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timing of hardware removal
Started by terri
Posted: August 2, 2010 at 20:49
approx. two weeks after having a plate and pins placed for a fracture to my fifth metatarsal (mid-shaft) I developed cellulitis and hospitalized for three days after the culture came back positive for MRSA. Currently at home with IV Cubicin. The orthopedist has told me the hardware must be removed but can't tell me when. The IDD gives me the impression it should be done ASAP and I would prefer to get it over with instead of waiting until I'm "healed up" and then going through another surgery. Have not been able to find a standard protocol for correct timing and hope someone has some answers? Additionally I had 6 dental implants placed 6 months ago-is this another potential problem? I would appreciate any help or advice from someone who has been through this.
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Re: timing of hardware removal
Reply #1 by ladyk
Posted: August 4, 2010 at 18:32
terri -

I'm in agreement with your physicians… and believe if MRSA has been cultured from surgical site, hardware should be removed ASAP. You gain nothing but further complications by not addressing this directly.

Nancy R has similar history to yours albeit in her case she had hip replacement where it was necessary for hardware to be removed, MRSA infection aggressively addressed, followed by implant without further infection problems. You can find her posts by going to forum's initial page and type in Nancy R in ‘Search Topic Names:”... many of her posts will be available. http://www.mrsa-forum-usa.com/index.asp?action=list

It is my impression the deciding factor for hardware removal is leaning on whether Cubicin will resolve infection without hardware removal, so physicians are affording this therapy time with hopeful results. But… the fact is the site is dirty (MRSA infected), and depending on length of time since IV Cubicin was initiated, will give clue as to whether this will have any positive impact.

How long have you been on Cubicin?

ladyk

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Re: timing of hardware removal
Reply #2 by Nancy R
Posted: August 5, 2010 at 02:05
I would hope your surgeon will move very quickly, for the hardware will be the perfect place for the bacteria to colonize. I know its scary, it was for me too. However, the longer you wait, the more the bacteria can move around the body. I was septic and delirious when I was re-admitted to the hospital almost 2 months post op. I had been on all kinds of antibiotics as the surgeon tried to correct the problem.

Ultimately, the hip implant had to be replaced and I was without any hip for 10 weeks as I was infused with Cubicin and Bactrim. Only when I tested clean did the second surgeon agree to try again. Thankfully, the second implant worked and the infection has not recurred. For the record, I learned almost a year later that the surgeon who saved my life only took my case because he knew no one else would. Even he didn't think he could save me. I'm his poster child now.

Cubicin worked very well for me. However the first heavy hitter infused antibiotic that was on (Zyvox) did not. It controlled the bacterial infection only while I was on it and it destroyed my immune system. It has taken me 3 years to rebuild it. Even now, I struggle with fatigue and joint pain. However, I'm alive!
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Re: timing of hardware removal
Reply #3 by Nancy R.
Posted: August 5, 2010 at 02:11
terri:

Are you on the East coast? If so, I would highly recommend that you contact Dr. Ronald Delanois and Dr. Michael Mont at Sinai Hospital in Baltimore, MD. They are considered the best in the world for treating infected joints and bones. They saved my life.
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Re: timing of hardware removal
Reply #4 by ladyk
Posted: August 5, 2010 at 19:53

Thanks so much Nancy~ I was hoping you were around to weigh in on this topic.

You're the best.

Hugs,
ladyk
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Re: timing of hardware removal
Reply #5 by Terri
Posted: August 5, 2010 at 22:34
Thanks so much for the replies! To answer your question, yesterday was day number 15 on the Cubicin. Saw the ortho and IDD yesterday- the ortho did tell me he was planning to wait 4-8 weeks for the bone to heal... the IDD said she could support that and just continue the IV therapy until surgery even if blood tests indicate the infection is gone (or under control)but it is clear she is more urgent about removal and the ortho is concerned about the bone healing and explained the dilema of timing decisions-ie; should the hardware come out asap and run the risk of more infection or wait until the numbers come down,bone heals -but risk colonization. Blood tests indicate platelets are still high (452)but coming down, sed rate is 27. I like both drs. but it seemed obvious that she was hesitant to give her true opinion re timing if was different from the ortho so I'm still not sure if I should push for quicker removal? Unfortunately I am not near Baltimore- I'm in Dallas, Texas. I will read your other posts, Nancy, in hopes of some clarification- but when you say move quickly- can you give me some idea based on the blood labs- how quickly this should take place. Thank you all so much for the help- I deal with several chronic health issues every day and certainly want this over asap so I don't have one more lifetime issue.
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