Alastair's hope to return to golf after joint replacement infection trial

Alastair Hay hopes to return to playing golf after a serious knee replacement infection recently struck him down on the green.

After seeking emergency help for a sore, swollen knee, that quickly made him severely unwell, Alastair said he was mostly upset to let his golf mates down that day.

"It became really clear to me that I needed urgent medical attention," Alastair said.

"Once I came to Fiona Stanley Hospital (FSH), it was explained that I had an infection in my knee replacement joint requiring antibiotics and surgical cleanout, with the possibility of needing a repeat knee replacement or even amputation."

Thankfully Alastair kept his leg, and following the surgery, he was offered to participate in a randomised clinical research trial to investigate best treatments for infections after joint replacements, with a specific antibiotic called rifampicin.

Hoping to improve outcomes for patients like Alastair with post-joint hip and knee replacement infections, FSH Consultant of Infectious Diseases Dr Ben Clark is working on the Randomised Arthroplasty infection worldwide Multidomain Adaptive Platform Trial – Registry (ROADMAP) alongside multiple centres in Australia and New Zealand, as well as the UK and Canada.

Dr Clark said the replacement of a degenerated joint with a prosthetic or artificial joint, otherwise known as 'arthroplasty', can be life-changing, restoring joint function and lessening pain.

"However, up to 3 per cent of replaced joints will go on to develop infections, requiring prolonged hospital stays, multiple surgeries and / or amputations and lengthy outpatient antibiotic treatments, with mortality rates reaching as many as one in ten patients," Dr Clark said.

Alongside FSH colleague Dr Laurens Manning and University of Newcastle, NSW, Prof Josh Davis, Dr Clark hopes the ROADMAP study will become the largest of its kind looking at periprosthetic joint infections (PJIs).

"ROADMAP will examine the medical and surgical management of these infections by studying our current standard of care across three areas; the choice of initial operation for acute haematogenous infections, duration of antibiotics, and the use of a specific antibiotic called rifampicin.

"With consent, treatments will be randomised and the patient followed up for 12 months, with treatment success the primary outcome measure. We know that patient outcomes improve if the correct PJI management strategy is chosen initially, so the ROADMAP data will better guide our future choice of operations and subsequent antibiotic management.

"With at least 1 million Australians having had at least one joint replaced, and numbers expected to rise with our ageing population, this study is important to prevent what can be devastating outcomes for patients and their families," Dr Clark said.

Alastair is now halfway through his trial antibiotic treatment course and said his bloodwork is looking positive.

"I'm so grateful for the medical care I received at FSH – it was amazing, and I'm sure I'll be back on the golfing green before too long," Alastair said.

Recruitment for ROADMAP commenced in March 2025 and will run until Dec 2027, with an aim to recruit 2,500 patients to the study.

The global sponsor is the University of Newcastle, with the National Health and Medical Research Council funding central infrastructure and sites in Australia, and Health Research Council in New Zealand.

As the Principal Investigator at FSH, Dr Ben Clark is working alongside global leads of the trial; Head of Infection Research Program, Hunter Medical Research Institute, University of Newcastle, NSW, Prof Josh Davis, and FSH and University of Western Australia's Prof Laurens Manning. FSH Orthopaedic surgeon Prof Piers Yates is part of a global ROADMAP surgical working group alongside Dr Chris Jones and Mr Tom Bucher, both orthopaedic consultant surgeons at FSFHG. The Clinical trial coordinators are Clinical Nurse, Infection Prevention and Management/ Infectious Diseases, FSH, Michelle England, and Department of Infectious Diseases, Harry Perkins Research Institute, UWA, Alana Di Giacomo supported by Infectious Diseases Research registrar, Dr Mathew Coote.

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