Life after bone infection: a retrospective comparison of quality of life in patients with periprosthetic joint infection and fracture-related infections

Background Periprosthetic joint infections (PJI) and fracture-related infections (FRI) are among the most severe complications in orthopaedic trauma surgery. In addition to a significant medical burden, both conditions are associated with prolonged hospitalisation, increased morbidity, increased costs and reduced health-related quality of life (HRQoL). While the clinical course of implant-associated infections is well characterised, comparative data on patient-reported outcomes remain limited. Objective This study aimed to compare HRQoL in patients treated for PJI versus FRI, and to analyse associations between clinical parameters such as ASA classification, length of stay (LOS), and number of revision procedures. Methods In this retrospective, monocentric cohort of 61 patients with microbiologically confirmed implant associated infections treated in 2021 completed the EQ-5D-3 L and EQ-VAS questionnaires by post in 2023 (response rate 37.9%). The cohort comprised 30 PJI and 31 FRI patients. The primary outcome was EQ-VAS. Secondary outcomes included the mean EQ-5D-3 L domain level (range 1–3; higher values indicate worse health). Clinical data were extracted from hospital records and analysed using parametric or non-parametric tests. Results Patients with PJI reported significantly reduced self-perceived health status (EQ-VAS: 50.4 ± 18.9) than those with FRI (61.9 ± 19.3; p = 0.036). The mean EQ-5D-3 L domain level was 1.83 ± 0.37 in PJI versus 1.65 ± 0.39 in FRI ( p = 0.061). PJI patients had significantly longer hospital stays (82.9 vs. 33.1 days; p < 0.001) and higher ASA scores (2.71 vs. 2.35; p = 0.01). Conclusion PJI was associated with significantly poorer HRQoL than FRI, possibly reflecting greater comorbidity and more invasive treatment. These findings emphasise the importance of interdisciplinary, patient-centred care, as well as the need for prospective studies to clarify HRQoL trajectories and mediators following implant-associated infections.