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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Medical
Satisfied Customers: 42695
Experience:  Medical Doctor Trained at a Top Academic Institution
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I am trying to weigh the option between. One stage and two

Customer Question

I am trying to weigh the option between. One stage and two stage surgery. And understand how much less affect the one stage option would have on my recovery.I understand that first hardware has to come out and the infection cleaned up the best it can but also understand that antiobotics can be given at the time of replacenent along with the antibacterial beads Am I correct I that statement? How long do these beads last at fighting future invading bacteria?
Submitted: 11 months ago.
Category: Medical
Expert:  Vakul Aren replied 11 months ago.

Welcome to JA,I will try and help you with your query.Currently a two stage surgery for chronic infection of old hip joint hardware is preferred by most surgeons.However,advocates of one stage surgery are there,the decision should be made by you and your surgeon after discussion on this subject.PolyMethylMetacrylate Antibiotic(PMMA) impregnated beads and other spacers(antibiotic loaded cement)have helped reduce cost and hospital duration by keeping a high antibiotic concentration locally for 3-4 weeks .This is the period that is required for absorption of the Seroma(serum filled gap in the cavity),this helps prevent any local infection and may reduce the need for I/V antibiotics in the post operative phase.Preoperative antibiotics may help sterilise the area and prevent infection along with spacers like beads/cement impregnated with antibiotics..Newer delivery system for antibiotics with elution time upto 4-6 months or longer are being developed and may be available.

Vakul Aren, Doctor
Category: Medical
Satisfied Customers: 3377
Experience: MBBS,DTM&H,30 years of experience
Vakul Aren and 3 other Medical Specialists are ready to help you
Expert:  Vakul Aren replied 11 months ago.
http://www.medsci.org/v06p0253.htm is a site ofinterest which gives more information on spacers and one and two stage procedures for infected hip arthroplasties.Please let me know about any specific information you may need.
Customer: replied 11 months ago.
Thanks for your input as is somewhat less biased towards the two stage procedure as don't know if I can withstand 2 surgerys,physically and mentally. Have anxiety and had major episode when learned of this new infectn last Friday. My question is in your opinion is the ninety two stage per cent worth the eighty percent one stage in which one to choose? I have a genetically abnormal hip and should that affect my decision? Also had a tremendous of pain after first surgery for 8-9 mths.and never did get rid of all the pain. Still taking 325/5mg oxycodone 3 times daily. Are there any pain meds that can better help control it..
..?.
Customer: replied 11 months ago.
Relist: Answer came too late.
Impatient
Expert:  Vakul Aren replied 11 months ago.
Sorry for the delay as I was away to the hospital.Since you have already had an infection following a THR,it is imperative that this problem does not recur.It would be prudent to get a two stage procedure done to remove any infected tissues.You will be able to do a complete sterilisation with appropriate antibiotics after getting a bacterial culture and antibiotic sensitivity done to select the most effective antibiotics ,thus preventing any chance of a second episode of infection.The problem of a genetically abnormal hip should make you doubly cautious,hence using a two stage surgery would be prudent.The anxiety will respond to benzodiazepines like Clonazepam/Lorazepam along with a good SSRI.You are already on a good narcotic analgesic,seeking the help of a Pain specialist will probably help reduce the intensity and duration of pain.
Customer: replied 11 months ago.


I am guessing that if two hip implants dont resist infection thats pretty much it am I correct? I have had impacted teeth in my lower jaw since i discovered them in the late sixtyies and never had them removed Have had 2 eruptions in last year but no infections that I was aware of . Is it apossibility that these teeth could be causing the bacteria to attach to the implant ?? Is ther anyway of telling if they are infected? Had panogram before implant and maxiofacial surgeon said looked ok to him. Are ther any pain medications between the level that oxycodone and then the jump up to powerful intravenous meds like morfine? Thannks for you time and look forward to your response

Expert:  Vakul Aren replied 11 months ago.
Continuous use of analgesics,especially narcotics ,causes tolerance to the narcotic and reduced efficacy to the drug.There exists a potential addiction potential attached to strong narcotic analgesics which suggests avoidance of long term use of these drugs.Use of drugs like Tramadol may be as effective.Your Dental Surgeon (DS) would be the best person to rule out any infective pathology of the teeth and gums.
Regarding infection of hip implants,I would agree that there would stastically be less chances of the second implant developing infection.
Customer: replied 11 months ago.
I previously asked if there were any antiobotics between the level of oxycodone and. The jump
To powerful drugs like morphine. I understand the reluctant to use these as are considered narcotic. And physicians defer to use them but is there medications between these levels.....?....
Expert:  Vakul Aren replied 11 months ago.
Tramadol is a synthetic narcotic with a low addiction potential,similarly Ketorolac has also been effective when used for short durations. Long term use of such analgesics and narcotic analgesics is usually not effective due to development of tolerance to these drugs.Addition of antidepressants like Amitriptyline/Duoloxetine and use of drugs like Gabapentin may help.
Customer: replied 11 months ago.
How inclusive are indium scans in detecting infections..?....
Expert:  Dr. Phil, MD replied 11 months ago.
Hello. I'm Dr. Phil, licensed and practicing Internal Medicine Physician. Excellent service is my goal.

I noticed you already rated positive

would you like me to continue assuming another rating if you are satisfied with my work?
Customer: replied 11 months ago.
Ok
Expert:  Dr. Phil, MD replied 11 months ago.
Indium scans are notoriously unreliable in detecting infections

If you are looking for an infection and can't find it, then it is a last resort

I have never found them to be that helpful

This is especially true if someone has taken antibiotics. In that case, they are basically useless
Customer: replied 11 months ago.
When you say taken antiobotics would you mean just prior to the test or how long before?
Expert:  Dr. Phil, MD replied 11 months ago.
Within 2-3 days prior
Customer: replied 11 months ago.
Would Celebrex,oxycodone,leapfrog, frolic acid ,hazard oramolophine be antibiotics?
Expert:  Dr. Phil, MD replied 11 months ago.
No they would not
Customer: replied 11 months ago.
I had an indium scan that the radiologist said he thought showed infection in my hip implant of one year ago. The doctors made the diagnosis of this test. They tried aspirating the area and found no fluids. What's your option?
Expert:  Dr. Phil, MD replied 11 months ago.
Just because they couldn't find fluids doesn't mean there is no infection

There could be infection here.

That is possible.

Customer: replied 11 months ago.
How do you find out for sure.?
Expert:  Dr. Phil, MD replied 11 months ago.
I would recommend an MRI of the hip or a bone scan to look for infection
Customer: replied 11 months ago.
How do you find out for sure.? Can you do MRI on a hip implant?..u
Expert:  Dr. Phil, MD replied 11 months ago.
yes they can
Customer: replied 11 months ago.
The radiologist who done the indium scan told me that a bone marrow scan didn't show anything .we deferred the bone scan as he said would've not showed doctors anything? What's your opinion? Thanks for your time
Expert:  Dr. Phil, MD replied 11 months ago.
I would advise the bone scan given the indium scan was positive and the fluid was negative

We need more tests to be sure
Customer: replied 11 months ago.
Again thank you for time and patience with me as I have anxiety problems
Expert:  Dr. Phil, MD replied 11 months ago.
No problem

Would you be so kind as to rate me positive?

I appreciate it. :)
Dr. Phil, MD, Medical Doctor
Category: Medical
Satisfied Customers: 42695
Experience: Medical Doctor Trained at a Top Academic Institution
Dr. Phil, MD and 3 other Medical Specialists are ready to help you
Customer: replied 10 months ago.
Is osteomyelitis an infection of the bone?..
Expert:  Dr. Phil, MD replied 10 months ago.
yes

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