Best Practices for Centers of Excellence in Addressing Periprosthetic Joint Infection

Abstract

Periprosthetic joint infection is a rare and devastating complication. Management of this complication often requires a multidisciplinary approach similar to that used for the care of patients with cancer. Several studies have reported better outcomes following total joint arthroplasties performed at specialized hospitals than those performed at general hospitals. Specialized institutions use care pathways that aid the multidisciplinary team in decision making. During the recent Musculoskeletal Infection symposium, specific issues were discussed with regard to the treatment of periprosthetic joint infection, including medical optimization, systematic approaches to infection management, and the importance of establishing registries to aid in the creation of Centers of Excellence. A Center of Excellence in periprosthetic infection could provide better overall outcomes with lower financial, physical, and emotional costs to patients.

Who Should Manage Periprosthetic Joint Infection? The Case for a Multidisciplinary Approach

“…This is likely due to the implementation of customized treatment plans and greater comorbidity management. 7 Knowing this, it can be deduced that a similar model may prove to be even more effective for the treatment of the most difficult complication of total joint arthroplasty; PJI. There is evidence in the literature to support this claim as well [11,15].…”

“…The days of surgeon-centered practice are long gone. Care for patients in nearly all fields has to, and needs to continue to, involve a multidisciplinary team of medical professionals [5,7,11]. This involves communication throughout patient care, from diagnosis to follow-up, with contributions from numerous specialists.…”

“…The superiority of multidisciplinary care for patients with osteoarthritis undergoing primary joint replacement has been well documented and routinely practiced for years [7,14]. Surgeons, anesthesiolo-gists, social workers, and physical therapists all play a role in the care of patients before and after surgery.…”

“…For these reasons many experts have likened the ideal model with which we should treat PJI to that of the cancer care model: The multidisciplinary approach [7,8]. In fact, the management of both disease states is exceedingly complex, and patient outcomes are arguably comparable between the two.…”

“…In fact, the management of both disease states is exceedingly complex, and patient outcomes are arguably comparable between the two. PJI can be devastating, with patient mortality higher than many common forms of cancer, at 5-year rates of 25-33% following two-stage exchange procedures [7,9]. While the intricacy of cancer cases has been recognized for a long time, it was not until recently that PJI was recognized as an entity that requires a coordinated and collaborative effort amongst a variety of medical professionals in order to deliver the best care possible [10].…”