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Thu, Jun 6 12:46pm · What kind of mobility can I expect with an antibiotic spacer in my hip in Joint Replacements

@briank1958, welcome. My 2-stage revision wasn't successful, but I think the main reason it failed was because they didn't have a positive culture to know, specifically, what kind of bug was causing the infection. My understanding is that 1-stage revisions and washouts are most successful if they catch the infection very early (my ortho was talking in terms of just a few days to a week as "early"). Another thing that I'd recommend if you go the 2-stage route is to try to keep the spacer in for as long as you can to increase your chances of success. I had mine in for three months and it was taken out just as soon as my blood numbers came down and the surgery could be scheduled. I think it might have been better to have more time with the numbers down and staying down before the 2nd stage. I was miserable with the spacer and couldn't wait to get it out and I let that override the recommendations of others to try to hang in there a little longer.
My mobility with the spacer was very limited. I could only get with a walker and stairs were a real challenge (but do-able). Showers needed a bench/chair and help. There is a tremendous amount of popping and grinding in the joint which is painful and unsettling in the beginning, but does improve somewhat. I was only able to sleep on my back (a reclining chair worked the best and was where I slept most of the time).
It wasn't until after my failed 2nd stage revision and then a wash-out that they finally were able to culture which strain of staph was causing my infection. I haven't been able to regain my full range of motion, but it's pretty close to full use of my hip (90%). I think all the scar tissue from the surgeries is what limits full flexibility.

It's been a year (today!) since I completed the last of my antibiotic meds. There were some real low lows along the way, but I'm feeling good.

Tue, Apr 9 10:42pm · What kind of mobility can I expect with an antibiotic spacer in my hip in Joint Replacements

@izabel and @linjane, I'm so glad to hear things are going well for you both!

My knee bothered me fo a while after getting things in order and resuming normal activity. At first, I worried that a new knee might be in order (more surgery was the last thing I wanted to think about), but the knee pain passed in a few months. I think after walking differently for so many years with the bad hip, and then the additional strain on it while doing PT and rebuilding strength, it took a while for the knee to adjust to the new "normal" and now it's fine. When I was still in PT, my threapist would tape my knee occasionally and I found that helped a bit.

Fri, Feb 1 11:40pm · "Scars can do weird things" in Joint Replacements

@contentandwell sorry for the delayed reply and thanks for your ideas. I do need to focus in on what's going on immediately preceeding these "flare-ups". So far it's (still) only happened twice. It has only seemed to be a superficial/dermal issue, but it's proximity to my hip issues always get me paranoid after all I've been through with the hip infections. My leading hypothesis is that it's a skin irritation brought on by the fact that that we let our dogs sleep in the bed with us and, like dogs, they shed hair and/or dander — but we do change & wash our bedding very frequently. Kicking the dogs out of the bed might be harder than the 5 hip surgeries, though. Haha.

@debbraw you are sooooo spot-on with the suggestion that fatigue might have something to do with the timing of these issues. With the hip infections that kept popping up in the past…it ALWAYS seemed like troubling symptoms would manifest on a Friday when it was diffucult to get in with the regular docs. I tended to think that it was just a Murphy's Law kind of thing, but your work schedule theory is right on the mark. My (mostly office) job isn't anything wildly out of the ordinary, but for the most part anyone's work schedule would lead to times when you're more stressed, tired, and more susceptible to health issues. That could make an interesting thesis/research project for someone (perhaps it's already been done).

I'm hoping that it's just some weird hyper-sensitivity brought on by the (repeated) surgeries and the scars they left behind…and that it will become less of an issue as time goes by.

Fri, Jan 25 1:36am · "Scars can do weird things" in Joint Replacements

First of all, I really want to thank Mayo Clinic Connect for the community you've developed here. I have learned so much and have been able to share my experiences with others. Thank you.

I've been on a rather long road after my right THR became infected. I first went through a 2-stage revision with an antibiotic spacer that I posted my initial questions about here, and chronicled some of my additional troubles: https://connect.mayoclinic.org/discussion/what-kind-of-mobility-can-i-expect-with-an-antibiotic-spacer-in-my-hip/

In any case, I feel confident my joint infection is behind me. It's been almost 11 months since my last surgery, and 7 months since I finished the last course of antibiotics.

However, about three months ago, I had a scare that made me fear the infection might be back. I had a lot of swelling, redness, and sensitivity immediatly adjacent to the posterior THR scar (and only on one side of the scar, the posterior side). This flare-up began to show on a Friday night when I couldn't get in to see my ortho or infectious disease (ID) doc and had mostly settled down by the time I was able to get in with them the following week. My ID doc ordered the regular blood work and while some of the numbers were elevated, none of the indicators were wildly out of place.

My ID Doc (who I totally respect) was rather puzzled about what this might have been and, among other things, offered this: "scars can do weird things".

Last weekend, the same thing happened again (it's ironic how almost all of my episodes seem to happen on a Friday night). There was the same swelling, redness and localized pain symptoms and this time it later developed a "rashy" look, as well. Once again, this manifested on only the posterior side of my scar and it was mostly gone by the time Monday rolled around. I didn't bother to go see either of the docs this time. I'm still paying off the last of my hip-related medial bills and I'm very reluctant to rack up another hundred or two $ in out-of-pocket costs for an office visit and possible lab test costs for something that might not be (?) very conclusive.

As of today (Thursday), there are no signs of the flare-up from this last weekend and I still have all of my strength and range of motion in my right leg.

Has anyone had experiences like this? If cost wasn't an issue, I'd be chasing things with a specialist, but I don't even know where to begin with something weird like a scar-related complication.

Thu, Jan 24 9:53pm · What kind of mobility can I expect with an antibiotic spacer in my hip in Joint Replacements

@izabel — what great news to hear your numbers have come down to where they should be and that you're trying your best to get some exercise. It's scary how much atrophy can happen in a relatively short time when you're so limited in what you can do. Of course, the surgery for your second stage will knock your mobility back down again, but the recovery will be that much quicker if you can maintain some (albeit reduced) level of strength and range of motion at this point.

You have the right attitude about being patient with this process. I think the longer you can stick with this stage (even though it's no fun at all), the better overall chances you have at success.

All the best,
Art in Alaska.

Dec 12, 2018 · What kind of mobility can I expect with an antibiotic spacer in my hip in Joint Replacements

@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.

Nov 12, 2018 · What kind of mobility can I expect with an antibiotic spacer in my hip in Joint Replacements

Wow, over three years and then an infection? I'm sorry to hear that, it must have been quite a shock. With my spacer they said I could be 50% weight bearing, and I doubt I could have really put 50% weight on it anyway…the pain was too great. Did they give your husband a reason for no weight bearing at all?

Nov 12, 2018 · What kind of mobility can I expect with an antibiotic spacer in my hip in Joint Replacements

I'm so glad you're on the other side of it! I had a terrible time with my spacer and was so glad to be done with it. Cultures do get contaminated sometimes, and I'm crossing my fingers for that to be the case with yours. You'll have your mobility back in no time, now get at it with the PT! 🙂