Long-Term Patient-Related Quality of Life after Knee Periprosthetic Joint Infection

Walter, Nike; Rupp, Markus; Hierl, Katja; Koch, Matthias; Kerschbaum, Maximilian; Worlicek, Michael; Alt, Volker

doi:10.3390/jcm10050907

Cited by 40 publications

(37 citation statements)

References 31 publications

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“…In the context of PJI, prior literature has established that up to 58% of patients risk depressive symptoms throughout their course of treatment and 21.9% report symptoms of anxiety and depression even up to an average of 5 years after eradication of their PJI [ 26 , 27 ]. The odds ratio of developing a new mental health diagnosis after undergoing revision surgery for PJI is as high as 2.10 and can range from 1.55 to 1.82 when examining new-onset depression in the total knee (TKA) and total hip arthroplasty (THA) populations, respectively [ [28] , [29] , [30] ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…While the overall incidence of PJI in THA and TKA is merely around 2% [ 7 , 8 ], affected patients experience an impaired quality of life. This may last for years, even after successful surgical treatment [ 9 , 10 ]. Accordingly, a preference for an early and accurate diagnosis of PJI is one of the most accepted consensuses in orthopaedic surgery [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Microbiological Advantages of Open Incisional Biopsies for the Diagnosis of Suspected Periprosthetic Joint Infections

Niemann

Otto

Braun

et al. 2022

JCM

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Background: Periprosthetic joint infection (PJI) represents a serious complication following total hip (THA) and knee arthroplasty (TKA). When preoperative synovial fluid cultures remain inconclusive, open incisional joint biopsy (OIB) can support causative microorganism identification. Objective: This study investigates the potential benefit of OIB in THA and TKA patients with suspected PJI and ambigious diagnostic results following synovial fluid aspiration. Methods: We retrospectively assessed all patients treated from 2016 to 2020 with suspected PJI. Comparing the microbiology of OIB and the following revision surgery, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the number needed to treat (NNT). Results: We examined the diagnostic validity of OIB in 38 patients (20 female) with a median age of 66.5 years. In THA patients (n = 10), sensitivity was 75%, specificity was 66.67%, PPV was 60%, NPV was 80%, and NNT was 2.5. In TKA patients (n = 28), sensitivity was 62.5%, specificity was 95.24%, PPV was 83.33%, NPV was 86.96%, and NNT was 1.42. Conclusions: Our results indicate that OIB represents an adequate diagnostic tool when previously assessed microbiological results remain inconclusive. Particularly in TKA patients, OIB showed an exceptionally high specificity, PPV, and NPV, whereas the predictive validity of the diagnosis of PJI in THA patients remained low.

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“…In addition, PJI is potentially life-threatening, with increased mortality rates compared with patients who do not develop an infection after joint replacement [ 3 , 4 ]. Hence, PJI has profound effects on the patients’ quality of life leading to high levels of psychological distress [ 5 – 7 ]. In recent years, beside the use of patient-reported outcome measures, quantitative analyses capturing patients’ experiences following one- and two stage revision for PJI were brought into the focus of orthopaedic and trauma surgery research [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Managing periprosthetic joint infection—a qualitative analysis of nursing staffs’ experiences

et al. 2022

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Background Periprosthetic joint infection represents a major complication in orthopaedics and trauma surgery. For an ideal management approach, it is important to understand the distinct challenges for all persons involved in the treatment. Therefore, it was aimed at investigating (1) the impact of periprosthetic joint infection (PJI) on the well-being of nursing staff to (2) identify challenges, which could be improved facilitating the management of PJI. Methods This is a qualitative interview study. In total, 20 nurses of a German university orthopedic trauma center specialized on infectious complications were recruited using a purposive sampling strategy. Content analysis was performed on transcripts of individual in-person interviews conducted between March 2021 and June 2021. Results Three major themes could be extracted including (i) feelings associated with the management of PJI and the need for emotional support, illustrating the negative emotional impact on nurses, whereby receiving collegial support was perceived as an important coping strategy, (ii) patients’ psychological burden, highlighting the nurses’ lack of time to address mental issues adequately and, (iii) realization of the severity of PJI and compliance problems. Conclusion Identified facilitating factors for PJI management include strengthening of mental care in the treatment of PJI, providing opportunities for exchange among multidisciplinary team members and implementing compliance-enhancing strategies. The findings of this study can be beneficial for improving professionals’ satisfaction, optimising the work environment, creating organizational structures which enhance opportunities for exchange and preventing mental health issues among the nursing team.

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Long-Term Patient-Related Quality of Life after Knee Periprosthetic Joint Infection

Cited by 40 publications

References 31 publications

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

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

Microbiological Advantages of Open Incisional Biopsies for the Diagnosis of Suspected Periprosthetic Joint Infections

Managing periprosthetic joint infection—a qualitative analysis of nursing staffs’ experiences

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