Successful Management of Periprosthetic Joint Infection Following Total Joint Arthroplasty, as Defined by the Patient: A Qualitative Study.

Abstract

BACKGROUND The 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. The secondary and tertiary aims were to identify factors that patients associate with successful treatment and to assess alignment with a 2019 outcome-reporting tool (ORT) by the Musculoskeletal Infection Society (MSIS). METHODS Patients treated for PJI at 2 international tertiary arthroplasty centers and for whom no less than 1 year and no more than 5 years had elapsed since their most recent revision surgery were included. From August 2023 to April 2024, patients participated in semistructured interviews with a phenomenological approach-an approach that aims to provide detailed examinations of personal lived experiences and to 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 a thematic analysis was performed. The concordance between patient-defined and MSIS ORT-defined treatment success was calculated. RESULTS Of 27 total patients, 21 (78%) reported considerable mental health impacts during the period from PJI onset to treatment conclusion. In defining successful PJI management, patients consistently emphasized the importance of function, pain relief, mobility, and independence. Nine (33%) of the patients (p < 0.001) did not agree with their MSIS ORT classification of success versus failure. CONCLUSIONS 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 PJI management process. Future avenues for research include the exploration of the feasibility and impact of implementing patient-centered care models that feature psychological support. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.