Davidson, Donald James;
(2024)
Understanding Periprosthetic Joint Infection.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Prosthetic joint infection (PJI) is a serious complication of joint replacement surgery associated with morbidity, mortality, and socioeconomic cost. The aim of this thesis is to improve our understanding of PJI by assessing the problem at both the population and the microbiological scale. Bacteria can establish biofilms on all implant grade material and there is in vitro evidence that certain material characteristics are less attractive to bacteria and impede early biofilm formation. Clinical evidence that the choice of materials affects the risk of PJI at the population level is limited. In the first section of this thesis, a population level assessment was made to determine the influence of different implant materials on PJI using infective revision as a surrogate indicator. Propensity score matched (PSM) cohorts from 679,006 knee replacement patients demonstrated that antibiotic impregnated bone cement had no protective benefit at reducing infective revision over plain cement. Analysis using PSM cohorts demonstrated that oxidised zirconium and highly crosslinked polyethylene had a statistically insignificant trend towards decreased infective revision compared to cobalt chromium and conventional ultrahigh molecular weight polyethylene, respectively, but the analysis was likely under powered. In the second half of the thesis, at the microbial level, an in vitro model of PJI was established and modified to produce biofilms of either low or high mass and vitality depending on the incubation conditions. The model was then used to trial novel disclosure agents to demonstrate the presence of biofilm on implant material. Biofilm characterisation techniques were then trialled at the mesoscale and microscale and analysed using a novel computer program which was developed and successfully trialled. Finally, biofilm was cultivated on implant grade material, disclosed, and characterised at the macro-, meso- and microscale using a novel multimodal imaging protocol paving the way for a future ex vivo assessment.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Understanding Periprosthetic Joint Infection |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2024. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Eastman Dental Institute |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10194061 |
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