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.

Liked by lynzze

@jbro

I'm catching up on reading all the postings in this discussion. I hope you are still free of infection since your false alarm episode that occurred approximately 3 months after your last IV antibiotics treatment. Today is the first day of my 3-month observation period in which I need to be free of infection for the doctors to say I am clear of an MRSA infection of the tissue near the incision (that hopefully never attached to my prosthesis) following my September THR. Yesterday I finished my 6 weeks of daily antibiotic infusions, which began with my October debridement surgery.
If my infection returns, then I will have to travel a path similar to yours, but my surgeon mentioned 2-stage rather than 1-stage for a 2nd THR. Apparently your surgeon gave you the option for 1-stage. Can I ask you to comment on that again?
Also, did the subject of a "salvage" procedure (resection arthroplasty, or "Girdlestone") ever come up as the most successful way to eradicate infection, albeit with functional outcomes that do not compare well with a successful THR?
Thank you for your time.

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Hi Jbro. My debridement was Nov 2017 with 6 weeks of oral antibiotics. However within 2 weeks of stopping I was very flulike with all the red flags for prosthesis infection. The only option for me in the UK was 2 stage hip replacement with the antibiotic spacer. I had this in June ( things move slowly with the nhs) I beleave this is gold standard treatment. Don't think I would have been happy with girdlestone surely that's last resort. Seen my consultant today all is going well and can start weight bearing in 2 weeks. We have also been given the go ahead to book a holiday, very much needed. I hope your debridement is successful and you don't have to go down this path. If you do it's just a case of putting your life on hold and getting through it. Good luck.
Lin

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@linjane

Hi Jbro. My debridement was Nov 2017 with 6 weeks of oral antibiotics. However within 2 weeks of stopping I was very flulike with all the red flags for prosthesis infection. The only option for me in the UK was 2 stage hip replacement with the antibiotic spacer. I had this in June ( things move slowly with the nhs) I beleave this is gold standard treatment. Don't think I would have been happy with girdlestone surely that's last resort. Seen my consultant today all is going well and can start weight bearing in 2 weeks. We have also been given the go ahead to book a holiday, very much needed. I hope your debridement is successful and you don't have to go down this path. If you do it's just a case of putting your life on hold and getting through it. Good luck.
Lin

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When you had flulike symptoms 2 weeks after stopping your 6 week antibiotics, did they immediately aspirate the hip joint to confirm the infection, and type? Then, did you have surgery right away to remove the prosthesis and have it replaced with a temporary cement spacer, which was subsequently replaced with a new prosthesis in June? If yes, how challenging was the recovery with the spacer?
Thank you for your time. I’m trying to get my mind around what may be ahead.

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@jbro

When you had flulike symptoms 2 weeks after stopping your 6 week antibiotics, did they immediately aspirate the hip joint to confirm the infection, and type? Then, did you have surgery right away to remove the prosthesis and have it replaced with a temporary cement spacer, which was subsequently replaced with a new prosthesis in June? If yes, how challenging was the recovery with the spacer?
Thank you for your time. I’m trying to get my mind around what may be ahead.

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Hi Jbro . Unfortunately in answer to your question the answer was no! I had to wait 9 weeks to get the MRI and result then the aspiration was done the next day! I then had to go 12 weeks to get his funding for the operation. The NHS is in crisis over here. I tried to go privatley to speed the process but the services were too fragmented. My consultant wanted all my care under the same roof. Even he was very frustrated at the time it took. The prosthesis came out in June this is when the spacer was fitted. It was a tough 4 months but I think reading all the above threads I had it easier than most as I could 50% weight bear and a good physio. It was only replaced at end of October. I'm still ploughing through the antibiotics. I feel confident it will be ok as it feels very good, the other hip never did. Good luck I hope you don't need the surgery. It sounds like they got on top of your infection very quickly. So hopefully you will be ok.
Lin

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@linjane

Hi Jbro . Unfortunately in answer to your question the answer was no! I had to wait 9 weeks to get the MRI and result then the aspiration was done the next day! I then had to go 12 weeks to get his funding for the operation. The NHS is in crisis over here. I tried to go privatley to speed the process but the services were too fragmented. My consultant wanted all my care under the same roof. Even he was very frustrated at the time it took. The prosthesis came out in June this is when the spacer was fitted. It was a tough 4 months but I think reading all the above threads I had it easier than most as I could 50% weight bear and a good physio. It was only replaced at end of October. I'm still ploughing through the antibiotics. I feel confident it will be ok as it feels very good, the other hip never did. Good luck I hope you don't need the surgery. It sounds like they got on top of your infection very quickly. So hopefully you will be ok.
Lin

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Lin, Thank you for your encouragement. I really appreciate it. I now see what you meant by “putting your life on hold” as you waited for the next obstacle to overcome on your way to the finish line. Your perspective is a blessing to me. Blessings to you.

Liked by linjane

REPLY
@linjane

Hi Jbro. My debridement was Nov 2017 with 6 weeks of oral antibiotics. However within 2 weeks of stopping I was very flulike with all the red flags for prosthesis infection. The only option for me in the UK was 2 stage hip replacement with the antibiotic spacer. I had this in June ( things move slowly with the nhs) I beleave this is gold standard treatment. Don't think I would have been happy with girdlestone surely that's last resort. Seen my consultant today all is going well and can start weight bearing in 2 weeks. We have also been given the go ahead to book a holiday, very much needed. I hope your debridement is successful and you don't have to go down this path. If you do it's just a case of putting your life on hold and getting through it. Good luck.
Lin

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lindane,
If you don’t mind me asking, what were your flu-like symptoms in late 2017? Elevated numbers from blood draws, fever, night sweats, swelling, redness, increased pain? If you had increased pain, how would you have described it at that time? Thank you, jbro

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@jbro

lindane,
If you don’t mind me asking, what were your flu-like symptoms in late 2017? Elevated numbers from blood draws, fever, night sweats, swelling, redness, increased pain? If you had increased pain, how would you have described it at that time? Thank you, jbro

Jump to this post

Sorry for the typo … linjane instead of lindane

REPLY
@jbro

I'm catching up on reading all the postings in this discussion. I hope you are still free of infection since your false alarm episode that occurred approximately 3 months after your last IV antibiotics treatment. Today is the first day of my 3-month observation period in which I need to be free of infection for the doctors to say I am clear of an MRSA infection of the tissue near the incision (that hopefully never attached to my prosthesis) following my September THR. Yesterday I finished my 6 weeks of daily antibiotic infusions, which began with my October debridement surgery.
If my infection returns, then I will have to travel a path similar to yours, but my surgeon mentioned 2-stage rather than 1-stage for a 2nd THR. Apparently your surgeon gave you the option for 1-stage. Can I ask you to comment on that again?
Also, did the subject of a "salvage" procedure (resection arthroplasty, or "Girdlestone") ever come up as the most successful way to eradicate infection, albeit with functional outcomes that do not compare well with a successful THR?
Thank you for your time.

Jump to this post

@jbro sorry for not replying sooner to your questions. I'm still doing well, even after the false alarm.
When my infection first presented (after the first THR), I first became suspicious something was wrong because I began to lose strength and range of motion (things I had regained through PT after the THR). The first infection wasn’t clinically obvious until it actually showed as large abcess coming out through the surgical scar but that was probably another 6 weeks past what I felt were the initial concerns I had relayed to my Ortho and his PA.
Through all of this, I had often asked about more rigorous testing. But, to put it into perspective, my infectious disease doc (who I really trust) helped me understand it from his perspective: blood work is only indicative of "something:" going on, and it could be anything from a cold/flu or a stubbed toe to an infection at the joint. He was very hesitant to order a joint aspiration because there’s a risk of actually introducing an infection when it may not have otherwise been present.
I think the biggest problem with my infection was the fact that they weren’t able to get a positive culture for anything until after the 2-stage process. Vancomycin is a powerful and broad spectrum antibiotic and while it effectively suppressed my infection, it apparently wasn’t quite right to eliminate what I had. I think they only offered the single-stage revisions after that knowing that the infection was “almost” gone, rather than something that had been there for a while and was most likely attached to the hardware.
My infectious disease doc would never give me a good answer when I asked him about how long until I could relax. “The longer, the better” is all I got. But I think once you make it 3-6 months out, you’ve made it past the infection you had. However, with this hardware, the risk of infection from a new source is always a possibility. Heck, dental cleanings introduce a potential risk of infection to our THR’s but there doesn’t seem to be anything conclusive in the literature about whether those should be treated with antibiotics as a preventative measure (from what I’ve seen).
Wishing you the very best,
Art.

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@jbro

Sorry for the typo … linjane instead of lindane

Jump to this post

No offence taken my name is Lin. I had a high temperature with rigors (shakes and chills). My CRP went to 130. The scar had remained painful to the touch even a gentle touch would make me wince, from the surgery 8 weeks previous. My hip kept getting stiffer, and getting upstairs was very difficult. It was confusing as it was the height of flu season here but I'd had a flu jab and I didn't Have the respiratory symptoms everyone one else had. At the time I thought it was the flu but after confirmation the infection was back both my consultant and I agreed that it wasn't flu. CRP can rise with flu anyway it's just tells you there in inflammation somewhere. I do hope you are not having problems but you must see your consultant ASAP if you are not sure. I have to say it's 7 weeks now since 2nd stage and I can now fully weight bear. It's difficult as my muscles are weak from 7 months of 50% but I feel everything is good, antibiotics finished yesterday and now it's just a waiting game but I'm positive this time. I felt after the debridement it wasn't going to end there. I don't feel like this time. Please let me know how you get on but I've got everything crossed for you. Good luck. Lin

REPLY
@linjane

No offence taken my name is Lin. I had a high temperature with rigors (shakes and chills). My CRP went to 130. The scar had remained painful to the touch even a gentle touch would make me wince, from the surgery 8 weeks previous. My hip kept getting stiffer, and getting upstairs was very difficult. It was confusing as it was the height of flu season here but I'd had a flu jab and I didn't Have the respiratory symptoms everyone one else had. At the time I thought it was the flu but after confirmation the infection was back both my consultant and I agreed that it wasn't flu. CRP can rise with flu anyway it's just tells you there in inflammation somewhere. I do hope you are not having problems but you must see your consultant ASAP if you are not sure. I have to say it's 7 weeks now since 2nd stage and I can now fully weight bear. It's difficult as my muscles are weak from 7 months of 50% but I feel everything is good, antibiotics finished yesterday and now it's just a waiting game but I'm positive this time. I felt after the debridement it wasn't going to end there. I don't feel like this time. Please let me know how you get on but I've got everything crossed for you. Good luck. Lin

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Forgot to add with high temperature every bone in my body hurt typical flu like symptoms.

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@linjane

Forgot to add with high temperature every bone in my body hurt typical flu like symptoms.

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Lin,
Thank you very much for your time and thorough answer. I am 3 weeks removed from the conclusion of my 6-week daily antibiotic infusions, and I was told to contact the doctors if I had two or more of the following: increased pain, fever, swelling, and redness. I was doing fine for the 1st week following infusions, then my scar tissue started to sting and burn most of the time. When I contacted the doctor’s office, they informed me that I had 3 layers of internal sutures that were at peak time for dissolving, which can cause severe irritation in some people. They also told me to resume taking Ibuprofen, along with the acetaminophen I had been taking, and let them know if that did not relieve the pain. It did help for the next week. Since my last CRP lab result (which was just before the beginning of this increased pain) was in normal range, I did not talk further with the doctors. Unfortunately, in the last three days, I have acquired a low grade fever, and the same pain sensations have returned, so now I have two of the symptoms. Since the fever seems to be lessening today, I am hoping it is nothing more than the cold virus that is sweeping through my area right now, and that this virus amplified my pain. Next week I am scheduled for my next CRP lab result. I hope and prayer it will not be elevated. Likewise, I hope and prayer you remain symptom-free, and your CRP lab results will continue to be normal.
Blessings, jbro

REPLY
@mrfish

@jbro sorry for not replying sooner to your questions. I'm still doing well, even after the false alarm.
When my infection first presented (after the first THR), I first became suspicious something was wrong because I began to lose strength and range of motion (things I had regained through PT after the THR). The first infection wasn’t clinically obvious until it actually showed as large abcess coming out through the surgical scar but that was probably another 6 weeks past what I felt were the initial concerns I had relayed to my Ortho and his PA.
Through all of this, I had often asked about more rigorous testing. But, to put it into perspective, my infectious disease doc (who I really trust) helped me understand it from his perspective: blood work is only indicative of "something:" going on, and it could be anything from a cold/flu or a stubbed toe to an infection at the joint. He was very hesitant to order a joint aspiration because there’s a risk of actually introducing an infection when it may not have otherwise been present.
I think the biggest problem with my infection was the fact that they weren’t able to get a positive culture for anything until after the 2-stage process. Vancomycin is a powerful and broad spectrum antibiotic and while it effectively suppressed my infection, it apparently wasn’t quite right to eliminate what I had. I think they only offered the single-stage revisions after that knowing that the infection was “almost” gone, rather than something that had been there for a while and was most likely attached to the hardware.
My infectious disease doc would never give me a good answer when I asked him about how long until I could relax. “The longer, the better” is all I got. But I think once you make it 3-6 months out, you’ve made it past the infection you had. However, with this hardware, the risk of infection from a new source is always a possibility. Heck, dental cleanings introduce a potential risk of infection to our THR’s but there doesn’t seem to be anything conclusive in the literature about whether those should be treated with antibiotics as a preventative measure (from what I’ve seen).
Wishing you the very best,
Art.

Jump to this post

Art,
Thank you for taking time to share your knowledge. I am very glad to hear that you were correct in calling it a false alarm, and that you have been doing well since then. It is easy for me to become paranoid when symptoms arise. My infectious disease doctor told me to contact the orthopedic surgeon if two or more of these symptoms were happening: increased pain, fever, swelling/loss of motion, and redness/wound drainage. Therefore, I was very discouraged 3 days ago ( 2-1/2 weeks after ending my 6-week daily antibiotic infusions) when I came down with a low-grade fever and my pain increased significantly around my scar tissue from two surgeries in 1 month (initial THP and wound debridement). Much to my relief, the fever broke today, and the pain decreased at the same time. (I am trusting it was nothing more than a flu/cold virus that amplified my hip pains.) Next week, I get my first blood draw in 3 weeks to check my CRP and Sed Rate. I hope and pray those results are in normal range like they were the last time, and, more importantly, I continue to be infection-free. Likewise, I hope and pray the same for you. It will be a great joy to get beyond our respective observation periods with a clean bill of health.
One question … what antibiotic did they use after your 2-stage revision, since vancomycin did not eradicate your infection previously?
Blessings, jbro

REPLY
@jbro

Lin,
Thank you very much for your time and thorough answer. I am 3 weeks removed from the conclusion of my 6-week daily antibiotic infusions, and I was told to contact the doctors if I had two or more of the following: increased pain, fever, swelling, and redness. I was doing fine for the 1st week following infusions, then my scar tissue started to sting and burn most of the time. When I contacted the doctor’s office, they informed me that I had 3 layers of internal sutures that were at peak time for dissolving, which can cause severe irritation in some people. They also told me to resume taking Ibuprofen, along with the acetaminophen I had been taking, and let them know if that did not relieve the pain. It did help for the next week. Since my last CRP lab result (which was just before the beginning of this increased pain) was in normal range, I did not talk further with the doctors. Unfortunately, in the last three days, I have acquired a low grade fever, and the same pain sensations have returned, so now I have two of the symptoms. Since the fever seems to be lessening today, I am hoping it is nothing more than the cold virus that is sweeping through my area right now, and that this virus amplified my pain. Next week I am scheduled for my next CRP lab result. I hope and prayer it will not be elevated. Likewise, I hope and prayer you remain symptom-free, and your CRP lab results will continue to be normal.
Blessings, jbro

Jump to this post

Before I replied I read Art's reply. I too had increased pain and redness at 3 weeks following my last surgery and whilst I didn't feel it was infection I saw my GP for confirmation. She wasn't happy and referred me to the on call trauma team who decided after many different doctors looked that it was the subcuticular sutures causing the problem or
possibly a haematoma as a result of using an anticoagulant post op. My CRP was 14. It has all settled and this hip has never felt better. It is very easy to become paranoid but everyone agreed I had done the correct thing by checking it out so if in doubt check it out!!! You asked Art about the antibiotic. When they find an organism they will culture it and test sensitivities and resistance to antibiotics to get the correct one for your infection. They may start one antibiotic before those results are in but will switch it if it's not the correct one. So it will be tailored for your needs. I too hope and pray all will be well but we are all still very vulnerable. Interestingly they don't do routine follow up blood work here as CRP and ESR can be affected by many things. They only do it if there are other worrying symptoms. One thing I will say is the pain I described on the wound that made me wince was a sting! I too recently had a cold and ached and i know other people who have had normal hip replacements that say the same. Good luck keep us informed.
Lin x

REPLY
@linjane

Before I replied I read Art's reply. I too had increased pain and redness at 3 weeks following my last surgery and whilst I didn't feel it was infection I saw my GP for confirmation. She wasn't happy and referred me to the on call trauma team who decided after many different doctors looked that it was the subcuticular sutures causing the problem or
possibly a haematoma as a result of using an anticoagulant post op. My CRP was 14. It has all settled and this hip has never felt better. It is very easy to become paranoid but everyone agreed I had done the correct thing by checking it out so if in doubt check it out!!! You asked Art about the antibiotic. When they find an organism they will culture it and test sensitivities and resistance to antibiotics to get the correct one for your infection. They may start one antibiotic before those results are in but will switch it if it's not the correct one. So it will be tailored for your needs. I too hope and pray all will be well but we are all still very vulnerable. Interestingly they don't do routine follow up blood work here as CRP and ESR can be affected by many things. They only do it if there are other worrying symptoms. One thing I will say is the pain I described on the wound that made me wince was a sting! I too recently had a cold and ached and i know other people who have had normal hip replacements that say the same. Good luck keep us informed.
Lin x

Jump to this post

Lin, Thank you for your experience and wisdom. It really helps. Blessings to you, jbro

Liked by linjane

REPLY

Not sure about a hip implant, but I had a knee Antibiotic spacer and was told I would also have limited mobility – which I was told after the surgery means I should avoid placing any weight on my left leg, I learned pretty quickly I would be doing little more than laying in bed for 8 weeks and my muscles atrophied incredibly quickly ! But your youth is in your favor – I'm 68 – IMO, make sure the surgeon makes your limitations are very clear and also learn what Phys. Training you can get during the time of your limited mobility. I think you will need a regular PT program to maintain your muscles which will help speed your recovery.
Good Luck & Merry Christmas.

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@lturn9

Not sure about a hip implant, but I had a knee Antibiotic spacer and was told I would also have limited mobility – which I was told after the surgery means I should avoid placing any weight on my left leg, I learned pretty quickly I would be doing little more than laying in bed for 8 weeks and my muscles atrophied incredibly quickly ! But your youth is in your favor – I'm 68 – IMO, make sure the surgeon makes your limitations are very clear and also learn what Phys. Training you can get during the time of your limited mobility. I think you will need a regular PT program to maintain your muscles which will help speed your recovery.
Good Luck & Merry Christmas.

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I too would agree with this I asked many if the team how mobile I would be after and nobody could tell me. I suppose until they get in there and decide exactly what they need to do they can't answer. I was shocked after at how limited I would be. However you do get used to it and find other ways to do things. It's a day by day thing and just getting through it Be positive and don't expect too much of yourself. I was lucky I was allowed to mobilise using 50% of my weight.

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