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Dwight Pargee
March 22, 2009
My saga
So I'm sitting here with an iv in my arm, getting my daily dose of antibiotics
and reflecting back over the last two years, thought I'd share my story.
The good news is I won't be buying any new shoes for the next couple of months,
actually that's not so good news because I love buying shoes...but I
digress.
Back in 1997 I was 33 and playing in a rugby game on sticky muddy field.
I had the ball in hand, made a cut, my foot stuck in the mud and bang!...I
dislocated my hip and fell like someone shot me... the hip was reduced
back into place and I was diagnosed with a torn labrum...I was treated
with PT, strength training, pilates and feldenkrais and got back most of
my function within a year, even able to play a bit of rugby, but my gait
was definitely permanently affected.
Fast forward 10 years and the hip is now bone on bone and end stage
osteoarthritis, I'm the perfect candidate for a resurfacing, my insurance
company doesn't agree and I fight them for two years until they finally approve
resurfacing with Dr. Boyd and a Cormet implant in Oct. 2007.
I recover well and a year and a half later, I'm able to mountain bike
20-30 miles at a time without pain, still got kind of a limp on long
mountain hikes though. then last fall I start getting more discomfort and
groin pain, and on
Christmas eve my car gets stuck in the snow, I push and pull and dig for
an hour and half in blizzard conditions, when I get it free, I can't bear
weight through my leg, severe pain.
I go to emergency room, get an x-ray, no fracture or dislocation, and am
diagnosed with severe muscle strains in the adductors and piriformis. my
surgeon prescribes antiinflammatories, PT as tolerated and crutches for
6-8 weeks..crutchin it for two months, I make slow progress, pain is
somewhat reduced and weight bearing ability seems to improve.
About three weeks ago, I felt severe pain returning while grocery shopping.
quickly, I go to ER in the middle of the night, x-ray again shows
nothing, the CT-scan shows fluid/inflammation build up around the joint,
emergency surgery is scheduled, they open me up and find a low-level staph
infection and clean out a massive of loose body debris called rice bodies*
(see appendix).
I now start daily iv antibiotic therapy for six weeks to kill the staph
infection, we surmise the staph entered my system through possibly a
light bloody nose that I had got in response to cold dry winter air a
couple of days before, no other cuts or signs of infection. my surgeon
says that they have been culturing everyone coming in for hip and knee
implants and they are finding staph in 1 out of 50 people in their noses.
They install a port into my arm runs directly into my vena cava to deliver the
antibiotic.
Two weeks ago Thursday I go into my orthopedic surgeon, expecting to get
my staples removed and looking forward to being able to get into the pool
and start some rehab.
Not so fast. had a new set of x-rays taken and then when I was in the room
with the surgeon he pulled up my x-rays on his computer, three sets, one
from December, one from two weeks and one from that morning.....he pointed
out what was askew, I said, "I'm fooked!"....and he said," well, yes
basically you are fooked''.... I didn't need my degree in biomechanics to
see that my acetabular cup had shifted about 5 degrees, north by
northwest.....he surmised the infection had gotten in behind the implant
and loosened it, and it was slipping periodically, causing my massive pain
with certain movements.
Last Tuesday I had another surgery to remove my MoM parts and put in a an
antibiotic impregnated cement spacer. I leave that in for six weeks,
non-weight bearing on crutches and continue with my daily IV antibiotic
therapy.
After six weeks, they go back in and give me a full hip replacement, this
time probably a ceramic on poly total hip.
The good news is that they think that with this protocol I have a 80-90%
percent of full recovery, and have been very successful in treating my
kind of staph infection with this protocol, it just takes awhile and is a
two-step process.
Already, I'm much more comfortable with the pain level greatly decreased and
even though I'm non-weight-bearing, I will be able to return to my work as
an exercise physiologist and rehab specialist part time in a week or two.
I'm looking forward again to my next surgery and then my full recovery
after that.
For now, I'm a bit tired.
Best,
Dwight
LCormet Dr. Boyd Oct. 2007
total hip revision in progress
* appendix
my surgeon just forwarded these pubmed links, he thinks the rice bodies
were formed by a type IV immune response to the MoM metal alloys.
Type IV Immune Response: Cell Mediated Reactions
Delayed hypersensitivity (cell-mediated) tissue damage results from the
interaction between sensitized T cells and specific antigen, which leads
to the release of soluble effector substances called lymphokines, direct
cytotoxicity, or both. Type IV reactions are involved in many autoimmune
and infectious diseases, but may also involve contact dermatitis (poison ivy).
These reactions are mediated by T cells, monocytes, and macrophages.
Necrotic granulomatous pseudotumours in bilateral resurfacing hip arthoplasties:
evidence for a type IV immune response.
Pandit H, Vlychou M, Whitwell D, Crook D, Luqmani R, Ostlere S, Murray DW,
Athanasou NA.
Virchows Arch. 2008 Nov;453(5):529-34. Epub 2008 Sep 4.
Article Website Page
Pseudotumours associated with metal-on-metal hip resurfacings.
Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CL,
Ostlere S, Athanasou N, Gill HS, Murray DW.
J Bone Joint Surg Br. 2008 Jul;90(7):847-51.
PMID: 18591590 [PubMed - indexed for MEDLINE]
Article Website Page
1: Acta Orthop. 2007 Apr;78(2):211-20. Links Neo-capsule tissue reactions in
metal-on-metal hip arthroplasty.
Witzleb WC, Hanisch U, Kolar N, Krummenauer F, Guenther KP.
http://www.ncbi.nlm.nih.gov/sites/entrez>
1: J Arthroplasty. 2008 Oct;23(7):1080-5. Epub 2008 Mar 14. Links
Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing.
Campbell P, Shimmin A, Walter L, Solomon M.
Article Website Page
Frequency of occurrence, mode of development, andsignificance of rice bodies in
rheumatoid joints
Article Website Page
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