Table 2.
Treatment trajectory of patients with prosthetic joint infection
| Pseudonym and revision type | Treatment trajectory |
|---|---|
| David 2 | Primary hip replacement 2011 Infection symptoms appeared in 2013 Managed for 3–4 months with dressings Two hospital stays to receive intravenous antibiotics, totalling 2 weeks—unsuccessful Referred to Treatment Centre 4—received first stage of a two-stage revision in 2013 Twelve months later still satisfied with ‘temporary’ hip Number of operations after primary hip replacement=1 |
| Catherine 2 | Primary hip replacement 2004 Replaced again in 2009 After 10 ‘dislocations’ referred to Treatment Centre 5. Hip replaced again in 2013 After 1 week, Catherine was in severe pain after her replacement and returned to Treatment Centre 5, with infection Two unsuccessful debridement operations Two-stage revision with spacer implant for 10 weeks. Final second stage was September 2014 Number of operations after primary hip replacement=6 |
| Lorna 2 | Primary hip replacement 2007—metal on metal Experienced some pain for the following 4 years but thought it was nothing serious. Eventually her leg ‘gave way’ as the top of her femur broke off. Referred to Treatment Centre 5—broken bone fragment removed and new prosthesis inserted Leg began to shorten as stem subsided into medullary cavity as bone was dying Hip replaced again with longer stem at which point an infection was introduced Hip debrided and implant retained—unsuccessful Two-stage revision—during the insertion of the spacer her femur was fractured (only discovered afterwards via X-ray) and subsequently the second stage was done after only 1 week during which screws were inserted to hold femur together Number of operations after primary hip replacement=5 |
| Wendy 2 | Fractured hip in 2010 but did not realise until 12 months later when she slipped in the shower and also fractured her femur for which she was X-rayed Emergency hip replacement—infection introduced Low-grade infection went undiagnosed before sepsis occurred. Near fatal Two-stage revision with spacer Spacer dislocated after 2 weeks and was replaced Number of operations after primary hip replacement=3 |
| Robert 2 | Primary hip replacement 2004 January 2013 hip subsided as stem sank into medullary cavity. Surgeon revised right hip Surgeon not satisfied so revised again 3 weeks later at which point an infection was introduced. A further washout was unsuccessful. Length of stay in hospital—9 weeks Hickman line inserted so patient could receive antibiotic shots at his local hospital every day for 2 weeks. Antibiotics unsuccessful Referred to Treatment Centre 6 November 2013 first stage of two-stage revision. All but 4 inches of femur removed. Antibiotic beads inserted and retained for 4 months March 2014 second stage Number of operations after primary hip replacement=5 |
| Don 2 | Primary hip replacement, April 2009—metal on metal August 2011—revised and debrided due to wear Had three dislocations between October 2011 and January 2012 February 2012 revision again to remedy dislocations (infection introduced) March 2012 debrided—unsuccessful January 2013—first stage of two-stage revision July 2013 further debridement needed April 2014—second stage Interim period of 14 months without spacer Number of operations after primary hip replacement=6 |
| Maggie 2 | Primary hip replacement 2005—metal on metal July 2013 revised (infection introduced) January 2014—first stage revision April 2014—second stage revision Fourteen weeks without hip or spacer Number of operations after primary hip replacement=3 |
| Charles 2 | Primary hip replacement 2003 December 2012 developed unknown infection. Washout—unsuccessful January 2013—first stage revision with spacer inserted February 2013—complications pulmonary oedema, thoracoscopic drainage October 2013—second stage of revision. Two weeks later hip then dislocated—further revision for dislocation resulted in nerve damage Ten months with spacer Hospitalised for 2 months Number of operations after primary hip replacement=4 |
| Ray 2 | Primary hip replacement February 2013—developed infection First stage revision—reoperated after discovering they had fractured his femur when fitting spacer Second stage Number of operations after primary hip replacement=2 |
| Amelia 2 | Primary hip replacement 2008 Eight to nine months later revised for dislocation. Extremely painful for a few months as infection had set in after screw broke and hip loosened. January 2013—first stage, no spacer August 2013—second stage Seven months without spacer Number of operations after primary hip replacement=3 |
| Jim 1 | Primary hip replacement October 2008 (hip resurfacing) 2013—onset of symptoms of infection. Single stage revision a few days later followed by 9 months of antibiotic treatment Number of operations after primary hip replacement=1 |
| Roger 1 | Primary hip replacement 2011 Developed sepsis only weeks later—near fatal Three washout operations—unsuccessful Stayed on antibiotics for 12 months under same surgeon then sent to Treatment Centre 1—turned down the offer of a revision operation for a further 12 months remaining on antibiotics until he could get cover to take care of his father Two years on antibiotics Single stage revision Number of operations after primary hip replacement=4 |
| Harry 1 | Left and right primary hip replacements 1992 May 2013 left hip replaced after fall (infection introduced) Single stage revision, unsuccessful Still has infection Antibiotics for 12 months at time of interview Number of operations after primary hip replacement=2 |
| Bill 1 | Primary hip replacement 1994 2004 replaced primary (infection introduced) Infection then remains for a further 10 years Unclear how many operations but at least one further revision operation in that time 2013 single stage revision Number of operations after primary hip replacement=approximately 4 |
| Harriet 1 | Primary hip replacement April 2011 February 2014—onset of symptoms of infection followed by single stage revision Number of operations after primary hip replacement=1 |
| Rory 1 | Primary hip replacement 2001 2005–2006 developed infection, and hip replaced in single stage revision 2012 further revision after femur snapped 2013 onset of symptoms of infection January 2014—single stage revision Number of operations after primary hip replacement=3 |
| Anthony 1 | Primary hip replacement right hip 2004 Primary hip replacement left hip 2007 2010 right hip became infected. Revised two-stage revision. Without hip for 3 months. Spacer broke after 2 weeks December 2010—second stage revision of right hip. Had heart failure during hospital admission and subsequent depression. Also diagnosed with leukaemia 2014 infection spread to the left hip. Revised with single stage revision Number of operations after primary hip replacement=3 |
| Simon 1 | Primary hip replacement August 2013 September 2013—single stage revision Number of operations after primary hip replacement=1 |
| Francis 1 | Primary hip replacement right hip December 2005 Primary hip replacement left hip February 2010 February 2011—diagnosed lump on right hip as bursar Twelve operations (draining and packing) over a period of 18 months October 2012—first stage operation of two-stage revision of the right hip with spacer beads inserted for 3 months January 2013—second stage operation March 2014—infection spread to left hip October 2014—single stage revision of left hip Number of operations after primary hip replacement=15 in total (14 on right hip) |