Infection can happy after any operation but is a particular problem if it follows joint replacement: the body's immune system is 10,000 times less effective at killing bacteria once it has formed a film over a metal implant than it is at bacteria in normal joint fluid. Infection happens after around 1% of hip replacement procedures. If it happens very early on (usually within 6 weeks of the hip replacement), it may be possible to wash out the infection and save the implants. If it is longer than this, the usual result is a need to remove all of the implants and debride any infected soft tissues. This is often followed by a period on antibiotics, followed by a second operation. In some circumstances it may be possible to treat the infection and reconstruct the hip at the same time: so-called 'one stage revision surgery'.
Previously, all of the decision-making processes involved in treating infected joint replacement was made by the orthopaedic surgeon alone. In more recent times, the value of involving other specialities has been recognised. Mr. Miles has set up and leads a multidisciplinary team meeting to deal with patients with infected joint replacements. This involves meeting between surgeons, microbiologists, radiologists, anaesthetists and infection control nurses where each plays a role. For example, the radiologists will interpret X-rays and scans as well as advise on the correct choice of imaging to gain further information. They may also use utrasound or X-ray guidance to take fluid samples from the joint. The microbiologist will be involved in culturing the bacteria, choosing appropriate antibiotics and monitoring the patient's response to them. Anaesthetists will insert special lines into veins to allow longer term administration of antibiotics if needed. Infection nurses will regulate and administer antibiotics as needed. This means that every level of action and decision making is made by the best qualified person to do so and leads to improved results.