Distribution of Total Hip Arthroplasty Periprosthetic Infection Care in the United States: Reported from the American Joint Replacement Registry.

Abstract

There has been recent interest in developing periprosthetic joint infection (PJI) centers of excellence in the United States (US). However, little is known regarding the current distribution of hip PJI management in the US. The purpose of this study was to utilize the American Joint Replacement Registry (AJRR) to evaluate the surgical volume of institutions and surgeons caring for PJI of the hip. The AJRR was utilized to capture all THAs performed between 2012 and 2022. This resulted in 1,157,938 primary and revision THAs performed in 1,351 institutions by 7,390 surgeons. Among the 128,339 revision THAs included, 24,506 (19%) were for PJI (THA-PJI). We established volume thresholds based on median annual volume groupings to identify high, medium, and low volume surgeons and institutions caring for THA-PJI. Proportion of surgeries performed by low, medium, and high THA-PJI volume institutions and surgeons was calculated. The median institution annual THA-PJI volume was three PJIs (range, one to 66), and the median surgeon annual THA-PJI volume was one PJI (range, one to 19). High-volume THA-PJI threshold for institutions was greater than 25 THA-PJIs/year and the high-volume THA-PJI threshold for surgeons was greater than 11 THA-PJIs/year. High THA-PJI volume institutions and surgeons performed 17 and 5% of THA-PJI, respectively. Only 4% of THA-PJIs were cared for by a high-volume THA-PJI surgeon at a high-volume THA-PJI institution. In 2022, only 15% of THA-PJI surgeries occurred at high THA-PJI volume institutions, and only 4% were performed by high THA-PJI volume surgeons. In the US, approximately one out of 25 THA-PJIs were managed by a high-hip PJI-volume surgeon at a high-hip-PJI volume institution. These data raise concerns about PJI centers of excellence potentially inhibiting access for our most critical patients, as a six-fold increase in PJI volume at a high-volume PJI institution is not currently solvent from a financial, physical, mental, or emotional perspective.