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Old 04-02-2008, 01:00 PM   #1
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Infections after Hip Replacement Surgery

Hi. I just scheduled my hip replacement surgery for August 4. And, then was entertained by a coworker with a gruesome story of a relative who had an infection from another injury result in horrific problems with a jointreplacement. {I think maybe I have to start being careful who I talk to before I actually have my surgery! The bad stories are just ssoooooo awful...)

I've read in other places, and on this board, that we need to always notify the dentist that we have joint replacements and take antibiotics before any dental procedure. But, it appears that if you develop any infection even a bladder infection, cuts, boils and dental absesses that you have to get treatment immediately. These infections can travel via your bloodstream to the rplacement.

As far as I can tell viral infections like colds and sore throats aren't a problem. Has anyone been told differently?

I'm assuming too that if you have to have any other procedure that you might need an antibiotic--so rule of thumb should be to tell every doctor that treats you that you have a joint replacement.

So, am wondering--are these concerns for the life of the implant (assuming so) or has anyone been told there's a time limit. (I have read in some places, for example, that you need to take antibiotics before dental work for 2 or 3 years, but other places say its for life. Haven't seen anything to say that other procedures require antibiotics for only a limited time).

Maggie

 
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Old 04-02-2008, 02:36 PM   #2
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Re: Infections after Hip Replacement Surgery

As you have deduced from your coworker's gruesome story, infection on the prosthesis is one of the more devastating complications of hip replacement. I also have an acquaintance who was without hips for a year because there was infection in both hip replacements and they were removed until the infection cleared up.

You are correct that it isn't viral colds and flu that cause worry. From my reading it is dental procedures that have the greatest potential for seeding bacteria onto the prosthesis where they can find a happy home and create a "slime" that the body's immune system can't fight. The ADA and the AAOS have issued a joint statement that presents what they agree on with regard to premedicating before dental procedures. Other possible culprits: urological infections and GI endoscopic procedures to name two. The recommendations for premedication may vary depending on the doctor, the amount of time that has passed since the surgery, other health problems that the patient has.

My hip replacements took place 5 & 6 years ago. I still premedicate before any dental procedure that is invasive ( would puncture my gum or draw blood) which is just about everything including cleanings, fillings, extractions, etc.). I'm currently scheduled for a colonoscopy (an endoscopic procedure of the bowel) and I'm going to see what the surgeon's take is on my need for antibiotics. If he says that I don't need antibiotics I will call the ortho surgeon's office and get his opinion. Some protocols call for premedicating for the first 2 years after surgery since this is when the risk is at it's highest. So far my surgeon has kept prescribing it for my dental appts. and my dentist considers that I will need this for life and will prescribe it even if the ortho surgeon doesn't. Interestingly, from my reading, one thing to watch out for is skin infections. A small cut can easily be ignored but, untreated, it can allow infection into the bloodstream. So the advice is - if your skin is broken by a cut or abrasion, don't ignore it. Wash it, put on disinfectant and a bandaid.

To be fair, some studies have shown that there may be as much risk from the antibiotics that are administered (allergic reactions, etc.) as there is from the bacteria. I can attest to this because I took amoxicillin before dental appointments (because of a heart murmur) for 20 years without incident and then suddenly developed a severe allergic reaction (full body rash but no anaphylactic shock). I was told that I can never take that antibiotic again. I use a different drug now. So far, no bad reactions.

 
Old 04-04-2008, 05:58 AM   #3
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Re: Infections after Hip Replacement Surgery

This just set me back. I know my teeth need work but I have put it off because of the expense.
I have been using olive leafe to keep things at bay and have been fine I have slight bleeding some days more then others.
But after reading this I don't know what to do first. Because I am sure they will want to take care of the teeth first and that is going to delay things for my hips right? OMG I am so upset.

 
Old 04-04-2008, 07:25 AM   #4
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Re: Infections after Hip Replacement Surgery

Yes, I believe that most surgeons would advise you to resolve all dental issues that require invasive treatment before hip replacement. You need to go into surgery with a "clean" mouth. Consult with your dentist to see what work you need to have done, then with the surgeon to get his take on the matter.

 
Old 04-04-2008, 06:54 PM   #5
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Re: Infections after Hip Replacement Surgery

Hi. I just received an information packet from my doctor and it states that it is imperative that you have any dental work done prior to surgery. This will include any extractions, filings or any type of treatment for infections in your mouth. If you don't take care of oral health prior to surgery, it could cause delay or possible cancellation of surgery because any mouth or gum infection could be a potential source of concern for your prosthesis following your surgery! So, you should definitely go to the dentist!

 
Old 04-05-2008, 06:04 AM   #6
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Re: Infections after Hip Replacement Surgery

Thanks to both of you for the info. I got a feeling that my surgery will be put off for my mouth first. This is a major setback for me. I was so ready for the hip not the mouth. Thanks again

 
Old 04-09-2008, 11:35 AM   #7
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Re: Infections after Hip Replacement Surgery

It's 2 years.

 
Old 04-09-2008, 12:41 PM   #8
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Re: Infections after Hip Replacement Surgery

i am almost 4 and 5 years post two hip replacements. whilst i had to have a letter from my dentist saying that my teeth and oral health were good prior to surgery, i have never had to take anti-biotics for a dentist visit since my two surgeries. i always tell the dentist and hygenist, at ever visit, but am always told that i do not need them. i live in england, maybe it's different here, or maybe thinking has changed in the last couple of years.
the longer you go on, after your surgery, the less you will worry about infection.

 
Old 04-09-2008, 09:03 PM   #9
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Re: Infections after Hip Replacement Surgery

Thanks! It's good to hear about other's experiences. It is interesting to hear about practices in other places. A friend of mine is going to India for a hip replacement in 2 weeks (I think they call it medical tourism). I can't imagine going so far from home for a procedure, but will be really interested to hear about her experience.

 
Old 01-31-2009, 05:44 PM   #10
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Re: Infections after Hip Replacement Surgery

I'm scheduled for hip replacement on Feb. 18, and the information that the nurse gave me at my last appt. 2 days ago (stuck in my hand as he ran out the door, in inimitable HMO style) says to have dental work done four weeks *prior* to surgery--the first anybody told me about that timeline. The surgeon said I should get dental work done when I saw him first a month ago, but there is a fair amount to do and the dentist will still be doing root canal work this week and next. I left a phone message for the HMO and am waiting to hear back--anybody know if this is going to be an issue? The preparations for this surgery are so elaborate (my sister flying in from out of state, my four college classes getting covered by four other teachers, arrangements for my dog), that I *really* don't want to have to postpone the whole thing--

 
Old 07-09-2009, 08:02 AM   #11
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Re: Infections after Hip Replacement Surgery

I was told no dental work, two weeks prior to surgery, no dental work, even cleaning, three months after surgery.

I understand that one's overall oral hygiene is a key factor. I try to keep my gums and mouth in order and will have to even more so now.

Also, I developed pneumonia in the rehab..fever one day after surgery, 102+, and then pneumonia with fever that lasted till I went home from rehab. I was treated with Avalox profilatically in the rehab, to ward off bacterial pneumonia.

I have asthma too, and received albuterol treatments in rehab, but really needed steroids. They allowed my breathing to be somewhat lower than usual to avoid steroids since they lower resistance to infection.

When I came home, I went on steroid dose pak and my breathing got better.

Then I developed a very slight infection from ingrown toenail from wearing heavy socks with wrong shoes in rehab and home. So back on antibiotics for 10 days.

My problem is I caught C-Diff in the hospital in 06 and almost died with it. Was there for weeks. So for past three years every time I take even one antibiotic pill I have to take flagyl for prevention of recurrence of C-Diff.
I also need Diflucan now since I get oral/esophageal thrush from the flagyl. The Nystatin no longer works.

I am going to see an infectious disease specialist end of this month. It is seven weeks since my hip replacement.

I need a plan for all of this premedicating...do I need flagyl still??

Also, I am diabetic, in good control, no meds, no insulin, good weight. I will probably get my nails cut every 9 weeks (allowed by Medicare) by my podiatrist. If I have no infection and it is a routine nail clipping, can I NOT premedicate. I just called surgeon about this.

I had a tooth bonding done this week and had premedicated for it and for cleaning and just because I ran into a woman in the office who had her hip replaced four months ago, I learned about the no-teeth-cleaned rule for three months. I called surgeon from dentist.

DO NOT GET TEETH cleaned for at least three more months.

Just now I got a call from surgeon's office. If I get routine nail clippings, no infection, no premedication is needed. That's good.

Now I have to find out about colonoscopy. Some say yes, some say no...will ask surgeon at next visit.

Too many antibiotics can lead to C-Diff...which can be deadly. I hope I never get it again.

Thanks everyone for sharing your information.

Some surgeons want pre-meds for life, some for two to three years....I plan to follow my surgeon's advice. I don't want a sepsis in my hip...I plan to err on the side of precaution and keep myself as infection free as possible.

terri

 
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