{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T08:09:13Z","timestamp":1780387753403,"version":"3.54.1"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Implant\u2010associated infections, including periprosthetic joint infection (PJI) and fracture\u2010related infection (FRI), are among the most challenging complications in orthopedic surgery. Although infection timing (early, delayed, late) is recognized as an important factor in surgical success, its impact on patient\u2010reported outcomes and length of hospital stay has rarely been compared between PJI and FRI in a single cohort. This study aimed to examine the association between infection timing and health\u2010related quality of life (HRQoL) as well as length of hospital stay (LOS), and to explore potential differences between PJI and FRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective monocentric cohort study of 60 patients with microbiologically confirmed implant\u2010associated infections treated at a German level\u2010I trauma center between January and December 2021, with follow\u2010up performed in 2023. Patients with PJI (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200929) or FRI (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200931) were stratified as early (&lt;\u20093\u2009months), delayed (3\u201324\u2009months), or late (&gt;\u200924\u2009months) to enable direct comparison between infection entities. Outcomes included EQ\u2010VAS, EQ\u20105D\u20103L mean domain scores, LOS, reinfection, revision surgery, amputation, and in\u2010hospital mortality. Group differences were tested using independent\u2010samples t\u2010tests for continuous variables and chi\u2010square or Fisher's exact tests for categorical variables, with subgroup analyses considered exploratory due to small sample sizes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 60 patients, 25 had early (PJI\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911; FRI\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914), 24 delayed (PJI\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911; FRI\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913), and 11 late infections (PJI\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20097; FRI\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094). EQ\u2010VAS was higher in FRI compared with PJI in early (63.4\u2009\u00b1\u200917.8,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913 vs. 48.3\u2009\u00b1\u200920.8,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20099) and delayed infections (66.2\u2009\u00b1\u200916.8,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911 vs. 56.6\u2009\u00b1\u200913.5,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910), while both groups showed markedly lower EQ\u2010VAS values in late infections (FRI: 39.7\u2009\u00b1\u200925.9,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093 vs. PJI: 43.3\u2009\u00b1\u200923.4,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096), which were analyzed descriptively due to very small subgroup sizes. The EQ\u20105D\u20103L mean domain score was lower (indicating better health status) in early FRI (1.55\u2009\u00b1\u20090.33,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200912) than in early PJI (1.91\u2009\u00b1\u20090.39,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20099) in unadjusted analyses. LOS increased with timing, particularly in PJI (early 39.6\u2009\u00b1\u200926.8 vs. 31.4\u2009\u00b1\u200929.0\u2009days; delayed 100.6\u2009\u00b1\u200982.2 vs. 28.2\u2009\u00b1\u200910.2;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015). Reinfection rates increased with later timing (early: 6\/11 PJI vs. 3\/14 FRI; delayed: 8\/11 vs. 8\/13; late: 5\/7 vs. 4\/4). Revision surgery was more frequent in early PJI (7\/11 vs. 4\/14;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.080) but was significantly more common in delayed FRI (12\/13 vs. 6\/11;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033). Amputation (\u2264\u20099%) and in\u2010hospital mortality (\u2264\u200915%) were rare and showed no significant differences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Infection timing was associated with both clinical and patient\u2010reported outcomes in implant\u2010associated infections. Later infections were associated with poorer HRQoL, longer hospital stays, and higher reinfection rates, based on unadjusted analyses, with distinct patterns between PJI and FRI. Early recognition and timely, stage\u2010adapted treatment strategies may help improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70323","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:08:32Z","timestamp":1776816512000},"page":"1173-1182","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Infection Timing on Outcomes: A Comparative Study of Periprosthetic Joint and Fracture\u2010Related Infections"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8113-6289","authenticated-orcid":false,"given":"Lena","family":"Schwake","sequence":"first","affiliation":[{"name":"Section of Medicine Universit\u00e4t zu L\u00fcbeck  L\u00fcbeck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper","family":"Frese","sequence":"additional","affiliation":[{"name":"Department of Septic Bone and Joint Surgery BG Klinikum Hamburg  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4927-549X","authenticated-orcid":false,"given":"Arndt\u2010Peter","family":"Schulz","sequence":"additional","affiliation":[{"name":"Center for Clinical Research BG Klinikum Hamburg  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidney","family":"Schaeffer","sequence":"additional","affiliation":[{"name":"Center for Clinical Research BG Klinikum Hamburg  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf\u2010Joachim","family":"Gerlach","sequence":"additional","affiliation":[{"name":"Department of Septic Bone and Joint Surgery BG Klinikum Hamburg  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius","family":"Grimme","sequence":"additional","affiliation":[{"name":"Department of Septic Bone and Joint Surgery BG Klinikum Hamburg  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