Detrimental Mental Health Outcomes Following Periprosthetic Joint Infection: A Systematic Literature Review

Aims Periprosthetic joint infection (PJI) remains one of the most devastating complications following total joint arthroplasty associated with high mortality rate. While treatment success has traditionally been defined by infection eradication and implant survivorship, growing evidence suggests that PJI is associated with substantial psychological morbidity and diminished health-related quality of life. This review aims to systematically evaluate the current literature regarding mental health outcomes following treatment for PJI. Methods A systematic literature review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, MEDLINE, Embase, and Cochrane Library databases were searched for studies reporting anxiety, depression, validated patient-reported mental health or quality-of-life outcomes following treatment for PJI. Studies reporting depression, anxiety, or mental health-related patient-reported outcome measures (PROMs), including SF-12, SF-36, EQ-5D, and PROMIS, were included. Study characteristics, outcome measures, and psychological outcomes were extracted and qualitatively synthesized. Out of 1,364 screened studies, 64 were included in this review. Results The most used PROM form was SF-12 (n=24 studies), while the most investigated surgical procedure was two-stage exchange (n=37). Through multiple studies utilizing validated PROM instruments, patients undergoing treatment for PJI consistently demonstrated a trend towards worse mental health compared to the general population (n=5), primary arthroplasty (n=8) and aseptic revision (n=8) cohorts. Reported prevalence of depression ranged from 27 to 36%, and anxiety prevalence reaching up to 29.50%. A two-stage revision arthroplasty, particularly during spacer treatment intervals, was associated with the greatest psychological distress. Although mental health outcomes generally improved following reimplantation, several studies demonstrated persistent impairments. More invasive procedures, failed treatment and chronic PJI were associated with a higher psychosocial burden, while articulating spacers were associated with better quality of life compared to static spacers. Salvage procedures and prolonged treatment courses were associated with the most severe and sustained psychological burden. Conclusions Available evidence demonstrates that PJI is associated with substantial and often persistent psychological and physical morbidities, even following successful infection eradication. Mental health impairment represents a critical component of the overall disease burden and is not adequately reflected in traditional definitions of treatment success. However, multiple studies suffer from limited sample size and lack of separation from successful and failed treatment procedures. Standardized assessment of psychological outcomes and multidisciplinary treatment approaches are warranted as part of patient-centered care and measurement of long-term patient recovery following PJI treatment.