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Revision surgery of total shoulder replacement due to infection Options
annamaria
#1 Posted : Tuesday, July 06, 2010 6:55:47 PM Quote
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Hi everyone

As I wrote under under Other Discussions I recently came out of hospital after having what is called Stage 1 revision surgery for an infected shoulder prosthesis.
I first had signs of infection in November 2008, so it has been chronic, severe and very late stage infection (prosthesis put in 1985!) I'm told bugs could have been lurking for years by the Bug Doctor.

Prosthesis was removed with some infected bone, shoulder washed out thoroughly and an antibiotic loaded cement spacer inserted. Intravenous antibiotics for 6 weeks along with oral ones 4x daily, side effects not too pleasant!

They monitor my blood for signs of infection ESR and CRP regularly and district nurses do daily obs when they administer IV antibiotics. The constant exudate of pus which has been ongoing since an initial operation on 23rd December has finally cleared (yippee!)

My inflammation markers dropped dramatically initially after the op, but at my rheumy appt today they have crept up to 60/70 although nothing like 300 before op. It could be the RA making itself felt, we hope so rather than infection with such mega antibiotics.

The surgeon is talking about doing Stage 2 which is removing the spacer and inserting another prosthesis quite soon. My rheumy feels a much longer interval is preferable or maybe no stage 2 for me cos of severe osteoporosis( just leaving in the spacer) and I'm more happy with this option even though I have little movement in my arm.

Think it's wait and see time and hoping to get back into hydro pool when IV midline is out!

Anyone had experience of revision surgery? I believe it's very uncommon in shoulders and less successful than hips and knees - I know Carol Tabbycat went through a very long journey before her second hip. How's it going Carol?

Sorry for the long saga, but I'm very upbeat after getting rid of all that infection and am determined to stay this way!

Thanks for reading this and take care,
Love Liz
xx
joeyvt
#2 Posted : Tuesday, July 06, 2010 6:58:13 PM Quote
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Hi Liz,

No experience of it personally but just wanted to say great news that the infection is gone now. May it only get better each day!

Joanna
Julia17
#3 Posted : Tuesday, July 06, 2010 7:22:06 PM Quote
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Hi Liz

Thanks for your post with the good news the infection has cleared up.

Wishing you all the best.

Julia xx
dorat
#4 Posted : Tuesday, July 06, 2010 9:14:04 PM Quote
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Hi Liz,

It's so lovely to hear that things are improving for you at last! What a long journey it's been.
I can't help with the shoulder revision but I tend to agree with your rheumy, you would think it would be better to wait a bit longer before replacing the joint to make sure all infection has definitely been got rid of.
You should do what you feel is right and if you don't want to have it done it should be your decision, not the surgeon's.
Have you managed to get out into the garden at all or do you have to stay in the house? It's such a pity if you are missing this lovely weather.
Hope the ESR and CRP settle down soon for you.

Lots of love, Doreen xx
Kathleen_C
#5 Posted : Tuesday, July 06, 2010 10:04:01 PM Quote
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Hi Liz,

What a long and painful road you have travelled! I`m so very glad that things have eventually improved, and there is, hopefully, light at the end of the tunnel.

I have no experience of revision surgery, but I think if it were me I would be taking the view of your rheumy, and waiting a bit longer to be absolutely sure of things.

Enjoy th hydro pool when you get back into it, and do take care,

Kathleen x

Tabbycat
#6 Posted : Wednesday, July 07, 2010 2:44:01 PM Quote
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annamaria wrote:


Anyone had experience of revision surgery? I believe it's very uncommon in shoulders and less successful than hips and knees - I know Carol Tabbycat went through a very long journey before her second hip. How's it going Carol?

Sorry for the long saga, but I'm very upbeat after getting rid of all that infection and am determined to stay this way!

Thanks for reading this and take care,
Love Liz
xx


Hi Liz,

Reading through your post, I can relate to everything you've said. It's absolutely no fun having a prosthesis removed because of infection, as well you know. It's disconcerting to read how bugs can be lurking months later! Do you know what the infection was called? Mine was bacteroides capillosus something found in human faeces!! They never did know (or at least they never confessed to me) what might have caused it, save for one microbiologist suggesting I could have had a leaky gut, to which I replied, "but wouldn't I have had other symptoms?" Whether or not my bowel was nicked during the original THR surgery and leaking slowly, I don't know. My infection wasn't diagnosed until about 12 weeks after the op when I'd healed up and they drained off 3 pints of pus during the first washout/debridement (had 5 in all).

The antibiotics gave me chronic diarrhoea which full dose Imodium only just kept under control (Tazocin) and an itchy rash after about 4 weeks on them. I was attached to a vac pump until the last washout treatment.

Before I could have the second stage op, my surgeon performed an aspiration to draw out a sample of fluid on my hip which was tested to check for signs of any remaining infection. Is this something they'll do for you too? I also had regular blood tests to check my inflammatory markers for signs of infection. I had hydro and had to be hoisted into the pool on a seat then had to hang onto the physio for support until I could hold onto the bar! Luckily he was a young lad who didn't mind!

Both my shoulders and elbows are ready for replacements (too late for anything arthroscopic) but I'm put off by the 30% infection risk. Were you told this? Having witnessed THR infection I'd rather tolerate the pain and still be able to drive etc. The thought of no shoulder joint fills me with dread! I hope you have a good orthopaedic team looking after you? I cannot fault mine and actually miss them now that I've recovered. Its good that you are keeping upbeat. I am very grateful to Stewart for keeping my spirits up and confess being told my THR had to come out was the lowest point but I had every faith in my surgeon and felt in good hands as it were. One of the worst aspects was not being able to take any DMARD and shuffling around on one leg took its toll on my upper limbs.

Keeping everything crossed you're now infection free!

Best wishes,




Carol
annamaria
#7 Posted : Wednesday, July 07, 2010 4:15:37 PM Quote
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Thank you so much for your replies. It's lovely of you to take the time, especially when Iwas offline for so very long.

Yes Doreen, I have been sitting outside, mostly in the shade as like Carol I have an itchy rash from the antibiotics which the sun seems to encourage. It is so good to smell the fresh air though and these last few days the smell of the sea and the roses in the garden have been so strong - maybe its the drugs too?!RollEyes How is your lovely garden, I still remember those photos of it in the snow, so beautiful.

That is an unusual bug to get Carol, the mind boggles as to how it got there! Mine was MSSA methicillin susceptible staphlyococcus aureus all around the prosthesis, as you say loads of it, but from the draining sinus under my arm it tested positive for MRSA for some months. The Bug Doctor was so excited, I think she may need to get out a bit more!

Like you say, it does make you more cautious about replacement surgery though I count myself so lucky to have had 20 odd surgeries before this has happened. I've been on the list for a total knee replacement since March (and was on the list 3 years ago for this too), but that could be a long way off at the moment.

They were great in hospital, but home is wondeful especially with the care of the district nurses every day since December 25th! It will be so odd without them as we have shared so much, in their lives as much as mine. I need to think of a really good present for them all, apart from definitely nominating them for our local healthcare heroes award.

Hope you are all having a reasonable day and take care,
Love Liz
xx
dorat
#8 Posted : Wednesday, July 07, 2010 4:53:12 PM Quote
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Hi Liz,

That's nice that you are able to sit out and get some of the sea air!
My garden is keeping me busy as usual at this time of year. I struggle a bit with it now but still manage to keep it tidy and look after what is there, I don't add much these days. Ian does the tubs which add a bit more colour. We have someone to cut the grass and hedges for us.
It's definitely easier to look after when covered in snow!BigGrin

Love, Doreen xx
jeanb
#9 Posted : Wednesday, July 07, 2010 7:29:17 PM Quote
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Hi Lovely Liz

Just catching up on your posts and will e-mail you tomorrow. There's so much to catch up on!

MUCH love
Jeanxxxxx
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