Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Jul 3;106(13):1197-1204.
doi: 10.2106/JBJS.23.00717. Epub 2024 May 9.

Patient-Reported Outcomes Following Periprosthetic Joint Infection of the Hip and Knee: A Longitudinal, Prospective Observational Study

Laurens Manning  1   2 , Alexander Rofe  3 , Eugene Athan  4   5   6 , Stephen D Gill  7 , Piers Yates  2   8 , Darcie Cooper  5   6 , Joshua S Davis  9   10   11 , Craig Aboltins  3   12 ; Australasian Society for Infectious Diseases Clinical Research Network
Affiliations
Observational Study

Patient-Reported Outcomes Following Periprosthetic Joint Infection of the Hip and Knee: A Longitudinal, Prospective Observational Study

Laurens Manning et al. J Bone Joint Surg Am. .

Abstract

Background: The role of patient-reported outcome measures (PROMs) as tools for monitoring the impact and outcomes of periprosthetic joint infection (PJI) is not well described. This study analyzed the Oxford Hip Score (OHS) or Oxford Knee Score (OKS) in a prospective observational cohort of patients with hip or knee PJI.

Methods: The PIANO (Prosthetic joint Infection in Australia and New Zealand, Observational study) cohort prospectively enrolled patients with newly diagnosed PJI from multiple centers. The OHS and OKS were evaluated at PJI diagnosis (baseline) and at 3, 12, and 24 months. Scores and score changes were examined according to PJI type, patient characteristics, and management. A successful functional outcome at 12 months was defined as an OHS of >38 or OHS of >36 and/or an improvement from baseline of >12 or >9, respectively.

Results: Of the 741 participants, PROMs were available at 12 months for 233 with hip and 342 with knee PJI. Significant improvements (p < 0.0001) were seen at 12 months for both the OHS (24.5 to 36) and OKS (25 to 34), with no further improvement at 24 months. Patients with late-acute PJI had a higher median baseline OHS (35; interquartile range [22 to 46]) and OKS (30 [18 to 41]) than those with early PJI (OHS: 19 [15 to 29]; OKS: 22 [16 to 29.5]) or chronic PJI (OHS: 23 [14 to 34]; OKS 22 [14 to 28]). Logistic regression showed that a clinical cure (adjusted odds ratio [aOR] = 1.88, 95% confidence interval [CI] = 1.28 to 2.76, p = 0.001) and early PJI (aOR = 2.56, 95% CI = 1.64 to 4.07, p < 0.0001) independently predicted a successful functional outcome. Chronic renal impairment (aOR = 0.31, 95% CI = 0.13 to 0.71, p = 0.007), congestive cardiac failure (aOR = 0.41, 95% CI = 0.17 to 0.95, p = 0.04), and clinical signs of inflammation (aOR = 0.53, 95% CI = 0.33 to 0.85, p = 0.009) at diagnosis independently predicted failure to achieve a successful functional outcome.

Conclusions: The OHS and OKS varied significantly at baseline and 12 months according to PJI type, emphasizing the need to consider the PJI type when evaluating treatment success. This study highlights superior functional outcomes associated with early PJI and with achievement of a clinical cure.

Level of evidence: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

Disclosure: This study was funded by seed funding grants from Heraeus Medical GmbH and the John Hunter Charitable Trust Fund. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I4 ).

References

    1. Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br. 2007;89(7):893-900.
    1. Galea VP, Ingelsrud LH, Florissi I, Shin D, Bragdon CR, Malchau H, Gromov K, Troelsen A. Patient-acceptable symptom state for the Oxford Hip Score and Forgotten Joint Score at 3 months, 1 year, and 2 years following total hip arthroplasty: a registry-based study of 597 cases. Acta Orthop. 2020 Aug;91(4):372-7.
    1. Ingelsrud LH, Terluin B, Gromov K, Price A, Beard D, Troelsen A. Which Oxford Knee Score level represents a satisfactory symptom state after undergoing a total knee replacement? Acta Orthop. 2021 Feb;92(1):85-90.
    1. Dunbar MJ, Robertsson O, Ryd L, Lidgren L. Appropriate questionnaires for knee arthroplasty. Results of a survey of 3600 patients from The Swedish Knee Arthroplasty Registry. J Bone Joint Surg Br. 2001 Apr;83(3):339-44.
    1. Hamilton DF, Loth FL, MacDonald DJ, Giesinger K, Patton JT, Simpson AH, Howie CR, Giesinger JM. Treatment Success Following Joint Arthroplasty: Defining Thresholds for the Oxford Hip and Knee Scores. J Arthroplasty. 2018 Aug;33(8):2392-7.

Publication types

MeSH terms