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Author Topic: Pre-Op Infection  (Read 1507 times)

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hipnhop

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Pre-Op Infection
« on: November 23, 2010, 09:01:26 PM »
I am interested to know if anyone can give me some advice? I'm 46 and I have been on crutches for the past 8 weeks. Docs do not want to perform HR because of a suspected infection I received after Cortisone shot (I got the shot in preparation for an Ironman race). Over the past 8 weeks I've had an aspiration and arthroscopic surgery. All tissue and fluid samples show NO sign of an infection. Yet my SED rate is high (15) and Doc does not want to proceed with hip resurfacing until rate is normal (<5). In the interim, I am seeing infectious disease doc trying to figure it out. They have prodded and poked me, three MRIs, Aspiration, Arthoscocpy, blood, urine test and I'm sick of all of it.

I can't walk or work. I drag myself to the pool and plop in the water for some exercise but swimming without being able to kick = drowning. I'm pushing down way too many toxic pills. They even took me off of antibitoic because they don't know what they are treating.

What really upsets me is that no one wants to talk about the Cortisone injection itself. I know inserting a needle in the hip could cause an infection. But I also know that cortisone destroys tissue and cartliage. It is the second part of this statement that no one wants to talk about. Why isn't it even a possibility that the cortisone wreaked havoc on my hip joint and tissue resulting in the indicators of extreme inflammation?

Help someone???

3/2011 and 2/2012 HR Dr. Craig Thomas

Pat Walter

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Re: Pre-Op Infection
« Reply #1 on: November 23, 2010, 09:24:27 PM »
I am not a doctor, but many of us have had cortisone shots into our hip capsules.  As far as I have read, one shot of cortisone will not just deteriorate the hip overnight.  Most surgeons will give you several, but that's all.  Maybe someone knows more, but none of us had our hips deteriorate right after the shot.  I believe it is a slow process.

http://www.arthritis-treatment-and-relief.com/cortisone-shot-side-effects.html


I looked up a little more info and found an interesting piece

"The most common side-effect is a '”steroid flare”. This is a condition where the injected cortisone crystalizes and can cause a brief period of pain worse than before the shot. This usually lasts a day or so and is best treated by icing the injected area. Another common side-effect is discoloration of the skin where the injection is given. This is usually a concern in people with darker skin, and is not harmful, but patients should be aware of this. Atrophy of the skin and thinning of the skin may also occur at the site of injection.

A potentially serious side-effect of cortisone injection, though rare, is infection. The best prevention is careful injection technique, with sterilization of the skin using iodine and/or alcohol.



The article, as others, suggest more than 3 shots a year can deteriorate bone - but I don't think it is an overnight process.  AVN often can be a problem.

"Risks
By Mayo Clinic staff
 
Cortisone shots carry a risk of complications, such as:

■Death of nearby bone (osteonecrosis)
■Joint infection
■Nerve damage
■Skin and soft tissue thinning around injection site
■Temporary flare of pain and inflammation in the joint
■Tendon weakening or rupture
■Thinning of nearby bone (osteoporosis)
■Whitening or lightening of the skin around injection site
« Last Edit: November 23, 2010, 09:25:11 PM by Pat Walter »
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Lopsided

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Re: Pre-Op Infection
« Reply #2 on: November 23, 2010, 09:27:28 PM »
Why isn't it even a possibility that the cortisone wreaked havoc on my hip joint and tissue resulting in the indicators of extreme inflammation?

It is. Don't know why anyone would have a cortisone injection.

Help someone???

Go find a good doctor, better than you have got now. Consult with one of the few of the best.


Proud To Be Dr. De Smet's First Uncemented Conserve Plus, Left, August 2010

littleb

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Re: Pre-Op Infection
« Reply #3 on: November 24, 2010, 01:27:57 PM »
Have they looked elsewhere for infection?

My daughter has a shunt. When she was 2 1/2 she ended up in the hospital for a month with menegitis. In the end they believed a simple ear infection was the root cause. We actually took her out at 9pm when one doctor said that though her rates were still up that could be due to the shunt itself and her body's reaction to it, if we stayed the other doctors would probably want to do surgery. Turned out he was right and she was fine. She will always have a higher rate.

Where is Dr. House when you need him?
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hipnhop

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Re: Pre-Op Infection
« Reply #4 on: December 01, 2010, 05:33:10 PM »
After numerous test, the Infectious Disease department informed me that i have Aseptic necrosis (bone death in the hip). Apparently the Cortisone shot caused it. I am hoping they will clear me for surgery.  Although I do feel my hips getting better. I was able to walk today with only one crutch.
3/2011 and 2/2012 HR Dr. Craig Thomas

andybc

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Re: Pre-Op Infection
« Reply #5 on: December 05, 2010, 07:20:30 AM »
I've just seen this post, now being 10 days post op myself.

I had exactly the same and I'm a radiologist. One of my partners injected me in March this year and when the local wore off that evening I was in agony. After 24 hours I got some bloods done and the markers were in the suspicious for infection range so I had a CT guided aspiration. There were a couple of gram +ve intracellular cocci seen. This equates to possible infection but, equally, could have just been contamination. My colleague is very good at intra-articular work and experienced, I might add.

On the strength of the above I had 3 months (!) of antibiotics - the first month's worth being quite unpleasant. Gradually my markers came back to normal. However, even with raised white cell count, platelet response, CRP and viscosity (not sure what the American equivalents are), I strongly suspect that the cause of my pain was actually haemorrhage into the joint.

I was off work for 6 weeks and in severe pain. That pain abated to the extent that I could walk with a pronounced limp (being stupidly too vain to use a cane) and culminated in my having a resurfacing 10 days ago. But life was totally miserable in the interim. I couldn't really get out of the house, due to the pain, other than to work.

Just to complicate things, I was scheduled for surgery about 2 months ago, but got shingles a week before, so I elected to postpone it. The pain from the shingles was of no consequence compared with the hip pain.

As regards the swimming, incidentally, that was the only thing I could do to stay fit. I swam with what we call a pool-buoy in the UK, which is a polystyrene float you hold between your thighs and that worked a treat for me.

As regards  potential surgery - have you had an MRI scan recently? If not, I would suggest you have one. It will give a good indication of whether you have infection present. Not foolproof but a very good indicator. It would be reassuring, of course, to see your vicosity return to normal but your other blood markers are also important. If it's only a raised viscosity and the others are normal and the mri doesn't show infection, that would all be pretty reassuring.

On the strength of possible previous infection, I elected for resurfacing on the grounds that to revise that is a whole lot easier than to revise a thr. It's crucial to have very good antibiotic cover. I had IV teicoplanin for 5 days and am now on oral fluclox for one  month. They will need to take samples from the joint at operation to be sent to the path lab to check for any signs of infection. They do immediate microscopy then set up cultures to see if any bugs grow; that takes about 4-5 days to come back. Mine were both negative, so, so far so good. However, I remain gently anxious about it because if you've had infection previously you're slightly more likely to get it again. I still think mine was probably haemorrhage, or, as Pat points out, steroid flare, which is a well recognised, albeit relatively unusual complication.

It sounds as though you're very much in the same boat as I was.

I chose my surgeon with great care. Open to close time is about 40 minutes for her, which is fast. The longer they're inside you, the more the risk of infection, to some extent. Her results are fantastic. Also, the hospital I went to has gold standard nursing care. They've nursed cases with pre-existing mrsa but never had it spread.

I've now just seen your subsequent post, which I somehow missed before, saying you have avn as we call it. If the pathologist says that causes your viscosity to go up (I'm not sure of that but have no reason to doubt it) then it sounds as though you're home and dry re the infection side of things. But I'd still suggest an MRI because that shows avn pretty well. Surgery may need doing sooner rather than later now, though. If it's many months away and you're taking a lot of anti-inflammatory pain killers, make sure you get it xrayed from time to time as the meds may mask the pain of worsening avn. If the latter becomes too advanced, then resurfacing will cease to be an option.

Good luck with everything. If you're into iron man competitions then surgery will probably be a breeze for you, if it comes to it.

Andy



hipnhop

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Re: Pre-Op Infection
« Reply #6 on: December 05, 2010, 12:21:14 PM »
Andy, thanks for your response and to all others too.  At this point they are ready to move forward with surgery. Although infection is not 100% ruled out they think the pain and high SED rate was in response to the AVN.  A contrast MRI showed severe bone death in my femoral head.

The only issue now is if Kaiser is going to allow my surgeon to get a more experienced HR surgeon to join her in the OR. I don't want to be her first HR.
3/2011 and 2/2012 HR Dr. Craig Thomas

littleb

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Re: Pre-Op Infection
« Reply #7 on: December 05, 2010, 02:09:00 PM »
Ed,

Could the doctors treating you for the AVN go to the insurance company on your behalf and explain that your case is too involved for a first timer? I would think her price would be about the same but without history of her ability which may not lead to the best possible outcome ending with possible additional surgery, costing them more.The real key for you will be finding another doctor your insuance covers that you are willing to travel to and has experience.
RBHR
Dr. Su
8/19/10

andybc

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Re: Pre-Op Infection
« Reply #8 on: December 05, 2010, 04:59:20 PM »
Gee Ed,

NO WAY should someone operate on you unless they are very experienced. The possibility of infection alone plus marked avascular necrosis dictate that you absolutely must have a surgeon who has a good number of these under his/her belt. MRI is pretty accurate in diagnosing AVN and it sounds as though it's pretty unlikely you had infection. Even so, if it were me, I'd discuss antibiotic cover with the surgeons/microbiologists.

I really do sympathise with your plight.

Very best wishes.

Andy

 

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