JOA - 2026-07-04 - Journal Article
Comparative Analysis of Periprosthetic Joint Infection Rates After Total Hip Arthroplasty Across Facility Types: A Single Institution Study.
Baek G, Baidya J, Huang R, Garemani R, Smith EB, Saxena A
Topics
Key Takeaway
Across 39,743 primary THAs at four facility types, overall PJI rate was 1.07% with no significant difference between tertiary hospital centers, community hospitals, orthopaedic specialty hospitals, or ambulatory surgical centers on multivariable Cox regression.
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Summary
This study asked whether PJI rates after primary elective THA differ across tertiary hospital centers, community hospitals, orthopaedic specialty hospitals, and ASCs within a single health system. Patients were retrospectively stratified by facility type and analyzed with multivariable Cox regression controlling for age, sex, BMI, Charlson Comorbidity Index, OR time, and surgeon experience. Overall PJI rate was 1.07%, and no facility type was independently associated with increased PJI risk.
Key Limitation
The ASC cohort (n=1,252) is disproportionately small and almost certainly represents a healthier, lower-risk selection of patients, limiting the generalizability of the equivalence finding to higher-comorbidity populations.
Original Abstract
BACKGROUND
As the surgical volume of total hip arthroplasty (THA) has grown, there has been a concomitant shift away from performing this procedure in traditional, inpatient facilities towards various outpatient centers. Several studies have investigated rates of surgical site and periprosthetic joint infections (PJI) among patients undergoing common orthopaedic procedures stratified by facility type. However, there is a paucity of studies comparing PJI rates after THA performed in tertiary hospital centers (THC), community hospitals (CH), orthopaedic specialty hospitals (OSH), and ambulatory surgical centers (ASC) associated with a single health system.
METHODS
Patients who underwent primary, elective THA from 2017 to 2024 were retrospectively identified and stratified into cohorts depending on facility type. There were 39,743 patients identified (THC: 16,286, CH: 11,314,
OSH
10,891,
ASC
1,252). Data regarding demographics, surgical variables, surgical outcomes, and PJIs were collected. Statistical analyses were performed to compare groups. Multivariable Cox regressions were performed to identify predictors of PJI.
RESULTS
The overall PJI rates across all facilities were 1.07%, and there were no differences in overall PJI rates between groups. Multivariable regressions controlling for facility type, age, sex, body mass index, Charlson Comorbidity Index, operating room time, and surgeon experience demonstrated that none of the facility types were associated with greater odds of developing PJI after THA.
CONCLUSION
The THAs performed at different facility types have similar rates of postoperative PJIs. THAs performed at ASCs and THCs had similar odds of PJI. Surgeons may therefore perform THAs at various outpatient centers without sustaining an increased risk for PJI.