Infection after knee replacement: a qualitative study of impact of periprosthetic knee infection

Abstract

BackgroundApproximately 340,000 knee replacements are performed each year in the USA and UK. Around 1% of patients who have had knee replacement develop deep infection around the prosthesis: periprosthetic knee infection. Treatment often requires a combination of one or more major operations and antibiotic therapy. This study aimed to understand and characterise patients’ experiences of periprosthetic knee infection.MethodsQualitative semi-structured interviews were conducted with 16 patients (9 men, 7 women; 59–80 years, mean age 72) who experienced periprosthetic knee infection and subsequent revision treatment in six National Health Service orthopaedic departments. Interviews were audio-recorded, transcribed, anonymised and analysed thematically. The concept of biographical disruption was used to frame our analysis, and four transcripts double-coded for rigour. Patients were interviewed between two and 10 months after surgical revision.ResultsParticipant experiences can be characterised according to three aspects of biographical disruption which we have used to frame our analysis: onset and the problem of recognition; emerging disability and the problem of uncertainty, and chronic illness and the mobilisation of resources. Participants’ experiences of infection and treatment varied, but everyone who took part reported that infection and revision treatment had devastating effects on them. Participants described use of social and healthcare support and a need for more support. Some participants thought that the symptoms that they had first presented with had not been taken seriously enough.ConclusionsPeriprosthetic knee infection and its treatment can be life-changing for patients, and there is a need for greater support throughout treatment and lengthy recovery. Future work could look at preparedness for adverse outcomes, help-seeking in impactful situations, and information for healthcare professionals about early signs and care for periprosthetic infection.

Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales

“…3 Treatment of prosthetic joint infection is expensive and protracted, and both the infection and the treatment have profoundly negative effects on patients and their families. [4][5][6][7] Treatment options include antibiotic suppression, debridement and retention of implants, excisional arthroplasty, and one-stage or two-stage revision. 8,9 However, all of these treatment options are associated with substantial morbidity and a high risk of adverse outcomes.…”

Surgeons are deeply affected when patients are diagnosed with prosthetic joint infection

“…It has the potential to improve patients' quality of life by reducing pain and improving function, but there is also potential for serious complications. Prosthetic joint infection (PJI) is a potentially life-threatening condition associated with severe pain, functional difficulties and poor quality of life [1][2][3]. If left untreated, PJI may result in limb amputation or death [4,5].…”

“…Surgical treatment can be prolonged sometimes involving multiple surgeries and hospitalisations and prolonged antibiotic treatment. PJI and its treatment has a profoundly negative impact on all aspects of patients' lives, including physical, social, emotional and economic aspects and patients undergoing treatment can experience feelings of isolation and insecurity, and an inability to live independently [1,2]. Cahill and colleagues found that the profoundly negative impact on patients' social functioning and mental health is notable with this group of patients rating their overall quality of life as poor with 12% of patients rating their current situation as equivalent to or worse than death [3].…”

“…Although recent research has concentrated on the impact of infection on patients [1,2], little is known about how surgeons may be affected when patients whom they have treated have infection. Adverse events may have considerable impact on healthcare professionals, particularly if the professionals are seen to be accountable for the outcome [8].…”

Spinal Cord Stimulation Infection Rate and Incremental Annual Expenditures: Results From a United States Payer Database

“…Even for patients whose devices are replaced, there could be significant negative impact on patient quality of life due to the infection and related treatment. Studies in other conditions have identified a significant impact of surgical site infection on patient quality of life . Further research is needed to understand the specific quality‐of‐life impact of SCS device‐related infections.…”