Abstract
Aim
To assess whether recurrence of PJI and osteomyelitis impacts patient-reported quality of life (QoL).
Method
We studied patients receiving surgical treatment for confirmed PJI or osteomyelitis in one of 26 centres in the UK. Patients completed the EQ-5D-3L questionnaire, directly after surgery, at day 14, day 42, day 120 and day 365 after surgery and were assessed for evidence of recurrence.
Results
Of 621 patients with PJI, 99 had recurrent infection (15.9%). Patients with recurrence reported significantly lower QoL at one year after surgery compared to those without recurrence (EQ-5D-3L index score with recurrence: 0.368, SD0.344 vs. no recurrence: 0.592, SD0.315, p<0.001). Patients were grouped based on the timing of their recurrence: <42 days (n=27); 42–120 (n=28); or >120 days (n=44) post-surgery. At the time-point immediately preceding the diagnosis of recurrence, QoL was significantly lower than in corresponding patients without recurrence (recurrence <42 days, p<0.05; 42–120 days, p<0.001; >120 days, p<0.05).
In 358 cases of osteomyelitis, 39 patients had recurrent infection (10.9%). Recurrence of osteomyelitis produced significantly lower QoL at one year after surgery compared to patients without recurrent infection (EQ-5D-3L for recurrence: 0.385, SD0.345 vs. no recurrence: 0.634, SD0.349, p<0.001). Patients with recurrence after 120 days (n=21) reported significantly lower QoL than those with no recurrence at the time-point immediately preceding the diagnosis of recurrence (p<0.01). In contrast to patients with PJI, patients with osteomyelitis who had recurrence diagnosed before 120 days (n=18) reported similar outcome scores to patients who did not have recurrence.
Conclusion
Failure to eradicate infection greatly affects patient QoL. This study supports the monitoring of EQ-5D-3L among patients treated for bone and joint infections; patients with poorer QoL at follow up should prompt a low threshold for investigation to assess whether recurrence or continued infection is the underlying cause.
