title: Health Care Needs and Support for Patients Undergoing Treatment for Prosthetic Joint Infection following Hip or Knee Arthroplasty: A Systematic Review.
abstract: BACKGROUND
  Hip and knee arthroplasty are common interventions for the treatment of joint conditions, most notably osteoarthritis. Although many patients benefit from surgery, approximately 1% of patients develop infection afterwards known as deep prosthetic joint infection (PJI), which often requires further major surgery.
  
  
  OBJECTIVE
  To assess support needs of patients undergoing treatment for PJI following hip or knee arthroplasty and to identify and evaluate what interventions are routinely offered to support such patients.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  MEDLINE, EMBASE, Web of Science, PsycINFO, Cinahl, Social Science Citation Index, The Cochrane Library, and reference lists of relevant studies from January 01, 1980 to October 05, 2016.
  
  
  METHODS
  Observational (prospective or retrospective cohort, nested case-control or case-control) studies, qualitative studies, or clinical trials conducted in patients treated for PJI and/or other major adverse occurrences following hip or knee arthroplasty.
  
  
  METHODS
  Data were extracted by two independent investigators and consensus was reached with involvement of a third. Given the heterogeneous nature of study designs, methods, and limited number of studies, a narrative synthesis is presented.
  
  
  RESULTS
  Of 4,213 potentially relevant citations, we identified one case-control, one prospective cohort and two qualitative studies for inclusion in the synthesis. Patients report that PJI and treatment had a profoundly negative impact affecting physical, emotional, social and economic aspects of their lives. No study evaluated support interventions.
  
  
  CONCLUSIONS
  The findings demonstrate that patients undergoing treatment for PJI have extensive physical, psychological, social and economic support needs. The interpretation of study results is limited by variation in study design, outcome measures and the small number of relevant eligible studies. However, our review highlights a lack of evidence about support strategies for patients undergoing treatment for PJI and other adverse occurrences following hip or knee arthroplasty. There is a need to design, implement and evaluate interventions to support these patients.
  
  
  BACKGROUND
  PROSPERO 2015: CRD42015027175.
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Setor K
authors.initials: SK
authors.lastname: Kunutsor
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Beswick
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Peters
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Rachael
authors.initials: R
authors.lastname: Gooberman-Hill
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Whitehouse
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Blom
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Andrew J
authors.identifier: http://orcid.org/0000-0003-3185-1599
authors.initials: AJ
authors.lastname: Moore
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D006801:Humans; D007592:Joint Diseases / Q000209:etiology* / Q000523:psychology / Q000628:therapy; D010003:Osteoarthritis / Q000601:surgery; D011183:Postoperative Complications; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000523:psychology / Q000628:therapy; D012944:Social Support; D016896:Treatment Outcome