Revision of THR by second operation

HarryB

Over the last two years, osteoarthritis in my right hip had been causing increasing difficulties. My range of movement without pain was limited. I couldn’t put my right sock on without using a ‘sock assistant’. Anything other than very limited gardening was impossible. Instead of 5-6 mile hikes without a problem, I could manage a couple of miles on the flat at a slow ramble.

I had my THR on 5th April. I was discharged early evening the next day. The pain kicked in with a vengeance during the night and I resorted to morphine for relief. Apart from that first night at home the pain was never horrendous and could be managed with standard painkillers. I learned to take a stronger analgesic an hour or two before any activity that promised to be more strenuous than my usual routine of short walks, which were around the house and garden in the first week, progressing outdoors from week two. It seemed I was the average, straightforward THR recovery patient, improving my range of activity on a daily basis.

All was going really smoothly until I had the clips removed, a day short of two weeks post-op. The nurse noted that my thigh was still quite swollen and booked another appointment two days later to check it. The wound had not fully healed and was still leaking fluid. The consultant had a quick look and could see no sign of infection, but prescribed a course of antibiotics anyway. Two days later, on further inspection of the still-seeping wound, he advised immediate treatment to minimise the risk of infection.

So next morning I was readmitted and the wound was attached to a VAC (vacuum assisted closure) machine, a device that uses suction to drain fluid. After two days of this, the drainage had not stopped, so the consultant advised afurther operation under a procedure called DAIR (debridement, antibiotics, implant retention). The wound was reopened, the joint flushed out, and the removable ceramic parts of the prosthesis were replaced.

After the operation and back in my side room on the ward, I realised that my mobility would be somewhat curtailed for a while. There was a drain from the wound into a plastic bottle; a Pico suction dressing had replaced the VAC; I had a catheter for urinary purposes; and twice a day a drip provided strong antibiotics via a cannula.

I did some internet research (a mistake, most people say). Hip replacement is the most successful elective operation the NHS does, but occasionally there are complications. DAIR is necessary in about 1% of cases. I was one of those unlucky ones. Although I didn't think of myself as unlucky. Infection had been detected and remedial treatment was under way.

The next day a different consultant appears on the ward round and informs me that infection has indeed been found on the cultures tested, which means I’ll be on antibiotics for up to three months after discharge. I see the therapy team and pass the mobility test for a second time.

It’s now a week since I was admitted. My wife says I’m becoming institutionalised. The drain bottle is replaced when the first one has reached 450 ml. The readings (in millilitres) are written on a whiteboard on the wall: a constant reminder that discharge (mine from hospital, that is) is still some distance away. The score is 150 ml in the last twenty-four hours – still too high. The bottle remains my constant companion.

Mr Johal is on the morning round. He explains that the full laboratory test results take seven days, possibly longer as we are now into a Bank Holiday weekend. The drain could be removed tomorrow. That’s what I’m told every day.

It has all the hallmarks of another boring day: a quiet holiday Saturday with no visitors. But somehow I manage to fill it without even opening the book I brought in with me. Watching morning television (there’s a fee to pay if you want to watch after 12 noon); catching up with the news online; replying to numerous WhatsApps; checking the failures of my Fantasy Football team; and catching up on missed sleep. Not necessarily in that order. Mr Johal is away running a marathon. He relays instructions remotely about releasing the vacuum in the drain bottle.

The next night the drain removal question is violently resolved when I trap the tube in the door on a visit to the toilet. It comes adrift from the wound; I’m patched up by the nurse on duty. Mr Johal says the dressing can be removed, together with the Pico pump. The lab results are in at last. Mr Johal talks about a key infection marker called CRP (C-reactive protein); it’s coming down. All that’s needed now to trigger my release is the plan from Infection Control headquarters.

In the afternoon the dressing is removed. The wound is looking good - well, as good as an eight-inch scar can ever look. Sister Claire sends a photo of it to Mr Johal to brighten his day. I expect it will soon have gone viral on the dark web.

Next morning Mr Johal arrives unexpectedly early and catches me in a state of semi-nudity for my daily wash. CRP is down again, along with the FTSE. I’ve never had an interest in either until today; I still couldn’t care less about the FTSE. Mr J briefly disappears to phone his colleague in Infection Control, then returns with the news I’ve been desperate for – I can go home! It’s a few hours before the hospital pharmacy sends my bagful of medicines up to the ward, but that seems insignificant now I know my release is imminent.

That first night back home I manage more than five hours sleep in total, more than any of the twelve nights on Ward 11. On my second day out of hospital I start to feel really tired. Just moving around the house, up and down stairs, occasionally around the garden – my new hip is not used to this. The antibiotics I’m on affect my urination, particularly at night, meaning I’m waking almost every hour for an excursion to the toilet.

Five days after my release, Jim takes me back to the hospital to Mr Johal's clinic for the removal of alternate clips and a blood test. I think my body is adapting to the antibiotics. My sleep patterns improve; not normal, but definitely better. Social life resumes: a friend drives me to our favourite coffee shop where my walking football friends meet after the weekly session. The banter hasn’t changed; I’ve missed being verbally abused on a regular basis. Another friend drives me home – it’s good to have all these offers of taxi services. Daughter and younger granddaughter visit us for the weekend.

A week after Mr Johal’s clinic, I return for more (reliable Jim my taxi driver again). Mr J says the blood results are good. In particular, the CRP score is down again. Remaining clips are removed and I have another blood test.

Four weeks after Op Mark 2, it’s another Bank Holiday. I’m still downing the antibiotics, which seem to be having other beneficial effects, as well as fighting the bacteria. My taste buds are a sharper. I don’t usually have a cooked breakfast, but today I’m enthusiastically scoffing egg, bacon and black pudding. It sure beats white toast and marmalade. Well, I think I deserve it. After all, I am one in a hundred.

noddingtonpete

Thanks for the update @HarryB glad it seems to be on the up for you but a long drawn out recovery. Hope it is all good now.

Janlyn

@HarryB Good to read your update - I hope you're progressing day by day. The increased appetite seems to be a good sign many of us had on release from hospital!