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

Laurens Manning; Alexander Rofe; Eugene Athan; Stephen D Gill; Piers Yates; Darcie Cooper; Joshua S Davis; Craig Aboltins; Australasian Society for Infectious Diseases Clinical Research Network

doi:10.2106/JBJS.23.00717

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

J Bone Joint Surg Am. 2024 May 9. doi: 10.2106/JBJS.23.00717. Online ahead of print.

Authors

Laurens Manning^{1

2}, Alexander Rofe³, Eugene Athan^{4

5

6}, Stephen D Gill⁷, 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

¹ Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Australia.
² University of Western Australia School of Medicine, University of Western Australia, Perth, Australia.
³ Department of Infectious Diseases, Northern Health, Epping, Melbourne, Australia.
⁴ Department of Infectious Diseases, Barwon Health, Geelong, Australia.
⁵ Centre for Innovation in Infectious Disease and Immunology Research, Geelong, Australia.
⁶ Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.
⁷ Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital and Deakin University, Geelong, Australia.
⁸ Department of Orthopaedic Surgery, Fiona Stanley Hospital, Murdoch, Australia.
⁹ Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
¹⁰ Department of Infectious Diseases, John Hunter Hospital, Newcastle, Australia.
¹¹ School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
¹² Department of Medicine Northern Health, University of Melbourne, Melbourne, Australia.

PMID: 38723046
DOI: 10.2106/JBJS.23.00717

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.