In the world of orthopaedic surgery, it is always encouraging to see when new clinical trials are set up, as they help to develop, strengthen and expand our knowledge. Trials are welcomed as they offer a unique insight into how patients respond to treatments, surgical methods, aftercare, medication and so on.

joint infectionThe University of Bristol is currently running a new trial which is designed to look specifically at the risk of developing an infection after patients have been fitted with prosthetic joints. If patterns can be identified, steps can be taken to address these, which will ensure that patient care and rehabilitation is improved even further.

Understanding the problem

If patients have undergone a total hip or knee replacement, the risk of developing serious side effects are small, but when they do occur, they can be very problematic. To put it into perspective, the number of patients who develop periprosthetic joint infection (PJI) is only 1%, however, if you’re in that 1% then it is a very unpleasant experience. Antibiotic treatment alone is not successful. Sometimes the joint can be salvaged with further surgery to remove the infected soft tissues, along with a course of powerful antibiotics.

Usually, the artificial joint needs to be removed and replaced with a new one, either as a one or two stage procedure. The orthopaedic community has long debated whether a one or two stage approach is preferable. If this is not successful the joint may need to be permanently removed and very rarely an amputation may even be required. So, for that 1% who develop PJI, the implications can be life changing.

What is the new trial all about?

The trial is being funded by the National Institute for Health Research, an organisation that works with the NHS and funds “health and care research and translate discoveries into practical products, treatments, devices and procedures”.

The University of Bristol is planning to investigate patients with infected joints in this clinical trial, which will be comparing one-stage with two-stage revision for the hip. As well as infection eradication, one of the key things the trial will be looking to understand is how the patients feel afterwards; both in terms of physical elements such as pain, mobility, dexterity and joint stiffness; and also emotional elements such as how they feel in themselves.

The surgical approach taken in each case will also be reviewed, to understand if there are any differences in terms of how expensive the different approaches are versus their outcomes, and also the level of complications experienced with each approach.

The final element is an open dialogue with both patients and surgeons. How did they feel the process went? Was it a positive or negative overall experience? What could have made the process better? How are they left feeling afterwards?

This is a very important study, as we have very little prospective data in this area. We will look forward to the results to see if there are any changes that can be made to our approach to this problem to treat the infection successfully and in particular improve the overall patient experience.

Joint replacement specialist Mr Simon Bridle is highly experienced in treating patients that have experienced PJI. Alongside his colleague, Mr Philip Mitchell, and their outstanding medical team, they often are referred patients that have experienced an infection after a hip and knee replacement and require management and revision surgery to produce the best possible outcome. To arrange a consultation with Mr Simon Bridle, call 020 8947 9524.