Table 2

Treatment trajectory of patients with prosthetic joint infection

Pseudonym and revision typeTreatment trajectory
David 2Primary 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 2Primary 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 2Primary 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 2Fractured 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 2Primary 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 2Primary 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 2Primary 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 2Primary 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 2Primary 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 2Primary 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 1Primary 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 1Primary 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 1Left 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 1Primary 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 1Primary 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 1Primary 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 1Primary 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 1Primary hip replacement August 2013
September 2013—single stage revision
Number of operations after primary hip replacement=1
Francis 1Primary 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)