Predicting risk in the management of infection in orthopaedics

Thesis

Bone and joint infections are a significant issue, affecting thousands more people each year and costing over £50 million to treat in the UK alone. Infection returns for many adults, even after intensive treatment with surgery and antibiotics. Ongoing bone and joint infection is painful and dispiriting; one in eight sufferers report a quality of life worse than death. People whose infection is not cured may need life-long antibiotics to suppress it, which can lead to antibiotic resistance and serious side-effects. Ongoing infection may require risky surgery, and itself has a higher mortality than many cancers.

The body’s ability to heal and fight infection around the time of orthopaedic surgery is crucial. This is a period where infection may become established on bone and implants, in such a way that only further surgery can reliably eradicate it. Healing may be affected by illness and some behaviours such as smoking. ’Pre-habilitation’ before surgery for orthopaedic infection might help healing, and reduce the chances of infection coming back.

Understanding which treatments work for different people affected by orthopaedic infection, and whose infection is most likely to come back, can help to tailor treatments and guide future research. This project describes studies that identify how different people with orthopaedic infection respond to treatment differently. One part describes developing a prognostic tool to predict whose infection is most likely to return. Other sections describe how best to help people with orthopaedic infections achieve the best health before an operation. Throughout the project, the experiences of people with orthopaedic infection are centred, and contribute to guiding recommendations for treatment.

Authors: Dudareva, M

• DOI: 10.5287/ora-zovv18qov
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: fracture related infection; peri-operative care; prognostic modelling; osteomyelitis; prosthetic joint infection; theoretical domains framework; antimicrobial stewardship
• Subjects: Infection; Therapeutics, Surgical; Osteomyelitis