Kate - Staph Infection 3 Years Post Op!

The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in fewer than 2% of patients

The most common causes of infection following hip replacement surgery are from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your prosthesis.

Following your surgery, you may need to take antibiotics prior to dental work, including dental cleanings, or any surgical procedure that could allow bacteria to enter your bloodstream. For many patients with a normal immune system the AAOS and American Dental Association recommend dental prophylaxis for 2 years after a primary total joint replacement surgery.

Warning signs of a possible hip replacement infection are:
• Persistent fever (higher than 100°F orally)
• Shaking chills
• Increasing redness, tenderness, or swelling of the hip wound
• Drainage from the hip wound
• Increasing hip pain with both activity and rest

I took this disclaimer right off a website for hip replacement. We all have read this disclaimer and most of us pay little attention to it. Only 2% of the people, certainly that couldn't be me!  After a hip resurfacing, the euphoria of returning to a normal life is so overwhelming that we spend little or no time considering what might go wrong.

I had my resurfacing in May of 2005 and the euphoria lasted until July of 2008.  It then ended abruptly with a staph infection in the resurfaced hip.  All in all I would not change anything about my resurfacing or the subsequent happy 3 years. I was able to hike in the mountains, ride my horse, run and play and enjoy life.  I had no pain, was back to any and all yoga poses I loved before my hip went bad, life was good.

On the day of July 20, 2008 I had a horse clinic in progress at the horse facility across the road. I had 29 out of town participants as well as their families or support groups.  We had 14 individual dressage lessons, and 8 groups of 4 each for cross country.  At the end of the day I was hosting a BBQ for all involved...about 60 people or so.  It was a warm sunny day, and things were going great. I ran through numerous dressage tests with kids on lead lines, cut and placed saplings as ground poles for jumps that required them, constructed several cross country jumps from hay bales. From 6 AM on I was going non stop. I felt great, superhuman like you sometimes do on an adrenaline high.  About 6 PM I was watching the last cross country group of the day when my phone rang. It was my daughter, and folks had started to arrive at the house for dinner, she wanted me home!

As I turned to go home I felt a twinge in my resurfaced hip.  I thought, well maybe I overdid it lifting logs or running today and it is sore.  By the time I got home, about ¼ mile I was walking with a pronounced limp...pretty odd considering how great I had been feeling less than 10 minutes before.  I got home, and got the food set out, things were going well, but I felt pretty bad so I retired to my office with a beer and several ibuprofen to complete all the necessary paper work for the schooling show we were putting on the next day.  I put my foot up and went to work, but each passing minute brought more hip pain, and more general aches and pains. When I got up to see how things were going it was about 7:30.  I felt worse than ever, and dug out a pair of crutches just to get around.  Finally everyone left, and I headed straight to bed, but could not sleep.  I started running a fever, then severe chills, like nothing I had ever had before.  I kept telling myself I had a show to put on the next day.  About 5 AM, my fever was 103 and I was weak, alternating between extreme chills and sweat producing fever.  My whole body ached like I had a severe case of the flu.  I called a few folks to tell them they would have to stand in for me at the show...luckily I had finished all the preparations the night before. I called my doctor who told me to get myself to the emergency room ASAP.  Since it was a Sunday in my small rural community things kind of got hung up for a while.  The pain killers really helped, and luckily they held off on antibiotics until they could determine what was actually wrong with me.  I knew my hip hurt...but of course x rays didn't show anything wrong.  On Monday my doctor and my orthopedic surgeon came up with a plan over the phone.  About noon I went in for a needle tap of my hip joint to determine if there was any infection.  At about 12:30 the needle tap revealed a joint filled with pus, and my blood cultures from the previous day came back positive for Staph.  I was sinking into severe Septic shock. 

As I emerged from the operating room where they had tapped my hip I was bundled off in the ambulance to the airport for the 3 hour air ambulance trip to Salem.  This all gets a little fuzzy now, as my body was shutting down rapidly.  I later learned my liver, heart and other major organs were starting to swell in reaction to the whole body infection. My surgeon met me at the hospital and I was in surgery by 5:30 PM.  He opened the joint, and flushed and cleaned it. He thought he had gotten all the infection, and the resurfaced joint looked so perfect he decided to leave it in and close me up. The next day I worked with an infectious disease specialist on what drugs I would need to take to complete the clean up of my system.  It turned out that my staph was just regular staph aureus, not the dreaded MRSA (antibiotic resistant) staph. We started on a course of antibiotics, and although I felt as though I had been through a month of hard labor, I was excited to start getting better.

After about 4 days in the hospital, a different Infectious disease MD came in to my hospital room, and told me I needed to have this hip out, an antibiotic spacer put in, and then in another 6-8 weeks a regular hip replacement. That didn't go over too well with me. I really wanted to keep my resurfacing, and I was just starting to feel human again.  He told me the odds were against me actually beating this infection, but of course I got my way. After 8 days in the hospital I went home on antibiotics, 1 gram of  ANCEF  3 x per day intravenously through a PIC line they had placed in my arm, and 875 MG 3 times a day of RIMFAMPIN. I followed this regimen for 7 weeks, and then was put on 825 MG 2X per day of AUGMENTIN.  I honestly did not get back much energy or strength until I finished the IV therapy.  I got progressively better on the AUGMENTIN and on December 4th I got the news I was better and could go off the antibiotics.  I wish I could say that is the happy ending to my story.

On December 7th I was etching and dyeing scarves with a group of friends for Christmas presents.  Again, I started out feeling pretty good, but by 2 PM I was beat, and headed home. I was starting to feel achy again, but being an eternal optimist I thought perhaps it was a touch of the flu.  About 7 PM the chills and fever returned as well as severe pain in my hip. No longer able to avoid the obvious, I headed to the hospital where I was given antibiotics and painkillers, and told to head to Salem the next day.  I was admitted to the hospital again, and they did another hip tap...the infection was definitely back.  On Dec 9th I had the resurfacing hardware removed, and a temporary antibiotic impregnated spacer put in. This required removal of part of my femur.  When they removed the hardware they found a colony of sneaky staph that had been holed up underneath the metal in my pelvic bone.  I got another PIC line, and after 7 days went home on the same Antibiotic regime as before.  Again the therapy itself is exhausting, and this time I had to be on crutches until the next surgery as well.  I finished the IV ANCEF and RIMFAMPIN therapy, and went on AUGMENTIN until my final surgery on Feb 24.  During this surgery I received a Big Femoral Head Conserve THR. 

Miracle of miracles, this finally seems to be working. This whole process has taken much of the optimist out of me.  But I am now 5 weeks out of surgery, and walking without assistance, feeling pretty good. I have been off of antibiotics since 5 days post surgery so am beginning to gain confidence that this time I am healed.  This recuperation is going OK, but slower than I would like. I think my body is still trying to sort out what it has been through, and my muscles had atrophied some from not being able to put more than 25% weight on the operated hip. 

The final part of the story is the best guess as to where the staph infection came from was an infected sliver in my foot. It wasn't bad...you know the type, so small you need a needle to dig it out, kind of red and pussy, but no big deal. I had had it for a few days, was cleaning it daily and putting triple antibiotic lotion on it. In the future I will pay more attention to these little infections, and so should you if you have a metal joint replacement. I will also never consider not taking my antibiotics prior to teeth cleaning or minor medical procedures. I try to share this experience with everyone who had a metal joint, because I have lost over 8 month of my life trying to overcome this infection, and even though I read the disclaimers, I never thought it could happen to me.  But it did, and it could happen to you as well. Since this experience I have met or heard of several people with similar experiences.  Please be careful, and see a physician if you have a persistent infection of any kind.

I am looking forward to a new year, and so far my new hip is performing well. I am disappointed to no longer have a resurfacing. I am only 53 years old, and really didn't want to have THR yet. But life goes on, and I have what I have.  I am hoping this is my last encounter with Staph aureus ! Remember, this infection occurred over 3 years after the hip resurfacing. All precautions were taken, and the infection did not occur from surgery itself, but from a later infection in my body, that migrated to the metal in the hip joint. I would urge anyone who develops a late stage infection in their resurfaced hip to forgo debridement, cleaning, and antibiotic treatment, and jump right to the two stage revision. In retrospect I could have had 6 months of life back had I chosen that option. 

IN conclusion I add another disclaimer from another website...take heed, you may be one of the 2 %.

Infection is the most feared of all the complications in total hip and total knee arthroplasty.  Fortunately, the incidence of infection is quite low.  The rate of infection should be less than 1:250 to 1:500 joint replacement surgeries.  The frequent causes for infection at the time of surgery are contamination during the operative procedure or bacteria being released into the blood from sources such as the urine, bowel, or lungs.  Surgically, we make every attempt to maintain a perfect sterile field.  We will use body exhaust, or space suits, to keep the surgeons as sealed from the operative field as possible.  In addition, we use a Water-Pic device to keep the wound meticulously clean.  We will also use antibiotics around the time of surgery to reduce the incidence of infection.  

If an infection is identified within the first two to four weeks after the surgery, initial attempts can be made to treat this with a surgical procedure to clean the wound thoroughly, and to place the patient on six weeks of intravenous antibiotics.  The success rate of this is approximately 25-80% depending on the type of arthroplasty, the medical condition of the patient, and the specific bacteria causing the infection.  

If the infection is identified after the first two to four weeks, the likelihood of success with cleaning out the wound and placing the patient on antibiotics is very low.  In this setting, it is recommended to undergo what is referred to as a two-stage reconstruction.  The first stage is to remove the total hip arthroplasty components to surgically clean the wound and remove all infected tissue, bone cement, and debris, to place an antibiotic impregnated spacer within the wound, and then to place the patient on intravenous antibiotics for six to eight weeks.  The patient is then taken off of antibiotics and will undergo an aspiration procedure.  If this aspiration is negative and the patient is doing well clinically in terms of no drainage, no pain, and no fever, the patient can then undergo revision or re-replacement with new joint replacement components.  The risk of recurrent infection with this procedure is approximately 10%.