Entezari Bahar, Lex Johnathan R, Davis Joshua B, Juryn Margaret S, Gabriel Daniel C, Chen Antonia F, Wolfstadt Jesse I
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
J Bone Joint Surg Am. 2025 Apr 25;107(12):1324-1332. doi: 10.2106/JBJS.24.01057.
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).
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.
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.
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.
Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
关于全关节置换术（TJA）后假体周围关节感染（PJI）患者主观体验的文献较少，且在定义治疗成功时未考虑患者价值观。本研究的主要目的是描述接受PJI治疗的患者的体验。次要和第三目的是确定患者认为与治疗成功相关的因素，并评估与肌肉骨骼感染学会（MSIS）2019年结果报告工具（ORT）的一致性。
纳入在2个国际三级关节置换中心接受PJI治疗、自最近一次翻修手术起已过去不少于1年且不超过5年的患者。从2023年8月至2024年4月，患者采用现象学方法参与半结构化访谈——该方法旨在详细考察个人生活经历，并确定关于如何体验特定现象的主题。访谈主题包括初次TJA的经历、PJI的诊断和治疗，以及患者对其PJI治疗成功的看法。访谈内容被转录，并进行了主题分析。计算了患者定义的治疗成功与MSIS ORT定义的治疗成功之间的一致性。
在27名患者中，21名（78%）报告在从PJI发病到治疗结束期间有相当大的心理健康影响。在定义成功的PJI治疗时，患者一致强调功能、疼痛缓解、活动能力和独立性的重要性。9名（33%）患者（p<0.001）不同意MSIS ORT对其成功与失败的分类。
PJI是TJA后的一种毁灭性并发症，患者定义的成功与临床医生定义的成功不一致。因此，在整个PJI治疗过程中为患者提供的支持不足。未来的研究途径包括探索实施以心理支持为特色的以患者为中心的护理模式的可行性和影响。
治疗性四级。有关证据水平的完整描述，请参阅作者指南。
