Misdiagnosed Joint Issues: A Patient's Journey Through Multiple Surgeries

It took three surgeries to finally identify the issue with the spine?

Hello Doctor,
I had surgery for HIVD in December 2005, and my recovery was good.
However, prior to radiation therapy, my wound may have come into contact with water, and I experienced unexplained fevers three times within a week.
I informed my doctor during a follow-up visit, but he said it was not a concern.
Four weeks post-surgery, I returned to work, which is relatively light as I am in sales.
However, after just one week, I experienced severe pain in my right leg (the affected limb from the HIVD).
The symptoms included continuous cramping, and even slight movements caused excruciating pain.
I couldn't sleep all night and had to call an ambulance to take me to the hospital.
The attending physician saw me the next day and advised hospitalization for observation.
After seven days in the hospital, I felt somewhat better but was still unable to walk.
The doctor then recommended another lumbar surgery.
After that surgery, I felt some improvement, but I still walked with a limp, and there was a noticeable discrepancy in leg length.
The doctor mentioned that I would gradually improve.
From February to April, my affected limb never truly touched the ground, leading to muscle atrophy.
During this time, I consulted an orthopedic specialist who also said I would gradually improve, but instead, my condition continued to deteriorate.
In May 2006, I was referred to Kaohsiung Medical University Hospital, where I underwent another surgery to insert screws in my spine, but it did not help.
I still could not apply weight to my foot.
In July, I returned to my original hospital (Chimei) to see a neurosurgeon (who was not my previous attending physician).
He took X-rays and indicated that there was an issue with my right hip joint and referred me to orthopedic specialist Dr.
Qin.
He used a device to scan and diagnosed me with arthritis, prescribing medication, but my condition worsened.
Three weeks later, I saw another orthopedic doctor, Dr.
Huang, who diagnosed me with bacterial arthritis.
After an MRI, he recommended hip joint replacement surgery.
I was hospitalized, had my bone removed, and after two weeks of treatment, I underwent hip joint replacement.
Now I can apply weight to my foot.
Sorry for the lengthy explanation.
I have a few questions for you, Dr.
Shi:
1.
I had a right total hip arthroplasty on September 27, 2006.
Can I use a walker to apply weight to my affected limb?
2.
When I walk without a walker, I limp.
Is this due to insufficient muscle strength? My legs have a significant size difference, and the calf and quadriceps muscles in my affected limb have atrophied.
I do not limp when using a walker.
Can walking help restore muscle strength?
3.
When I perform strength exercises for my affected limb, I sometimes experience soreness, but it improves the next day.
Is this due to overexertion?
4.
When I walk quickly without a walker, I do not limp, but I do limp when walking slowly.
Is this due to insufficient muscle strength?
5.
I am still taking antibiotics for inflammation, but I experience unbearable itching all over my body.
I have tried different antibiotics, but the itching persists.
Could this be related to the antibiotics or the blood transfusion? Should I see a dermatologist?
6.
The doctor said I have gonococcal arthritis.
I researched it online, and it seems to be a sexually transmitted infection.
However, I have had a single sexual partner since marriage.
Could you explain the possible reasons for this? (I have been married for two years.)
7.
Will I be limping for the rest of my life? Is this common among patients with artificial hip joints, or is it just due to insufficient muscle strength?
8.
The doctor mentioned that my arthritis may have been present since the pain began earlier this year, but why did no physician detect it? Two neurologists and two orthopedic surgeons (the one who performed my hip replacement saw me in March and also advised rest for recovery).
Is it possible that the issues with my limb post-HIVD surgery were only related to the lumbar spine? How could no doctor identify the underlying cause? Must we patients undergo multiple surgeries without improvement, losing our jobs and health in the process? If I had not sought a second orthopedic opinion, I would have undergone a fourth spinal surgery for nerve adhesion.
9.
Could you please provide detailed answers to my questions? Thank you.
10.
My attending physician seems reluctant to communicate.
Thank you.

Xiao, 30~39 year old female. Ask Date: 2006/10/20

Dr. Shi Guozheng reply Orthopedics

After total hip arthroplasty, patients typically need to rely on a cane for about three to six months.
Using a walker allows for some weight-bearing, but it is advisable to discontinue the walker only after three to six months when there is no pain.
Muscles that are not used for a period may atrophy, leading to thinner legs or feet, but resuming exercise should help regain some muscle mass.
Soreness may result from overexertion, and usually, reducing activity or resting will alleviate this.
Limping can occur due to insufficient muscle strength.
If there is an allergy to antibiotics, an alternative that is both effective and non-allergenic should be used.
Joint infections can also arise from the bloodstream, and a decrease in the body's immune response may increase susceptibility to infection.
After joint replacement, some individuals may no longer experience a limp.
If symptoms persist after herniated intervertebral disc (HIVD) surgery, it can be concerning, and if hip issues arise, it may be coincidental.
It is important to communicate clearly with your physician before surgery to align expectations.
I hope this information is somewhat helpful to you.

Reply Date: 2006/10/20

More Info

I'm sorry to hear about your challenging journey with joint issues and multiple surgeries. It sounds like you've been through a lot, and it's understandable to have many questions regarding your current situation and future outlook. Let’s address your concerns one by one.

1. Using a Walker After Hip Replacement: After your hip replacement surgery on September 27, you can indeed use a walker to help you bear weight on your affected leg. This is a common practice to ensure stability and safety while you regain strength and mobility. It's essential to follow your physical therapist's guidance on how to use the walker effectively.

2. Limping Without a Walker: Limping when not using a walker may be due to muscle weakness in your affected leg. After a significant surgery like a hip replacement, it’s normal for the muscles to weaken, especially if they have not been used properly for an extended period. Using a walker can provide support and help you walk more evenly, which can also encourage muscle engagement.

3. Muscle Pain After Strength Training: Experiencing soreness after strength training is common, especially if you are just starting or increasing the intensity of your workouts. This soreness, known as delayed onset muscle soreness (DOMS), typically occurs when your muscles are adapting to new stresses. However, if the pain is severe or persists, it may be a sign of overtraining or improper technique, so it's wise to consult with a physical therapist.

4. Walking Speed and Limping: The observation that you limp when walking slowly but not when walking quickly could indicate that your muscles are not yet strong enough to support a slower, controlled pace. Fast walking may engage different muscle groups or allow for a more natural gait, while slow walking may expose weaknesses.

5. Allergic Reactions to Antibiotics: If you are experiencing itching and discomfort while on antibiotics, it could be a side effect of the medication. Some individuals have allergic reactions to certain antibiotics, which can manifest as skin rashes or itching. It’s advisable to consult with your healthcare provider about these symptoms, and they may refer you to a dermatologist if necessary.

6. Understanding Gonococcal Arthritis: Gonococcal arthritis is indeed associated with the bacteria that cause gonorrhea, which is a sexually transmitted infection. However, it can occur in individuals who may not have obvious symptoms of the infection. It’s important to discuss your concerns with your healthcare provider, as they can provide more context about how this condition may have developed in your case.

7. Long-term Mobility Concerns: Whether you will experience a permanent limp depends on various factors, including your recovery progress, physical therapy, and overall health. Many patients with hip replacements can regain significant mobility and function, especially with diligent rehabilitation. It’s crucial to stay proactive in your recovery and follow your therapist's recommendations.

8. Missed Diagnoses: It can be frustrating when multiple healthcare providers do not identify the underlying issues. Unfortunately, joint problems can sometimes be complex and may not present clear symptoms initially. It’s essential to advocate for yourself and seek second opinions when you feel your concerns are not being addressed adequately.

9. Feeling Like a Test Subject: Your feelings are valid, and it’s understandable to feel overwhelmed by the number of procedures and the lack of clear answers. It’s crucial to find a healthcare provider who listens to your concerns and works collaboratively with you on your treatment plan.

10. Communication with Your Doctor: If you feel your primary physician is not communicative, consider discussing your need for more information directly with them or seeking a second opinion from another specialist who may be more open to dialogue.

In conclusion, your journey has been undoubtedly challenging, but with the right support and proactive management, there is potential for improvement. Continue to engage with your healthcare team, advocate for your needs, and focus on your rehabilitation. Your health and well-being are paramount, and it’s essential to find a path that works for you.

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