Psychological burden of bone and joint infections: Systematic review on mental health and quality of life implications

doi:10.5312/wjo.v17.i3.112040

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Mar 18, 2026 (publication date) through Mar 17, 2026

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World Journal of Orthopedics

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. Mar 18, 2026; 17(3): 112040
Published online Mar 18, 2026. doi: 10.5312/wjo.v17.i3.112040

Psychological burden of bone and joint infections: Systematic review on mental health and quality of life implications

Daniele De Meo, Tommaso Accinni, Davide Staccini, Flavia Petrucci, Paolo Martini, Vittorio Candela, Carmine Zoccali, Stefano Gumina

Daniele De Meo, Davide Staccini, Flavia Petrucci, Paolo Martini, Vittorio Candela, Carmine Zoccali, Stefano Gumina, Malattie Infettive in Traumatologia e Ortopedia-Infections in Traumatology and Orthopedics Surgery Study Group, Policlinico Umberto I Hospital, Rome 00161, Lazio, Italy

Daniele De Meo, Davide Staccini, Paolo Martini, Vittorio Candela, Carmine Zoccali, Stefano Gumina, Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome 00100, Lazio, Italy

Tommaso Accinni, Department of Human Neurosciences, Sapienza University of Rome, Rome 00100, Lazio, Italy

Flavia Petrucci, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome 00100, Lazio, Italy

Author contributions: All the authors contributed to this work. De Meo D, Accinni T, and Gumina S conceptualised and designed the study; Candela V, Zoccali C, and Gumina S supervised and made critical revisions; De Meo D, Staccini D, and Petrucci F conducted the literature review; Martini P and Zoccali C did the analysis; De Meo D, Accinni T, and Candela V did the interpretation of data; De Meo D, Accinni T, Staccini D, Petrucci F and Martini P drafted the original manuscript; all authors prepared the draft and approved the submitted version.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Daniele De Meo, Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Piazzale Aldo Moro 3, Rome 00100, Lazio, Italy. daniele.demeo@uniroma1.it

Received: July 16, 2025
Revised: August 4, 2025
Accepted: January 7, 2026
Published online: March 18, 2026
Processing time: 243 Days and 16.2 Hours

Abstract

BACKGROUND

Bone and joint infections (BJIs), such as periprosthetic joint infections and fracture-related infections, are severe complications in orthopedic surgery with profound physical, social, and psychological consequences. While their physical and economic impacts are well documented, the psychological burden remains underrecognized.

AIM

To systematically review the existing literature on the impact of BJIs on mental health and quality of life, and to identify validated tools used to assess these outcomes.

METHODS

Systematic review was conducted on PubMed and Scopus database. Seventeen studies published between 2010 and 2024 were included (5 qualitative, 12 quantitative).

RESULTS

Qualitative findings revealed consistent emotional suffering, including fear, helplessness, depression, and social withdrawal, especially during the interim phase of two-stage revisions. Quantitative studies confirmed a significant deterioration in mental health, even after clinical resolution of the infection. Among the tools employed, the International Classification of Diseases-10-Symptom Rating and the Hospital Anxiety and Depression Scale emerged as the most sensitive for detecting psychological distress.

CONCLUSION

Despite growing awareness, there is still a lack of specific psychological interventions and standardized assessment protocols for this vulnerable patient population. These findings underscore the urgent need for integrating mental health evaluation and support into comprehensive BJI treatment strategies to improve outcomes and long-term quality of life.

Keywords: Mental health; Bone infection; Periprosthetic joint infection; Fracture related infection; Anxiety; Depression; Quality of life; Psychopathology

Core Tip: This is the first systematic review to explore the psychological impact of bone and joint infections (BJIs), including periprosthetic joint infections and fracture-related infections. By analyzing both qualitative and quantitative studies, we demonstrate that BJIs cause substantial and persistent emotional distress - comparable to oncologic conditions - especially during complex treatment phases. The International Classification of Diseases-10-Symptom Rating and Hospital Anxiety and Depression Scale scales emerged as the most sensitive assessment tools. Our findings call for urgent integration of mental health evaluation and targeted psychological support in BJI care pathways to improve patient outcomes and quality of life.