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.

@izabel

PS And to add to my woes I have a 5cm leg length deficiency due to the fall.

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@izabel
I see you sure are going through a difficult time. It's wonderful that you have your husband there to help you just like I'm here to help my husband. We have just been taking day by day. Some days are better then others.

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@jimandlisa

@izabel
I see you sure are going through a difficult time. It's wonderful that you have your husband there to help you just like I'm here to help my husband. We have just been taking day by day. Some days are better then others.

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@jimandlisa Thank you for responding (Lisa, I assume). Does your husband manage well on one foot with a walker? I find it difficult with personal everyday tasks and get weepy whereas I am normally a strong-willed person. I will follow your progress and wish you wellness for the new year.

@linjane Pleased you are doing well. This is really a fight with these viruses. When I was admitted to the hospital for my knee replacement I had contracted MRSA from the previous hospital so on IV antibiotics and into isolation I went before surgery. Needless to say they double checked me for MRSA this time but instead I brought E-Coli to the table!!!

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@izabel

@jimandlisa Thank you for responding (Lisa, I assume). Does your husband manage well on one foot with a walker? I find it difficult with personal everyday tasks and get weepy whereas I am normally a strong-willed person. I will follow your progress and wish you wellness for the new year.

@linjane Pleased you are doing well. This is really a fight with these viruses. When I was admitted to the hospital for my knee replacement I had contracted MRSA from the previous hospital so on IV antibiotics and into isolation I went before surgery. Needless to say they double checked me for MRSA this time but instead I brought E-Coli to the table!!!

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@izabel You poor thing MRSa was bad enough but guess you wanted to keep it company now with E coli hope you feel better soon and quit bringing bugs in .lol
I know how serious this is just joking with you .I came home from hospital with MRSA so know what you went through.

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@lioness

@izabel You poor thing MRSa was bad enough but guess you wanted to keep it company now with E coli hope you feel better soon and quit bringing bugs in .lol
I know how serious this is just joking with you .I came home from hospital with MRSA so know what you went through.

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Hi @lioness You have to laugh or you'd cry! Why do these bugs creep up/into us? Actually, my Surgeon and Internist both told me that we all have E–Coli in our system but only 1% will get it, especially if you have something foreign in your body, ie, replacements! The silent killers, like Cancer … I was perfectly healthy when mine was diagnosed!

I will do my utmost to avoid such aliens in the future!

Have a nice weekend. Hope you are safe from the fires.

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@izabel

Hi @mrfish I have followed your journey and ups and downs with interest. I am in a similar position and would gratefully accept anyone's advice. I am 70 years old and retired having lived a healthy life until …..

I had my left hip replacement in December 2014 following a fall after finishing radiotherapy for a breast cancer operation in October 2013. All went well with the recuperation of the hip replacement following 6 weeks of no weight bearing using a walker for 6 weeks and 18 PT sessions (quite useless actually).

In October 2017 I had another fall and after two hospital visits, X-Rays, MRI and PT for knee problems, during which time I could not walk, a visit to a private Ortho Specialist in February suggested it was more hip than knee problems and took an X-Ray which showed the stem was loose and had slipped. Briefly, back to original Surgeon, a car accident on the way to pre–ops and 3 hospitals later I came home with a knee replacement, hop revision to be done 6 months later after bone strengthening due to diagnosis of Osteoporosis. Six months pass and October 18 hip revision scheduled. Opened up and infection discovered, hip and femur power washed, spacer installed and put in isolation on IV antibiotics. Five days later infection identified as E-Col, put o appropriate antibiotics (Amoxcillin/Clavulanic Acid) via IV and taken out of isolation. After 8 days taken off IV due to veins collapsing, put on tablets 3xday and sent home with 'no weight bearing' instructions. I have to have blood tests every two weeks and this week was told things going well and cut back medication to 2xday due to my weight (115lns), I have to have 4 weeks clear before replacement can be scheduled.

I am finding it difficult to manage life in general. My staples were removed last Friday and I have a well healed scar. My problem is I cannot manage hopping or standing on one foot. My husband is a Godsend but I know it is a strain on him mentally and physically as I did everything (shopping/cooking/cleaning/gardening) for 50 years besides working full time.

Sorry this is so long but I just need support and encouragement to get me through this difficult time.

…. Disabled in Portugal ….

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Dear Izobel, I'm sorry to hear your story. I can identify totally. The blood tests are to monitor to infection mine went from sky high to normal within 4 weeks of discharge from hospital. I hope and pray the same will be the case for you. It is a huge strain on our partners, I too did all and worked consequently my husband had a breakdown as a result of 6 lots of surgery in 2 years ( one being emergency surgery and 12 hours later our daughter had to have an emergency Caesarian. Our grandson was 1 year old a few weeks ago. You really couldn't make my story up!!!!). My leg too was a lot shorter at least 4 cm, following the first stage op but my surgeon promised me he would correct this with the second stage. This is what happened so have faith. I really wish you well. There is light at the end of the tunnel.

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@izabel

Hi @lioness You have to laugh or you'd cry! Why do these bugs creep up/into us? Actually, my Surgeon and Internist both told me that we all have E–Coli in our system but only 1% will get it, especially if you have something foreign in your body, ie, replacements! The silent killers, like Cancer … I was perfectly healthy when mine was diagnosed!

I will do my utmost to avoid such aliens in the future!

Have a nice weekend. Hope you are safe from the fires.

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@izabel Thanks yes Im not in the fire areas I know what you mean I have the herpes and Epstein-Barr in me since I had chicken pox and mono. We just have to try and navigate the mine fields.Have a nice Thanksgiving.

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@lioness

@izabel Thanks yes Im not in the fire areas I know what you mean I have the herpes and Epstein-Barr in me since I had chicken pox and mono. We just have to try and navigate the mine fields.Have a nice Thanksgiving.

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Hope everyone is progressing well and that the Americans have a wonderful Thanksgiving … and don't over indulge! My husband is American and I lived there for 20 years but we don;t necessarily celebrate it but acknowledge it. We have friends coming over tomorrow bringing a roast chicken for lunch so that will do for us. I would love some pumpkin pie … but I do have pumpkin jam in the fridge. Pumpkin is popular here.

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@izabel

@jimandlisa Thank you for responding (Lisa, I assume). Does your husband manage well on one foot with a walker? I find it difficult with personal everyday tasks and get weepy whereas I am normally a strong-willed person. I will follow your progress and wish you wellness for the new year.

@linjane Pleased you are doing well. This is really a fight with these viruses. When I was admitted to the hospital for my knee replacement I had contracted MRSA from the previous hospital so on IV antibiotics and into isolation I went before surgery. Needless to say they double checked me for MRSA this time but instead I brought E-Coli to the table!!!

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@izabel Yes this is Lisa. Sorry I have not been back on before this. I recently started back to work so it's been more of a challenge to work and take care of him. But yes he is getting around fairly good with the walker. He really tried to do things on his own. He don't like to depend on anyone. And it is just really bothering him to sit around and do nothing. So he is constantly up with the walker moving. Which I guess is giving him practice on one foot. But by the end of the end he is really tired. Hope things get better and we can keep in touch.

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@mrfish

Thank you Candace. Wow…a year w/ a spacer! I had mine for three months and was sooo glad to get it out…but my infection came back pretty quickly. Others on here who had experience with spacers recommened keeping it for as long as I could, so that's good advice. You've had the spacer for 4-5 months or so now…how well are you able to get around?

Fortunately my latest episode a few weeks ago turned out to be a false alarm (of sorts). I definitely had some kind of infection going on…swelling, redness and hot to the touch. It was on one side of my surical scar, but it was improving by the time I got in to see my infectious disease Doc. He thinks it might have been something superficial, and not originiating from the joint. He said "scars can do weird things sometimes". It scared the heck out of us, but he other times the joint infection presented, it also came with a loss of strength and flexibility. That didn't happen this time and I take a little comfort in that fact.

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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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@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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