Patient and Health Professional's Perspectives of Periprosthetic Joint Infection: A Systematic Review and Meta-Ethnography

Abstract

Background: Periprosthetic joint infection (PJI) is a major challenge for surgical teams and patients following an orthopedic surgical procedure. There is limited understanding on patient and health professional's perception of PJI. The aim of this study was to examine the literature to better understand the perspectives of patients, and those who manage PJI. Methods: Published and unpublished literature databases were systematically searched from inception to June 21, 2024. Qualitative studies reporting the perspectives of living with and managing PJI were included. Data were synthesized using a meta-ethnography approach and the GRADE-CERQual tool. Results: Of the 584 citations identified, 10 studies (n = 91 patients; n = 70 health professionals) met the eligibility criteria and were included. Three themes, all moderate-certainty evidence, were identified from the health professional data, including the following: (1) importance of PJI; (2) impact on health professionals; and (3) support for change. From the patient data, six themes on the basis of moderate-certainty evidence were identified: (1) psychological and social impact; (2) physical impacts; (3) relationship with health professionals; (4) relationship with others; (5) uncertainty over the future; and (6) support for change. A novel line of argument was developed offering third-order constructs, on the basis of first- and second-order themes. Conclusion: PJIs are perceived as devastating by both patients and health professionals. They impact on all aspects of a patient's physical, social and psychological health, each interacting on one another over the course of infection and management. Strategies to improve communication, multidisciplinary management, and personalization of care are advocated by both patients and health professionals to promote better outcomes.

Keywords: infection; joint replacement; multi-disciplinary; orthopedic surgery; qualitative; revision.