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Recurrent Hip Replacement Infection
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Recurrent Hip Replacement Infection

On Aug 3, 09, I had a revision of my total hip replacement that had been present for 6 years.  The pelvic part had loosened.  Three weeks later, I was diagnosed with a Staph infection around the implant.  The surgeon took out the pelvic implant, flushed the area and reinstalled another implant.  The Staph was sensitive to Cephelaxin(not a MRSA).   In November, had hip pain with a recurrent infection.  Both implants were removed and an antibiotic spacer was put in.  Started on iv Cefa in a Pikk line 3 times daily for 6 wks.  It was a non resistant Staph, still sensitive to Cefa.  Off antibiotics for 2 weeks, inflammatory markers were normal.  Slides taken during the revision when they replaced the metal implants on Jan 12 '10 showed less than one WBC per high power field.  Three weeks later(Feb 5), had a draining tract out my incision with copious amounts of pus.  Cultured to be a non resistant Staph again.  Had another surgery to put in an antibiotic spacer and am currently on Oxacillin 24 hrs a day thru a Pikk line.

My orthopedic doctor and infectious disease doctor have different ideas as far as treatment goes now.  There is no research to indicate exactly what we need to do.   Both their plans sound like they are reasonable.  

By the way, I am a 55 year healthly male.   Do you have any ideas or suggestions as to what should be our next step or where I could go for more information.    Thank you so much.

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The most important thing is to avoid infections and to maintain complete asepsis and follow perfect hygiene which you might be doing by now.

Some people have less resistance and the resistance also decreases with intake of continuous antibiotics. You would need to check your antibody levels. I would also suggest you to eat healthy and diet rich in proteins and calcium.

I would suggest you to consider blood culture and also the culture of the tissue surrounding the implant and also culture of the pus.

Follow up with a microbiologist along with your regular orthopedician and infectious diseases specialist.

Take care!
I have had blood cultures, pus cultures, and cultures around the implant with each surgery.

My orthopedic specialist wants to use two antibiotic spacers, the one that is in now, and exchange it with another one at six weeks.  Then follow up at 8 weeks if inflammatory markers are normal, then re-implant with the metal.

My infectious disease specialist wants to go with at least 8 weeks of antibiotics, iv, along with the antibiotic spacer.   Then wait about a month without antibiotics before re-implanting with the metal to see if any signs of infections show up before the final metal implant.

One other question, has any research been done to find out exactly how long the antibiotic spacers contiune to release antibiotics locally?  Why is six weeks the magic number, does it contiune to release antibiotics at effective levels for more than six weeks or do we know?

Sorry about all the questions, but I have been fighting this infection for over 5 months and 5 surgeries.

Thanks so much!

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