Case of an infected hip

[muzza]

I recently heard of a person with a resurfaced hip who suffered a cut to the foot  when walking on the beach.  The cut got infected and the infection lodged in the metal hip. Apparently, the person nearly died and it took months of hospitalisation and treatment before recovery.

I intend talking to my surgeon again about what precautions should be taken to prevent hip infection from general wounds and infections. I was wondering if any one on this forum has information or advice from their surgeon regarding  the issue of infection at later stages after hip resurfacing.

[obxpelican]

Many doctors want you to medicate (anti-biotics) post-op whenever you get dental care like cleanings, root canals etc, along with medicating whenever you even think you have an infection of any kind.  Best to get a hold of your doctor, but always (IMHO) be VERY conservative when you think you might have an infection because an infection in the hip is VERY serious.

Spencer Roberts is one our resident experts on infection in the hips his email is magoo451@msn.com he's a great guy, I suggest you email him if you have any questions in regard to an infection in the hip, he's been through it.


Chuck

[Pat Walter]

The general information that I have read over the last 5 years is that normal cuts as you talked about do not usually cause deep infections in the hip.  It is infection from something like dental work that gets into the blood stream.  Usually people take care of normal cuts with antiobiotic creams or lotions, but don't normally worry.  Of course, there are always exceptions to most things.  I have never worried about my hip from cuts or even a bladder infection or sinus infection.  I just get antibiotics to treat anything serious.  I always take 4 antiobiotic pills of cephelexin 500 mg before dental work.  I would not spend too much time loosing sleep worrying about infections.

[John C]

The key word here is walking on the "beach". Oceans are very healthy environments for micro-organisms, including bacteria. Here on Maui, the hospitals are very aware of the amount of staph that lives in the sand along the islands beaches. Anytime someone gets a minor cut and spends time in and around the ocean here, the odds are very high that they are in for a serious infection, one that would pose extremely high risk to any artificial joints. Before I had my resurfacing, this risk of infection from minor cuts being exposed to the ocean environment  was probably my biggest long range concern, and it continues to be.
I am in the ocean for many hours every day, and any minor cut, like I am dealing with right now, is treated with thorough cleaning, antibiotic ointment, and layers of waterproof bandages like my life depended on it; I know that my hip does.

[muzza]

Thanks for all the comments and information.  I too used to do a bit of surfing.  There is a very popular beach here in Victoria, Australia, called 13th Beach. Great waves, but at one end of the beach, there is a storm water outfall. The beach is notorious for complaints by surfers having picked up sore throats, colds and infections after surfing there.  I once cut my finger on the reef at 13th Beach.  The finger infected and gave me a lot of trouble. It took ages to heal. I didn't have my metal hips then, fortunately.

When I heard about this fellow having all the trouble with a  simple beach cut, I did think about that time I had the infected finger.   If I get back into surfing, I'll steer clear of 13th Beach.

[roosevelt heights]

In Feb 2010 I had my RH resuraced. In April 2010, I completed my bilat procedure on my LH. Approx three weeks after that procedure, I commenced 'aqua therapy". A week after that I began to experience chills and fever...To make a long story short, after sever hours in ER, I was rushed to the hospital where my surgery was performed with a fever of 103...I spent 3 days in the hospital, while they worked on reducing my fever, and my surgeon removed the bacteria "pockets" near my hip....I went home with a PICC line injecting a daily dose of meds to fight the infection for 6 weeks...Add to that I continue to take oral  meds during this time with hope that the doctor sees improvement...Some say I am crazy, but my hips have never felt better ! Moral of the story, make sure your incision or any wounds are treated properly...and any sign of infection, contact you doctor...

[muzza]

Pat,

I have asked my surgeon several times about this matter of hip infection some time after surgery.  He did say cuts and abrasions are not a problem. But he did say bladder and urinary tract infections could cause problems, as well as boils and skin infections.  He did name a type of bacteria that was dangerous, I think he said gram positive bugs.

He only had one case of hip infection well after surgery - an older man who got an infection after dental treatment without anti biotics.

[Pat Walter]

Hi muzza

Thanks for your post.  Interesting information that your doctor has given you.  We all need to be careful about infections and have them treated quickly.

Other surgeons have said that urinary tract infections were not a potential problem. 

Guess we won't argue about what the surgeons think - but be careful when we have problems and get them taken care of.  Then we don't have to worry.  We all want to keep our hip resurfacings until we are very old!

Pat

[silvercat]

Pat, I got n infection in one small spot on my incision wher it opened a bit probably from the long air travel home and all the sitting.  The doctor in the states and DeSmet were very concerned and right on it immediately.  This was a staph infection.  DeSmet wanted me on antibiotics for 3 weeks not just 10 days.  So the infection is gone and the wound is mostly healed. 

I was wondering about the 4 Keflex/Cephelexin 500 which is what I was given.  Do you just take the four the day of or a couple days before or what?  and is it just 4 and that is all?  I have been wondering about this issue.  I also had Bactrim for the 1st 10 days. 

The general information that I have read over the last 5 years is that normal cuts as you talked about do not usually cause deep infections in the hip.  It is infection from something like dental work that gets into the blood stream.  Usually people take care of normal cuts with antiobiotic creams or lotions, but don't normally worry.  Of course, there are always exceptions to most things.  I have never worried about my hip from cuts or even a bladder infection or sinus infection.  I just get antibiotics to treat anything serious.  I always take 4 antiobiotic pills of cephelexin 500 mg before dental work.  I would not spend too much time loosing sleep worrying about infections.

[Pat Walter]

Hi silvercat

I definitely would listen to Dr. De Smet and take the antibiotics for 3 weeks.  You don't want to take any chances with infections. 

I take 4 - 500 mg cephelexin one hour before I get my teeth cleaned or any type of dental work. Some recommend only doing that for 1 year and others to always do it.  I prefer to stay on the safe side.  I now have to protect both my hip and my new aortic valve - so I don't take chances.  Infections are bad news and usually can cause a lot of problems, so be careful.

Pat

[BerkeleyGirl]

I am indeed worried about infections since I'm prone to bladder infections and occasional face rashes which I treat with a low-dose course of antibiotics for a couple of months. And before my hip problems, at least, I've traveled all over the world... months in Tibet and Nepal trekking, or in Southeast Asia, etc. Because I also get migraines (I really sound like a mess, don't I? :-), I'm accustomed to carrying meds with me... but I fear that I'll be chained to a growing arsenal of meds for the rest of my life.

Does anyone know if there's less infection problem with a THR than with a HR? Or with metal devices vs. ceramic (say, with a THR)? I still have to decide which I'm going to have at my surgery scheduled for Dec. 13. The doc (one of those with 500+ resurfacings) said that because of my body shape and size, and my hypermobility (which can be a risk factor for metal wear with a HR), I might want to consider THR rather than HR. He's willing to perform either and has left the choice up to me.

I've been distraught over making this decision, and the infection and metal ions issue is a real factor. Thanks for any information.

[John C]

Yes, infection is a serious concern, because it can lead to a very bad long term outcome, so you are wise to be careful. It was the main reason that I put off my surgery for many years. When I looked into this, I was told that the infection risk is similar in all replacement devices, but resurfacings are slightly easier to treat, because of not having the long stem to give the bacteria access to the inside of the femur, where it would be very hard for antibiotics to reach.

[muzza]

I had a scare recently. I was on holiday in Hong Kong and at the horseraces at Sha Tin. I had lunch which was chopped up chicken, still on the bone in the Chinese style. Anyway a sliver of chicken bone pierced my gum and stuck there. My gum started bleeding profusely. I pulled the sliver of bone out and the bleeding stopped after a while.   The possibility of infection problems with my metal hips was in the back of my mind and I thought i'd better wash my mouth out and cleanse the wound. All I had on hand was a pint of beer which I swilled around my mouth. I had a couple more pints during the course of the day which made me more relaxed about things.

Didn't think much more about it until the following night when I woke up with a headache and what I thought was a slight fever.  I got worried and sought out an all night medical clinic. The doctor examined the gum wound, took my temperature and blood pressure etc. and said not to worry, I didn't have any indications of infection - no need for antibiotics - just rinse my mouth regularly with an antiseptic mouth wash. The headache went away and luckily all was well.

[BerkeleyGirl]

That is indeed scary. It seems to make sense just to carry antibiotics all the time, just in case. I carry migraine meds, and you do get used to it.

[Pat Walter]

Berkeley Girl

I don't think you have to be that scared about infections.  Just use normal common sense.  A tube of triple antiobiotic ointment will do in many cases.  Not all small infections will end up on the hip device.  I have a new aortic valve and the infection can actually destroy the valve requiring another open heart surgery.  So I am careful, but not going to spend my life worrying about it.  If I get an infection, it will have to decide if it is going to attach itself to my BHR or my new aortic valve! Some infections are worse than others.  Standard urinary tract infections and sinus infections are most common.  Either one normally requires a doctor visit and some antiobiotics.  I have not worried about my BHR if either happened.  I just don't let things get really bad.  We just need to be careful, not frightened about getting on with our lives.

Pat

Pat