Hip replacements now a problem with infection

Bones, joints and muscles
1

I could do with some advise, has anyone ever had these problems?

I had both my hips replaced in Italy where I worked and lived due to Arthritis now after 5 years I started to get some pain in my left hip so I went to a hospital here in Thailand where I live now to have it checked out, after a number of tests they found I had quite a big infection.

The surgeon told me I would need two operations, first one to remove the artificial hip and insert antibiotic cement moulded as the ball of the bone to go into the hip socket and to leave this in for 2-3 months I was told not put any weight on it and not to use a walker only to move by wheelchair which basically meant bedridden.

I had blood tests done at the hospital every 2 weeks to check how the infection was doing,
it eventually came down from an infection count of more than 150 to only 8, but then it started to go up to over 30 the surgeon explained this is because after 3 months the antibiotic was no longer working and there was still some infection left so I would need another operation to change the antibiotic cement to a new one for about 2 months until the infection count goes down to zero.

Everything was fine for a while then after about a month the infection count strangely started to go up again the doctor tried many different types of antibiotics tablets but to no avail, the doctor explained the problem is the infection that was type S had changed to type R, because of the use of many different antibiotics for a long period the infection had become resistant and the antibiotic can no longer kill it.

So they decided to use an antibiotic that plays a role of the drug of last resort, intended for use in people suffering from multidrug-resistant infections it worked and the infection eventually count came down to 10 at my last blood test.

I went to the hospital yesterday the surgeon told me seeing as the infection is now low he sent me for a blood test an X-ray and finally a CT scan then to go back to see him again for the results the blood count had come down to only 7 now great I thought.

The surgeon explained that due to the treatment being for a long time 6 months to now have the hip implant there would be a high risk 80-20 of the infection returning and could not give me any guarantee of success, it was as if a bombshell had hit me.

He said, so now I have two options to consider replacing the hip and accepting the risks was the first or the second option would be to have an operation to remove the cement but not replace the hip this way less complications.

I would be able to walk he said but only with the aid of a walker or crutches,
I was in total shock after all I had been through and being bedridden for 6 months this was the final result.

The doctor is going to get a second opinion about my case from another surgeon that is at a different hospital.
I have an appointment with my surgeon for next Friday and he will explain what the other surgeons thoughts are and I have to tell him which option I have decided.
What a decision to make a nightmare and it’s not over yet.

I’m sorry for the long post.

2

Hello John,
Oh my stars … not the news any one of us wants to ever hear.
Hip surgery for infection is a long and difficult recovery journey.

I experienced cobalt poisoning from primary surgery. 6 years later during revision the joint looked like a engine crank case with all the black necrotic tissue and bone from corrosion . All components were replaced , some with ceramic and no more mom. It was a 2 year recovery to walk again. I don’t have any advice but piles of sympathy for what lies ahead. This is what we all fear and you have a difficult decision to sort thru.

I’m so very sorry you’re struggling with this. Hopefully this turns around soon . Prayers for your comfort and peace of mind as you begin to embark on a decision.

You might ask about a wound vac and a wound vac dressing after surgery.

I am not a doctor, just wanted to share a bit of my revision journey hoping to encourage and support you.

3

Thanks for your reply,
My doctor explained recovery from infection in joints take a long time as very little blood goes through it and the antibiotics travel in the blood therefore little arrives at the joint.
I see you also went through a much longer bad period than I have and you have managed to walk again in the end.
This is my aim and even if the surgeon has told me he does not recommend I choose the hip replacement because of the high risk of the infection returning in his words “it would be a disaster” I have already decided to take my chances “life is a gamble anyway” so I choose to have the hip replacement done and go on from there fingers crossed.

4

Hello,
I know that this decision to go ahead with treatment was not a easy one. Just as you said," Life is a gamble".
When will the surgery begin for antibiotic treatment and spacers?
I hope this will all work out for you . You are so brave knowing all the risks and still willing to take them and this can be a long road.
Sending positive support and will keep you in my prayers.
Hoping you have family and friends for home support .
Please keep me posted …I will always be here.

5

Hi,
I have an appointment for next Friday with the surgeon when I to say which option I want to do and he will tell me about the second opinion from the other surgeon, the surgery will be about a week after my visit.

I have a lady doctor at the hospital that deals with the medical part not the surgeon, I am still taking the multidrug-resistant infection antibiotics called (Zyvox) that she prescribed for me. I spoke with her last week and she made the appointment for me to see the surgeon saying it was time to speak with him about a date to remove spacers, cement and doing the hip implant operation.
She also explained that I must continue with these antibiotics during my hospitalisation and after at home for a maximum of two months from the date I started as this is the maximum period of time recommended to take them.
One of the reasons I have decided to have the hip implant is because I don’t believe the surgeon about it being a high risk that the infection may return because it’s been a long time over 6 months since I had my first operation also where did he get that figure (80-20) from the top of his head I think and when he told me it would be disaster if the infection returned, I asked him why but he didn’t really explain there was also one or to other things that I wont get into.

Good I have my wife and daughter for support.

6

Hi John,
Nice to hear you have family there for you that’s a very important support system.
You have already been thru more than most. Infections are so difficult . It’s exhausting just coping with daily life. My biggest pet peeve with surgeons is that sometimes surgeons don’t take enough responsibility to take enough time for comprehensive explanations. It’s helpful to know all the factors involved. Like you most of us need all the info to make quality decisions.
Thank you for clearing up where your are now with your treatment so far . Now your next surgery plan is to remove the spacers and on to hip implants.
Are they metal ceramic or both. Be sure no metal on metal. When you know what model and manufacturer please let me know.
Antibiotics will be a good thing for fighting those nasty bugs. (IV and oral ).
Also if you haven’t already ask for a dietician to help with diet to support healing and foods to eliminate ,and supportive probiotics to take , Foods like sauerkraut pickeled beets , foods to support good bugs in the gut .No sugar…its a tough one.
Let me know when your surgery is scheduled , hope its at a big hospital with a great team to get you thru with many experienced specialists .
I will keep you in my thoughts and prayers.
Sending healing blessings your way.