Abstract
BackgroundHip 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.ObjectiveTo 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.DesignSystematic reviewData sourcesMEDLINE, 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.Selection criteriaObservational (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.Review methodsData 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.ResultsOf 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.ConclusionThe 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.Systematic Review RegistrationPROSPERO 2015: CRD42015027175
Highlights
Joint arthroplasty is a common surgical procedure, with over 185,000 primary hip and knee arthroplasties performed in England, Wales and Northern Ireland in 2014 [1, 2]
We systematically searched MEDLINE, EMBASE, Web of Science, PsycINFO, Cinahl, Social Science Citation Index, and the Cochrane Library from 1980 to October 05, 2016 for observational studies, qualitative studies, and clinical trials that have reported on the support needs and interventions for patients being treated for prosthetic joint infection (PJI) or other major adverse occurrences following joint arthroplasty
Using a systematic review approach, we have assessed evidence on the support needs and support interventions for patients being treated for PJI and other major adverse occurrences following joint arthroplasty
Summary
Joint arthroplasty is a common surgical procedure, with over 185,000 primary hip and knee arthroplasties performed in England, Wales and Northern Ireland in 2014 [1, 2]. Post-discharge support for patients treated with revision surgery is not currently included in clinical guidelines [15, 16] Recognising their importance in other conditions with a high risk of a poor outcome such as congestive heart failure [17] and chronic obstructive pulmonary disease, [18] there is a pressing need to identify the support needs of patients with PJI and to provide effective support. Such information can be used to design or improve services that may deliver benefit for patients. 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
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