable/safe quite yet.

@janelaine and @froggy1, thank you (and others) for your support. Janelaine, I'm hoping your infection clears soon and you might be able to get your new hip. I'm so sorry that it seems to be taking so much longer for a fungal infection to clear out. Froggy1, its quite flattering to be called brave by you. After getting to know more about you and your long road to where you are today, you are truly the brave one here (but thank you). And, to be able to find humor among the challenges is a testament to your strong character and willpower. I can only begin to understand your frustration and possible disillusionment with what medicine has been able to offer you so far. But I want to sincerely say "hang in there", perhaps new technology or procedures might give you a shot at something closer to normal.

My next challenge is going to be getting off the narcotics. My pain levels are already way, way down–I could probably manage with ibuprofen now–and I've begun to significantly reduce the dose and frequency of my tramadol and oxycodone…but I've already noticed the beginning of withdrawal symptoms from just this. I've done some reading on the topic and asked my ortho for advice or possible medical help, and was very disappointed with his response. He did say I shoud talk with my normal doctor; perhaps that's the correct protocol. So, I do plan to speak with my normal doc this week and see what she may have to suggest and if we can develop a plan/schedule—but I don't think she has much experience with detox treatment (maybe I'm wrong). But again, since the orthos are the ones who prescribe so much of the pain meds, you'd think they'd devote the effort to help you get off of them. Since I'm alrerady back at work full-time, I probably need to find a 3 or 4 day weekend to carry out the initial cut-off to deal with the worst of it. I do have experience with opioid withdrawal after my first hip replacement, but that was only after 4-5 weeks of pain pills, while this time it's been about 4 months of the stuff. I remember sleeplessness was a huge problem last time so I was going to inquire about short-term sleeping medication, and I've also been reading a little about buprenorphine as something that might help lessen the withdrawal symptoms. Recreational marijuana is also legal up here in Alaska and I've had some experience with that, but that was mostly in college a few decades ago. Maybe there's no real medical way to make it meaningfully easier and I'll just need to tough it out — which I'm fully prepared to do in the very near furure. But, any advice would be appreciated.

Moderators, is there a discussion thread on the topic here on connect.mayoclinic?

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What great news about your operation and recovery, except for the issue with pain meds. I have been fortunate that I haven't had to deal with as much pain because there are very few pain meds I can take.

Starting Monday I am on a two week holiday from taking the dreaded anti-fungal medicine. My labs are good enough for my ortho doc, but the infectious disease doc wanted me to take them for a few more days. I will have lab work done on March 12 If the infection is gone, surgery for a THR will be scheduled probably in April. The spacer will have been in fI've months I am hopeful and more than ready to get my life back . This started in May 2017

So best wishes to you, Mr Fish thanks for everyone's support and encouragement this can be a lonely road without support.

I will check back in when I have a surgery date. Keep us posted on how you are doing I'm very happy for you!

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Okay, here's another update. It's a bit after the fact, bear with me.

So, to recap, on Feb 14 I finally got the antibiotic spacer removed after living with it for 3 months and functional hip hardware re-implanted Things were going great…I was back in physical therapy and regaining strength and mobility quickly. That’s about where we left off last time.

The dressing over the incision was hooked up to a small wound vac that I was supposed to wear for one week after being released from the hospital. Almost nothing drained from the incision into the wound vac until the day before it was supposed to come off. Then a bunch of “old” blood drained out and nearly filled the vac’s reservoir overnight. I called my ortho and they got me in right away…the drainage had stopped by then and he figured it was just a clot that had liquefied and drained. He considered putting another wound vac on with a new dressing, which I wasn’t very happy about. I was trying to get back to work and that’s not very easy if you have to drag around a bunch of post-surgical devices with their associated tubes and hoses (and this was also on a Friday afternoon and getting insurance approvals for another device wasn’t happening quickly on a Friday afternoon). Since the drainage had stopped, they re-dressed it with a bunch of gauze and tegaderm and I was to let them know if any drainage resumed.

Things went well thru the weekend until the following Tuesday (3/27) when, after a morning PT session, a bunch of new drainage occurred. Not blood this time, but a tannish fluid…and a quite a it of it, the gauze became saturated. I called and then texted a picture of the gauze to my ortho’s PA. They called me back right away, asked when I last ate anything and wanted me to come in for a “wash-out” surgery in 3 hours. Calling that a shock doesn’t really describe it…I guess the drainages I’d had were a clear sign something wasn’t right, but it’s hard to mentally prepare yourself for surgery and all that entails on such short notice.

So, I go in and do the wash-out that day and was put on IV antibiotics. I expected to stay in the hospital for another 2-3 days after surgery while they fine-tuned the antibiotics dosage. Two days later, my ortho tells me a culture they took during the wash-out was growing something but it probably would take another day until it grew enough for them to identify it. Throughout all the previous tests and cultures, they had never been able to successfully culture anything from my hip, so it was kind of a positive that they might finally know what, specifically, had been causing me all these problems.
The next evening, the ortho and my infectious disease specialist come into my hospital room to let me know the culture produced staph (not mrsa) and they were recommending yet another surgery. He said the chances success from the wash-out surgery I had just gone through and antibiotics was somewhere around 50-60%…if I agreed to one more surgery to swap out the hardware and continued antibiotics, we were told the chances of success went up to nearly 90%. I was really weary of another surgery (one week exactly after the wash-out), but the increased chances for success were pretty striking, so with my wife we decided to follow their recommendation. This was going be the 5th overall surgery on my right hip, and it would be surgery #4 since just last November, and a 3rd surgery in the span of just under 3 weeks. They made me stay in the hospital thru the weekend until the next surgery. That was a tough time; there was a lot of frustration, anger and tears.

Tomorrow marks 2 weeks since the most recent surgery (which was on 3/6). I’ve got a PICC line (again), giving myself cefazolin infusions three times a day, and taking rifampin capsules twice a day.

I’ve re-started PT once again, and I went back at work last week (6 days after surgery). It’s frustrating to have put in so much work to regain mobility just to have more surgeries kick me back down again. No more surgeries scheduled as of now; just waiting to see how this course of antibiotics goes. I need to talk with my infectious disease specialist again because I want to better understand his plans…what is he looking for in my weekly bloodwork? When does he anticipate discontinuing the antibiotics? What’s the plan after ending the antibiotics–hopefully not just “wait and see". What more can they/we do to make surer this treatment actually works?

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