Revision Total Joint Arthroplasty for Periprosthetic Joint Infection at Centers of Excellence Decreases Risk of Complications and Improves Discharge Dispositions Despite Further Travel Distance.

Abstract

Total joint arthroplasty (TJA) is a widely performed and effective procedure for the treatment of degenerative joint disease. Periprosthetic joint infection (PJI) is now recognized as the leading cause of TJA failure, so recent efforts have emphasized the creation of centers of excellence (COEs) for the management of this morbid condition. We sought to understand the difference in outcomes and travel distances for patients undergoing TJA at COEs. A retrospective study was conducted to identify TJA patients who underwent revision surgery for PJI between January 2016 and March 2024. A total of 894 patients underwent revision TJA for PJI between January 2016 and March 2023 in our health system. Electronic medical records were reviewed to extract patient demographic data, surgical details, discharge outcomes, and outcome information. Surgery types were also included in the statistical analysis to assess outcome data systematically. Data analyses were conducted using Chi-square tests. Analysis of variance and independent t-tests were used to compare proportions and means of outcome data, respectively, between the COE and noncenter of excellence (Non COE) groups. Statistical significance was set at P < 0.05. The COE patients had lower overall complication rates (22.2 versus 29.7%; P = 0.027) and incidence of sepsis (10.3 versus 18.2%), whereas there were lower rates of mechanical complications in the Non COE group (3.3 versus 6.5%; P = 0.033). Patients traveled farther to COE hospitals (32.5 ± 2.65 versus 24.4 ± 4.15 miles, P = 0.033) and were more likely to be discharged home (11.9 versus 7.4%, P = 0.036), whereas Non COE patients were discharged to a skilled nursing facility (32.1 versus 21.0%, P = 0.001). Patients treated at COE hospitals had fewer complications and improved discharge disposition despite traveling farther distances for their care.