Periprosthetic Joint Infection Centers of Excellence: Moonshot or Misstep? A Survey of the American Association of Hip and Knee Surgeons Members.

BACKGROUND

Periprosthetic joint infection (PJI) centers of excellence (COEs) have been discussed as an innovative model to improve health care quality and value in treating PJI. A national network of regional PJI centers may have the ability to improve patient outcomes, standardize treatment protocols, accelerate research, and provide economies of scale while caring for this patient population with complex needs. This study surveyed perceptions toward establishing a PJI COE among members of the American Association of Hip and Knee Surgeons (AAHKS).

METHODS

A 16-question survey was approved by the AAHKS Advocacy Committee and distributed to all 2,529 fellow-level members of AAHKS. Study results were analyzed using descriptive statistics. There were 626 survey responses (24.8% response rate).

RESULTS

More than two-thirds of survey participants (69%) reported that they would consider participation in some form of PJI COE. Most surgeons believe managing PJI is a cost to their hospital system. The top concern among respondents was that PJI COE may become a "dumping ground" for inappropriate referrals. Participants reported financial concerns regarding the possibility that establishing such a program may trigger a reevaluation of reimbursement for primary total joint arthroplasty procedures.

CONCLUSIONS

Although primary total joint arthroplasty is a target of national health care cost containment efforts, PJI is yet to be addressed. This gives AAHKS the opportunity to prospectively advocate for reform. A PJI COE designed to perform a high volume of infection revision procedures may be advantageous in providing the specialized and longitudinal care required by PJI patients. The AAHKS surgeons expressed interest and reservations in the establishment of PJI COEs that can inform future policy.