Periprosthetic Joint Infection: Are Patients Still Better Off Than If Primary Arthroplasty Had Not Been Performed?

Abstract

Background: This study sought to evaluate patient-reported outcome measures (PROMs) before primary total joint arthroplasty (TJA) and after successful treatment for periprosthetic joint infection (PJI), with the hypothesis that patients still demonstrate clinical improvement despite the occurrence of PJI.

Methods: A single tertiary academic center's institutional database was retrospectively reviewed for patients who underwent primary TJA, developed PJI, and were managed for PJI from January 2019 to December 2023. Patients who did not have PROMs recorded were excluded from the study. Pre- and postoperative generic and joint-specific PROMs were collected. Patient pre-primary and post-final revision surgery for PJI PROMs were subsequently compared. The minimum follow-up after PJI treatment was six months. A total of 55 patients (31 TKA and 24 THA) were included with a mean follow-up of 1.8 years (range, six months to 4.5 years). All PJIs were managed via debridement, antibiotics, and implant retention (DAIR), 1-stage, 1.5-stage, 2-stage revision, or resection arthroplasty.

Results: After final revision surgery for PJI in TKA, patients had lower median patient-reported outcome measure information system (PROMIS) pain interference (PI) scores than before their primary surgery (62.0 [55.0, 67.0] versus 67.0 [65.0, 70.5]; P < 0.01). However, median PROMIS physical function (PF) post-final revision for PJI and pre-primary scores were similar (38.0 [33.0, 42.0] versus 34.0 [29.5, 40.0]; P = 0.08). After final revision surgery for PJI in THA, patients had lower median PROMIS PI scores than before their primary surgery (57.5 [53.8, 64.0] versus 68.0 [66.5, 74.0]; P < 0.01). After final revision surgery for PJI, patients also had higher median PROMIS PF scores than before their primary surgery (39.5 [33.5, 48.2] versus 29.5 [28.8, 34.2]; P < 0.01).

Conclusion: Patients who have been successfully managed for PJI show improvement in generic and joint-specific PROMs compared to their pre-primary TJA PROMs.