Only 18% of Knee PJIs Are Treated by High-Volume Surgeons: Implications for PJI Centers in the US

Introduction: There has been a recent push to develop periprosthetic joint infection (PJI) centers of excellence in the United States (US). However, little is known regarding the current distribution of surgical management of total knee arthroplasty (TKA) PJIs in the US. The purpose of this study was to utilize the American Joint Replacement Registry (AJRR) to evaluate the surgical volume of surgeons and institutions caring for PJI of the knee. Methods: The AJRR was queried to identify all TKAs performed between 2012 – 2022. This resulted in 1,779,442 primary and revision TKAs performed in 1,366 institutions by 8,658 surgeons. Among the 159,248 revision TKAs included, 45,914 (29%) were for PJI. A high-volume knee PJI surgeon was defined as >11 knee PJI procedures/year and a high-volume knee PJI institution was defined as >40 knee PJI procedures/year. Results: The median institution annual knee PJI volume was 4 PJIs (range, 1 – 113), and the median surgeon annual knee PJI volume was 2 PJIs (range, 1 – 45). Twenty-nine percent of knee PJI procedures were performed by surgeons who did < 3 of these surgeries/year, and 37% occurred at hospitals that cared for < 10 knee PJIs annually. Overall, 10% of knee PJI procedures were performed by high-volume knee PJI surgeons, and 15% were performed at high-volume knee PJI institutions. In 2022, 12% of knee PJI procedures were performed by high-volume PJI surgeons and 16% at high-volume PJI institutions. Conclusion: Only 18% of knee PJI procedures in the US are managed by a “high-volume” PJI surgeon or institution that care for a high volume of knee PJIs. As such, establishing PJI centers of excellence would likely inhibit access for our most critical patients as a 5-fold increase in PJI volume is not solvent from a financial, physical, mental, or emotional perspective.