¹Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland

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Objectives and questions: The aim of this study was to assess the impact of periprosthetic joint infection (PJI) in the hip and knee on patients' quality of life using patient-reported outcome measures (PROMs) following successful surgical treatment.

Material and methods: We included 106 patients with clinically confirmed PJI who underwent at least one septic revision surgery (DAIR, one-stage or two-stage implant exchange revision, or arthrodesis) for hip (n=73) or knee (n=33) arthroplasty between January 1, 2021, and December 31, 2021. Quality of life was assessed using the EQ5D outcome instrument and compared to age-matched normative national data. Hip functionality was evaluated using the modified Harris Hip Score for patients undergoing two-stage hip revision surgery.

Results: We successfully interviewed 50 patients (40 hip, 10 knee). None exhibited signs of reinfection. Mortality rates were 8.22% (6/73) in the hip group and 18.18% (6/33) in the knee group. At a mean follow-up of 32.47 ± 3.12 months (min. = 26.87; max. = 38,37), the mean EQ5D index was 0.65 ± 0.31, with an EQ5D-VAS rating of 57.46 ± 20.84, compared to age-matched German normative scores of 0.891 (p < 0.001) and 68.6 ± 1.1 (p < 0.001), and reported scores for patients after primary total hip arthroplasty (THA) of 0.94 ± 0.10 and 76.36 ± 24.03. There was no significant difference between hip (n=40) and knee (n=10) patients in EQ5D index scores (0.66 ± 0.29; 0.6 ± 0.38; p= 0.583) or VAS scores (47.45 ± 21.23; 47.5 ± 20.31; p=0.995). Patients exhibited increased limitations in every subdimension of the EQ5D. In total, 72% of patients reported problems with mobility (compared to 15.9% of the German reference population), 46% with self-care (compared to 2.7%), 72% with usual activities (versus 9.9%), 80% with pain or discomfort (versus 27.6%), and 50% with anxiety or depression (versus 4.3%). The mean modified Hip Score at a mean follow-up of 33.67 ± 3.4 months was 56.53 ± 24, indicating poor functional outcome, compared to age-matched normative values of 93.06 and reported scores after elective primary THA of 91.99 ± 9.40.

Discussion and conclusions: Even years after successful surgical eradication of periprosthetic joint infection, patients experience significantly reduced quality of life compared to the reference population. Further clinical studies should evaluate the long-term physical and psychological symptom burden on PJI patients using PROMs.