Pathways in Prosthetic Joint Infection

Umraz Khan has been involved in promoting ortho-plastic surgery in the UK. The care and management of patients with prosthetic joint infection has been a key element of his clinical practice for the past 16 years. Mr Khan is a senior, full-time Consultant plastic surgeon at the North Bristol NHS Trust. He has set-up and established a well-respected service for the care of patients who present with conditions which benefit from combined care. The clinical outcomes are some of the best in the world. Mr Khan has been recognised for his contribution to plastic surgery by several learned societies around the world.Graeme Perks qualified MBBS in London, before becoming a FRCS and moving to Melbourne, Australia, where he worked as a lecturer in the Monash University Department of Surgery with a research interest in transplant organ rejection. After completing the Australian national plastic surgery programme he returned to the UK for further training, and was appointed Consultant Plastic and Reconstructive Surgeon in Nottingham in 1995. Mr Perks is the Head of the Department of Plastic, Reconstructive and Burns Surgery at Nottingham University Hospitals NHS Trust, and served as BAPRAS president between 2013-2014.Rhidian Morgan-Jones has been a knee surgeon in Cardiff since 2001. During that time he subspecialized in revision knee replacement with a major interest in prosthetic joint infection. Mr Morgan-Jones is the UK country delegate for the European Bone & Joint infection Society and an elected trustee for the British Orthopaedic Association. He lectures and publishes widely.Mr Peter James is a Consultant Orthopaedic Surgeon specialising in complex primary and revision knee replacement with a special interest in management of complex infections. He graduated from Nottingham University Medical School with Honours in 1985 and trained in Leeds, Glasgow and Belfast before taking up a consultant post in 1995.He established the first Specialist Revision Network in the UK with colleagues which has now run successfully for three years. He has also established a dedicated multi-disciplinary team within his hospital to manage complex knee revision problems which incorporates dedicated plastic surgical input as well as direct care from a dedicated infectious diseases consultant. As a result of his experience he lectures widely across both the UK and internationally on all aspects of complex knee reconstruction and management of the infected TKR.Mr Colin Esler is Consultant and Honorary Senior Lecturer at the University Hospitals of Leicester NHS Trust. He has a tertiary referral practice for problem knee arthroplasties, including infected knees. His research has involved the measurement of the outcomes of primary and revision knee surgery regards function and from patient reported outcomes. He has been involved in the design and evaluation of revision knee systems. He is President of the British Association for Surgery of the Knee (2016-18) and is a member of the Medical Advisory Committee and Editorial Board of the National Joint Register (England, Wales, Northern Ireland & the Isle of Man).Mr Smyth is the Clinical Lead for Vascular Surgery at Manchester Royal Infirmary and has been a Consultant Surgeon there for nearly 20 years. Currently advising the GM Transformation Unit on provision of Vascular Services for the future, he also and has previously served on regional Committees for a range of vascular services in the North West and on the Audit and Governance Committee of the Vascular Society of GB&I, as well as the National VSGBI Council, who supported his involvement and contribution. Dr Vanya Gant's career spans clinical infectious diseases, microbiology, a specific interest in infection in prosthetic joints and haematological malignancies, molecular diagnostics, flow cytometry of bacteria, and conceiving and managing large healthcare-related projects, both NHS and private.

The Vascular Society, and Microbiology have, in this publication, brought together the knowledge and work of experts in the science and art of management of these very difficult cases.

• 1: Introduction 2: Assessing risk of PJI 3: Preoperative assessment 4: Thromboprophylaxis and haematomas 5: Considering safe patient pathways 6: Pathways for established PJI 7: Specific microbiology issues relating to PJI 8: Revision arthroplasty networks 9: Typical cases