What are patients’ preferences for revision surgery after periprosthetic joint infection? A discrete choice experiment

Objectives: Understanding patients’ preferences for treatment is crucial to provision of good care and shared decisions, especially when more than one treatment option exists for a given condition. One such condition is infection of the area around the prosthesis after hip replacement, which affects between 0.4 and 3% of patients. There is more than one treatment option for this major complication and our study aimed to assess the value that patients place on aspects of revision surgery for periprosthetic hip infection.

Design: We identified four attributes of revision surgery for periprosthetic hip infection. Using a discrete choice experiment (DCE) we measured the value placed on each attribute by 57 people who had undergone either one- or two-stage revision surgery for infection.

Setting: The DCE was conducted with participants from 9 National Health Service hospitals in the United Kingdom.

Participants: Adults who had undergone revision surgery for periprosthetic hip infection (n=57).

Results: Overall, the strongest preference was for a surgical option that resulted in no restrictions on engaging in valued activities after a new hip is fitted (β=0.7). Less valued, but still important attributes, included a shorter time taken from the start of treatment to return to normal activities (6 months; β=0.3), few or no side effects from antibiotics (β=0.2), and having only one operation (β=0.2).

Conclusions: Results highlight that people who have had revision surgery for periprosthetic hip infection most value aspects of care that affect their ability to engage in normal everyday activities. These were the most important characteristics in decisions about revision surgery.