I just wanted to log my experience getting a hip resurfacing. I’ll try to give facts and not opinions but it may be hard.
01. Researched resurfacing starting in 2006. Stumbled on your site or at least your Yahoo group.
02. Decided on a resurfacing in Aug 2007.
03. Decided on a doctor, Mitchell B. Sheinkop, who agreed to do a BHR on my left hip which was bone-on-bone from osteoarthritis. He also told me that he would use the posterior. We scheduled for Nov 2007.
04. At the pre-op visit the Friday before the Monday surgery, Dr. Sheinkop’s colleague told me that the doctor would be using a direct lateral approach and using the Cormet device. Because this wasn’t what I wanted and what we had agreed to, I canceled the surgery.
05. While trying to decide whether to have the surgery or cancel it, I was able to get a same day second opinion from Dr. Scott Rubinstein. The doctor’s basic message to me was, you don’t need to rush into this if you’re uncomfortable and Dr. Sheinkop is a good surgeon. From # 4 above, you can see that I canceled the surgery with Dr. Sheinkop.
* note that I wrote about this experience in the Yahoo group discussion board.
06. I backed off on the idea of surgery figuring that my experience was a bit of a sign that I shouldn’t have the surgery just yet.
07. In July of 2008 I visited with Dr. Rubinstein again to talk about having him do my resurfacing with a BHR via a posterior approach. The conclusion of that appointment was a resurfacing scheduled for Nov 2008 at St. Joseph’s Hospital in Chicago (the one on Lake Shore Drive).
08. I had the surgery with Dr. Rubinstein. The only odd thing at the time was that he had closed the last layer of skin with some kind of suture that looked like fishing line (mono-filament) with barbs on it to help lock the thread in (so I was told). He was generous with the amount of leave/disability he approved for me. I wound up taking 6 weeks. My recovery was really good. I enjoyed the restored function and rehabbed religiously (although I wasn’t a candidate for sainthood).
09. In mid Dec 2008 I had a follow up appointment with Dr. Rubinstein. I asked him about the wound and small amount of fluid that was coming out. He told me that it was just the stitches at the lower levels of tissue dissolving.
10. In Jan 2009 I still had a wound that was scabbed. The wound would express puss if I pressed on it.
11. In Feb 2009 (a Friday) I came down with a fever and a significant pain around my left hip (the operative hip). I called Dr. Rubinstein about this and he agreed to see me at the hospital on Monday.
12. Dr. Rubinstein aspirated the hip all the way into the capsule and cultured the fluid. It came back negative for infection so he did a debridement and stapled me up this time. I left the hospital with a plan for 6 weeks of Cephalozin via IV.
13. I did the six weeks of IV antibiotics.
14. Two weeks after stopping the antibiotics, I went for a bike ride with a friend. We rode 15 miles. I returned home and relaxed in my recliner. When I got up an hour later, I knew I was fooked — I had the same pain as before and I could feel the beginnings of a fever. I called Dr. Rubinstein and we set up another Monday morning meeting at the hospital which would include the ID doctor. The ID doctor was very good as far as his knowledge of what we needed to do and in how he explained things to me. He understood I was very upset and he seemed to care that I was in a crappy situation. His name was Joel Spear.
15. We did another aspiration of the hip and didn’t see anything or culture any bacteria (as we later found out, cultures taking several days). Dr. Rubinstein did another debridement this time using gallons of saline for lavage. Only after the lavage did he open the joint capsule and attempt to clean the metal implant. He stapled me back up and I went home for 6 weeks of IV antibiotics. The cultures revealed that we were dealing with staph aures that was sensitve methecillon. The drug of choice was Cephalozin again but the dose was doubled to 2 grams in 20cc of saline 3 times a day. In addition, Dr Spear added Rifampin which somehow helps the Cephalozin work at the intracellular level.
16. I did my six weeks but this time my wound popped some staples and wouldn’t close. I was put on a wound vac. I was also seeking second opinions on what to do. During the first and second debridement, I wanted to keep the implant given how much effort I had sunk into research and how much time I had spent waiting to have the use of a functional hip. My plan after the second debridement was to stay on lifelong antibiotics.
17. I saw an ortho doc and an ID doc at Northwestern in Chicago. The ID doc said that lifelong antibiotics was a reasonable option. The ortho doc said I was too young, 43 years old, to deal with an infected implant. I didn’t like the ortho doc for my own reasons, one of which being he was CERTAIN that the only sane course of action was to remove the BHR and go with a screwed in THR.
18. I saw an ortho doc and an ID doc at the Mayo clinic in Rochester, Minnesota. This place was soooo organized. I met with both the ortho doc and the ID doc in the same room at the same time. The four of us discussed pros/cons of two stage removal vs. lifelong antibiotics (my wife being the 4th person in the discussion). We all came to the conclusion that two stage revision to screwed THR was the best choice I had for a robust infection-free life.
19. The ortho doc at Mayo was Dr. Sierra. He did the resection in June 2009. I went home without a hip and was non-weight bearing on my left leg since I only had an antibiotic impregnated spaces composed of some kind of acrylic cement and Vancomycin.
20. I did another round of IV antibiotics (2 grams Cephazolin for 6 weeks 3 times a day) while I hopped around on one leg and crutches.
21. The cultures of the BHR implant that was removed grew loads of staph aures but at least it was susceptible.
22. After six weeks, I had two weeks without antibiotics.
23. In late August 2009 I had a screwed in acetabular cup put in with a metal liner. The ball size was 44cm. The manufacturer was DePuy. Four days post op I was walking with a cane and no pain meds. From a function and pain perspective, this was a much better experience than the Nov 2008 BHR. Sure its apples-to-oranges but at least I had something good happen.
24. Now I have a bit of knee pain that I’m trying to get to the bottom of. My gut is telling me that my leg wasn’t put back on the way God had it attached. Of course, a bit of knee pain given what’s transpired probably isn’t a big deal and I’ve got to allow more time for healing before I draw my own conclusion.
1. A long healing wound is a problem.
2. Pus is a problem.
3. Pus however small isn’t the result of stitches dissolving.
4. Fishing line mono-filament sutures suck. The scar was ugly compared to the staples and silk thread.
5. Anyone can get an infection.
6. Infections suck.
7. I no longer consider Dr. Rubinstein a doctor I would use or recommend. He might be fine, the infection may not have been his doing. However, he was in charge of my case and it didn’t go well for me.
8. If I ever have the need of hospital services I will go the Mayo Clinic. Those people know how to run a hospital. Yeah, there’s some red tape but most of their processes make sense, work quickly, and serve the patient.
9. Did I say I will only go to the Mayo Clinic if I’m in need of serious medical care?
There may be more learnings but I’ve written enough and I want to be done with this segment of my life. Let me know if there’s anything you want to do with this content. My goal in writing to you was to get this whole story into words in one place and to maybe help the next guy avoid five surgeries in nine months.
I don’t know if I’ll be back in touch. Of course, if you want to correspond, I’ll be happy to do that. Its just that I want to be done with this segment of my life because it has been painful. I purposely didn’t mention the direct and indirect mental and financial hardships that this experience allowed me and my family and friends go through. That’s information for one or more groups that focus on those things.
Finally, I am thankful for your web site and Yahoo group. They helped me see some hope for a full life instead of despair. That hope got me to this point where I’m using a cane and able to shop for a birthday present for my wife with my kids only 5 days after THR surgery. I’ll take the good that I can get.
Update Sept. 19, 2009
I had 23 days of use on that DePuy THR Screwed Cup with Metal Liner and Uncemented Stem. The infection roared back Monday September 14. I went back in the hospital (the Mayo Clinic) on September 15. Dr. Sierra debrided the left hip and after surgery recounted to me that the puss under my skin erupted when the pressure was released. I’m stitched back up with silk thread and I have an articulated antibiotic impregnated hip spacer. The antibiotic is vancomycin. Its essentially non-weight bearing. Its less barbaric than that first spacer which was really just like the bumpers on a boat (femur) and the tires hung from a pier (acetabular cup) keeping each from causing harm to self or to the other.
The plan is another 6 week course of IV antibiotic (switching from cephazolin to nafcillin). Nafcillin has the added burden of needing to be administered every 6 hours vs. every 8 for the cephazolin. As a compliment to the antibiotic I’ll be taking rifampin again. After the 6 weeks on antibiotics, I’ll be off of them. Our goal is to give the staph aures a chance to emerge in those 6 weeks. If it does, then we’ll be doing another surgery to implant another articulated antibiotic impregnated hip spacer and another 6 weeks of antibiotic with 6 weeks of waiting time. We’ll repeat this process until it ends in me have a new hip installed. From this point out my doctor says I’m not a candidate for metal-on-metal because the potential reaction by the soft tissues can look like the result of an infection. We don’t need fake infections at this point. So I’ll likely be getting the same DePuy THR w a screwed cup but this time a plastic liner. At this point I’ll take anything that works.