Krenn Vincent Tilo, Bönigk Maria Sarah, Trampuz Andrej, Liebisch Martin, Perka Carsten, Meller Sebastian
Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Empowerment Research Institute GmbH, Magdeburg, Germany.
PLoS One. 2025 Mar 12;20(3):e0319509. doi: 10.1371/journal.pone.0319509. eCollection 2025.
Periprosthetic joint infections (PJI), along with the extensive medical and surgical interventions required for treatment, impose a substantial psychological burden on patients. Given the need for patients to adapt to long-term physical limitations and ongoing medical challenges, this qualitative study aims to explore the nature of psychological coping amongst patients with chronic cases of PJI. A total of 18 patients (8 men and 10 women, aged 55 to 92) who underwent a total knee or hip arthroplasty revision due to chronic PJI were recruited at a single academic institution between August 2022 and July 2023. Semi-structured interviews were conducted at two timepoints and analyzed using thematic analysis. We identified the nature of coping with PJI as patients' process-orientation towards healing. This encapsulates constant adaptation to challenges and losses in day-to-day life, managing expectations and proactively developing a sense of self-efficacy during treatment and healing. Patients expressed uncertainty and unpredictability to treatment trajectories and getting a feeling of being stuck, where health and well-being oscillates between progression and regression. These experiences contributed to unstable relationships with healthcare practitioners which were influenced by loss of trust and perceived treatment failures. A holistic view on patients, taking them seriously in their concerns and providing clear information were identified as crucial factors in shaping a positive patient-physician relationship. Acknowledging the fluctuating nature of chronic PJI treatment, physicians should adopt a process-oriented approach that promotes step-by-step healing while maintaining a positive patient-physician relationship. Recognizing the profound psychological impact, we propose the establishment of a new subdiscipline, namely 'Psycho-Endoprosthetics', to facilitate interdisciplinary collaborations for research and practice in septic surgery.
人工关节周围感染（PJI）以及治疗所需的广泛医疗和外科干预，给患者带来了巨大的心理负担。鉴于患者需要适应长期的身体限制和持续的医疗挑战，这项定性研究旨在探讨慢性PJI患者的心理应对本质。2022年8月至2023年7月期间，在一家学术机构招募了18名因慢性PJI接受全膝关节或髋关节置换翻修手术的患者（8名男性和10名女性，年龄在55至92岁之间）。在两个时间点进行了半结构化访谈，并采用主题分析法进行分析。我们将应对PJI的本质确定为患者对康复的过程导向。这包括不断适应日常生活中的挑战和损失、管理期望以及在治疗和康复过程中积极培养自我效能感。患者对治疗轨迹表示不确定和不可预测，并有一种被困住的感觉，健康和幸福感在进展和退步之间波动。这些经历导致与医护人员的关系不稳定，这受到信任丧失和感知到的治疗失败的影响。将患者视为一个整体，认真对待他们的担忧并提供清晰的信息，被确定为塑造积极的医患关系的关键因素。认识到慢性PJI治疗的波动性质，医生应采用以过程为导向的方法，促进逐步康复，同时保持积极的医患关系。认识到其深远的心理影响，我们提议设立一个新的子学科，即“心理假体学”，以促进脓毒症手术研究和实践中的跨学科合作。
