Clinical and psychosocial impact of limited mobility during the interstage period of two-stage revision arthroplasty for prosthetic joint infection: a state-of-the-art review.

BACKGROUND

Two-stage revision arthroplasty remains the gold-standard treatment in the United States for patients diagnosed with periprosthetic joint infection (PJI) of the hip and knee. However, during treatment, patients have an extended interstage period between prosthesis removal and reimplantation which is frequently characterized by substantial reductions in mobility, prolonged rehabilitation, and a high incidence of medical and psychosocial complications. This review examines the physical, psychological, and social effects of immobility during the interstage period.

METHODS

A comprehensive literature review was conducted to identify studies addressing mobility limitations, functional assessment tools, and associated outcomes in patients undergoing two-stage revision arthroplasty for PJI. Studies were included if they reported on clinical complications and psychosocial outcomes affected by the prolonged interstage period and mobility limitations.

RESULTS

Patients undergoing two-stage revision often experience significant immobility lasting several months, which can be influenced by pain, soft-tissue compromise, and spacer type. Prolonged inactivity can contribute to muscle atrophy, joint stiffness, and impaired range of motion and is often associated with an increased risk of venous thromboembolism, pressure injuries, and bleeding complications related to extended thromboprophylaxis use. Psychologically, patients frequently report heightened anxiety and depression during the interstage period, compounded by uncertainty regarding infection eradication. Socially, patients have restricted independence, are dependent on caregivers, and have occupational disruption that further diminishes their overall quality of life (QoL). Current studies demonstrate wide variability in how mobility is assessed, hindering cross-study comparison and limiting targeted rehabilitation strategies.

CONCLUSIONS

The interstage period of two-stage revision arthroplasty is a critical, yet understudied phase marked by significant physical, psychological, and social challenges that are not fully captured by traditional orthopedic patient-reported outcome measures . Standardized measurement of mobility is needed to assess the impact of limited mobility during the interstage period. Also, novel treatment approaches that shorten or eliminate the interstage period have the potential to mitigate complications, enhance functional recovery, and improve overall QoL for patients undergoing staged management of PJI.