Increased Prevalence of Depressive Symptoms in Patients Undergoing Revision for Periprosthetic Joint Infection

Abstract

Background Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty. Patients undergoing revision for PJI may experience psychological distress and symptoms of depression, both of which are linked to poor postoperative outcomes. We, therefore, aim to identify the prevalence of depression and depressive symptoms in patients before treatment for PJI and their link to functional outcomes. Methods Patients undergoing either debridement with implant retention (DAIR) or 2-stage exchange for PJI with minimum 1-year follow-up were retrospectively reviewed. The 2-stage (n = 37) and single-stage (n = 39) patients that met inclusion criteria were matched based off age (±5 years), gender, and body mass index (±5) to patients undergoing aseptic revisions. Outcomes evaluated included a preoperative diagnosis of clinical depression and preoperative and postoperative Veterans RAND 12 Item Health Survey mental component score and physical component score. Results Compared to matched controls, the prevalence of depressive symptoms was significantly greater in patients undergoing 2-stage exchange preoperatively (40.5% vs 10.8%, P < .01) but not postoperatively (21.6% vs 10.8%, P = .20). Patients undergoing DAIR with either preoperative depressive symptoms (31.3 vs 40.9, P = .05) or a preoperative diagnosis of depression (27.7 vs 43.1, P < .01) had significantly lower physical component scores postoperatively. Conclusions Patients undergoing 2-stage exchange for PJI have a four times higher prevalence of preoperative depressive symptoms than patients undergoing aseptic revision. Patients undergoing DAIR with depression or preoperative depressive symptoms have lower functional scores postoperatively. Orthopedic surgeon screening of PJI patients with referral for treatment of depression may help improve outcomes postoperatively.

The Effect of Spacer Treatment of Infected Hip and Knee Arthroplasties on Patients’ Mental Health: A Narrative Review of the Literature

“…In more detail, regarding the normative data of the populations examined in the analyzed papers [25][26][27][28][29][30][31][32], of the seven works that provided data on the pre-operative state, all reported a worse mental condition than the normal population [3,[11][12][13]15,18]. This condition is well known in the literature; several authors have, in fact, highlighted the higher rate of anxiety and depression in patients diagnosed with PJI, also analyzing how the same mental state is related to the greater risk of infection [15,17,[33][34][35][36][37]. From this point of view, our review suggests that although the mental state appears to be compromised in all the analyzed works, these conditions could be transitory with a certain improvement over time.…”

Impact of Perioperative Dexamethasone Administration on Infection and Implant Osseointegration in a Preclinical Model of Orthopedic Device-Related Infection

“…Despite the success of joint arthroplasties, they are not without challenges. Complications, such as infection, implant failure, and the need for revision surgeries, still occur and are associated with a significant physical and mental burden for the patient and a significant financial burden for healthcare systems [ 20 , 21 ].…”

A qualitative study of patients' experiences before, during and after surgical treatment for periprosthetic knee joint infection; “I assumed it had to be like that … ”

“…However, literature is sparse regarding the patient's perspectives or experiences. One study showed that PJI of the knee negatively affected psychological wellbeing (Hegde et al, 2021). Patients with PJI of the knee treated using the two-stage protocol have also been shown to have high levels of psychosocial distress compared to those with malignant diseases (Knebel et al, 2020).…”