title: Deep prosthetic joint infection: a qualitative study of the impact on patients and their experiences of revision surgery.
abstract: OBJECTIVE
  Around 1% of patients who have a hip replacement have deep prosthetic joint infection (PJI) afterwards. PJI is often treated with antibiotics plus a single revision operation (1-stage revision), or antibiotics plus a 2-stage revision process involving more than 1 operation. This study aimed to characterise the impact and experience of PJI and treatment on patients, including comparison of 1-stage with 2-stage revision treatment.
  
  
  METHODS
  Qualitative semistructured interviews with patients who had undergone surgical revision treatment for PJI. Patients were interviewed between 2 weeks and 12 months postdischarge. Data were audio-recorded, transcribed, anonymised and analysed using a thematic approach, with 20% of transcripts double-coded.
  
  
  METHODS
  Patients from 5 National Health Service (NHS) orthopaedic departments treating PJI in England and Wales were interviewed in their homes (n=18) or at hospital (n=1).
  
  
  METHODS
  19 patients participated (12 men, 7 women, age range 56-88 years, mean age 73.2 years).
  
  
  RESULTS
  Participants reported receiving between 1 and 15 revision operations after their primary joint replacement. Analysis indicated that participants made sense of their experience through reference to 3 key phases: the period of symptom onset, the treatment period and protracted recovery after treatment. By conceptualising their experience in this way, and through themes that emerged in these periods, they conveyed the ordeal that PJI represented. Finally, in light of the challenges of PJI, they described the need for support in all of these phases. 2-stage revision had greater impact on participants' mobility, and further burdens associated with additional complications.
  
  
  CONCLUSIONS
  Deep PJI impacted on all aspects of patients' lives. 2-stage revision had greater impact than 1-stage revision on participants' well-being because the time in between revision procedures meant long periods of immobility and related psychological distress. Participants expressed a need for more psychological and rehabilitative support during treatment and long-term recovery.
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK.
authors.forename: Andrew J
authors.identifier: http://orcid.org/0000-0003-3185-1599
authors.initials: AJ
authors.lastname: Moore
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK.
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Blom
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Whitehouse
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Gooberman-Hill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001168:Arthritis / Q000188:drug therapy* / Q000209:etiology*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002983:Clinical Competence; D004739:England; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D036301:Qualitative Research; D012086:Reoperation / Q000379:methods*; D014852:Wales
chemical_list: D000900:Anti-Bacterial Agents
keywords: Infection; Joint Prosthesis; Patients; QUALITATIVE RESEARCH; Surgical Revision