Around 2,000 patients in the UK each year face a second complex surgery after their hip or knee replacement becomes infected, and surgeons disagree on which approach works best. This matters because deep prosthetic joint infection is a devastating complication. It causes severe pain, poor quality of life, and if untreated can lead to disability, amputation, or death. About 10% of patients develop a second infection within two years of revision surgery. Currently, 26% of patients receive a single-stage replacement and 70% a two-stage procedure that leaves them immobile for months—but no one knows which strategy actually lowers re-infection risk. The research programme will run a randomised trial comparing one-stage versus two-stage revision for infected hip replacements, analyse national registry data to identify predictors of infection, and study patient preferences for different outcomes. It will also assess costs from a societal perspective. If successful, the programme will produce clear evidence on the best surgical strategy, allowing surgeons to move beyond personal preference. This could reduce re-infection rates, shorten the period of poor mobility and quality of life for patients, and save the NHS money by avoiding repeat surgeries.
View original technical description
Aims and Objectives The overall aim of the programme is to improve treatment of patients with deep prosthetic joint infection after total hip or knee joint replacement. Background and rationale Deep prosthetic joint infection (PJI) is a serious complication of total joint replacement (TJR) causing severe pain, poor quality of life and, if untreated, disability, amputation and death. UK incidence is about 1% necessitating around 2000 complex surgical procedures per year. Surgical revision involves prosthesis removal, debridement, antibiotic treatment and replacement. The prosthesis is replaced in the same operation (1-stage) or delayed for 3-6 months (2-stage). 2-stage revision allows additional antimicrobial strategies but mobility and quality of life are poor between stages and further surgery is required. About 10% of patients have re-infection within 2 years. The surgical treatment with lowest re-infection risk is unclear with decisions largely based on surgeon preference. UK estimates are that 26% of patients receive 1-stage and 70% 2-stage revision. Research environment Four tertiary referral centres treating PJI will participate with Avon Orthopaedic Centre coordination. We have expertise conducting large randomised trials and application of research methods in the orthopaedic setting. Research plan A programme of 7 work packages (WP) aims to improve treatment of PJI after TJR. Work packages will have patient forum input throughout. WP1. Systematic reviews and individual patient data meta-analyses will compare re-infection after surgical strategies. Evidence on prediction, diagnosis and monitoring will be reviewed. WP2. Analysis of National Joint Registry data will identify predictors of PJI and determine whether treatment is more successful in high volume specialist centres. WP3. Qualitative in-depth interviews will study the impact on patients of PJI and treatment, and will help refine methods for treatment evaluation. WP4. In a multicentre randomised trial we will compare 1- and 2-stage surgical revision of hip PJI. Patients will be eligible if the treating surgeon believes either treatment appropriate. Primary outcomes will include patient-centred measures. WP5. Treatment costs will be estimated and effects of patient- and hospital-specific factors estimated with statistical modelling. Economic implications of 1- and 2-stage revision for hip PJI will be assessed from a societal perspective. WP6. Patients' preferences for surgical revision of PJI will be explored using discrete choice methods. We will assess trade-offs that patients are willing to make between patient-centred and clinical outcomes, and explore how treatment strategies change preferences for outcomes. WP7. The programme will disseminate evidence on best practice, including cost effectiveness, conferring benefits to patients and NHS. Projected Outputs & Dissemination plans By addressing effectiveness and acceptability, the programme is well-placed to recommend improvements to care and deliver: Reviews and meta-analyses of PJI treatment, predictors and diagnosis by year 4 Predictors of PJI and effect of surgeon and unit volume on outcomes by year 3 Evidence on patient impact of PJI by year 4 Evidence from a randomised trial on treatment effectiveness by year 5 Information on cost impact of treatments by year 5 Knowledge on trade-offs between patient-reported and clinical outcomes in the context of 1- and 2-stage revision by year 5 The findings will inform: Patients We will establish how care and outcomes can be optimised after PJI. Guidance material developed with Arthritis Care, programme patient group, health promotion professionals and press offices will enable patients to maximise recovery in partnership with the NHS. Clinicians Evidence on improving care and outcomes will affect clinical practice. We will present findings at conferences and in peer-reviewed journals, and develop
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know