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This qualitative study investigated the lived experiences of 27 patients who underwent treatment for periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) at two tertiary centers. Through semi-structured interviews and thematic analysis, the study identified four distinct phases of the PJI experience and highlighted the significant negative impact on patient mental health. Patients defined successful PJI management by function, pain relief, mobility, and independence, which often differed from clinician-defined success.
Patient-defined success in PJI management following TJA emphasizes function, pain relief, mobility, and independence, highlighting a potential disconnect with clinician-centric outcome measures.
Literature on the subjective experience of patients undergoing treatment for periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) is scarce, and treatment success is defined without consideration of patient values. The primary objective of this study was to characterize the experience of patients undergoing PJI management, with secondary aims of identifying factors that patients associate with successful treatment, and assessing alignment with an outcome-reporting tool (ORT) published by the Musculoskeletal Infection Society (MSIS) in 2019. Patients treated for PJI at two international tertiary arthroplasty centers within 1 to 5 years since their most recent revision surgery were included. From August 2023 to April 2024, patients participated in semi-structured interviews with a phenomenological approach – an approach that aims to provide detailed examinations of personal lived experiences and identify themes regarding how a particular phenomenon is experienced. Interview topics included experiences with primary TJA, PJI diagnosis and management, and patient perceptions of the success of their PJI management. Interviews were transcribed and analyzed through thematic analysis. Concordance of treatment success between patients and the MSIS ORT was calculated. A total of 27 patients were included in the study. Thematic analysis of patient interviews revealed that the patient experience with PJI can be divided into four distinct phases: 1) PJI onset, 2) PJI diagnosis, 3) operative course and rehabilitation, and 4) long-term sequelae. During PJI onset, patients endorsed feelings of invalidation and delay to diagnosis. At the time of PJI diagnosis, patients described a lack of understanding and preparedness for PJI, contributing to negative emotions such as sadness, anger, surprise, etc. During the operative course and rehabilitation, patients struggled with physical limitations – this was especially noted among patients who underwent two-stage revision procedures. Physical limitations persisted long-term. A common theme across all phases was a negative impact on patient mental health. Twenty-one patients (77.8%) reported significant mental health impacts from PJI onset to the conclusion of treatment (Table 1). In defining successful PJI management, patients consistently emphasized the importance of function, pain relief, mobility, and independence (Table 2). Nine of the patients (33.3%, p PJI is a devastating complication following TJA, and success as defined by patients does not align with success as defined by clinicians. As a result, there is insufficient support offered to patients throughout the management process. Future avenues for research include exploration of the feasibility and impact of the implementation of patient-centered care models featuring psychological support. For any figures or tables, please contact the authors directly.
