Dr. Thomas Fehring: How OrthoCarolina is tackling an issue that affects 1% of TJR patients

Written by Angie Stewart | August 23, 2019 | Print  | Email

Thomas Fehring, MD, launched the OrthoCarolina Periprosthetic Joint Infection Center in Charlotte, N.C., with four fellow hip and knee surgeons: Keith Fehring, MD, Brian Curtin, MD, Jesse Otero, MD, and Bryan Springer, MD.

Dr. Fehring told Becker's ASC Review about his vision for the program and discussed its importance.

Note: Responses were lightly edited for style and length.

Question: How did the idea for the center come about?

Dr. Thomas Fehring: Prosthetic joint infection is a devastating diagnosis for patient and surgeon alike. It is very difficult for a patient who expects pain relief and improved function to be told they have an infection and may need multiple procedures to be cured. Additionally, the mortality following this diagnosis can be as high as some cancers. I have a unique perspective on this difficult problem because last year I went through a two-stage procedure myself to clear an infection that occurred as a collegiate athlete. Fortunately, I am a member of the OrthoCarolina Hip and Knee Center and work with a group of surgeons and [infectious disease] consultants with vast clinical and research experience concerning PJI. As I recovered, I reflected on a need for a center which could provide multidisciplinary care to meet the unique needs of the PJI patient. 

Most arthroplasty surgeons only treat a few PJI patients per year. However, with close to a million total joints being performed in the U.S. with a PJI [prevalence] rate of 1 percent, 10,000 patients will need specialized infection treatment per year. Our center is currently referred one to two patients per week for PJI, so establishing a center really became a continuation of a multidisciplinary team approach that already existed. Additionally, I was challenged by one of my patients to establish a support group or website to help guide patients and their caregivers through this difficult process. We established such a website, and it can be found at healingjoints.org.

Q: How did the center tie into major industry trends we are seeing today?

TF: Healthcare can be somewhat fragmented, especially when multiple physicians working in multiple offices are needed to treat a specific patient. When a patient has a PJI, a number of subspecialties are required for treatment success, ranging from orthopedic surgeons to infectious disease consultants to internal medicine specialists and, on occasion, plastic surgeons. When care can be provided at one location, such as the OrthoCarolina Periprosthetic Joint Infection Center together with the Musculoskeletal Institute at Atrium Health, all of these subspecialties are closely aligned to provide the best care for an infected joint replacement patient. By streamlining the treatment process with experienced physicians [and] following established protocols, such consolidation allows for the most efficient and cost-effective care.

Q: How do you and the other four physicians ensure great outcomes for patients with prosthetic joint infection?

TF: To have great outcomes, you need to have a team of dedicated physicians. At our center, we take a multidisciplinary approach to the treatment of PJI. In addition to five arthroplasty surgeons to manage the complexities of debridement and reconstruction, we have two orthopedic/plastic physicians to help manage flaps and complex wound problems (Ryan Garcia, MD, and Michael Gart, MD). We also have a team of experienced infectious disease consultants and hospitalists to help manage the antibiotic and medical issues as they present. Additionally, we have the support of our hospital system through the recently created Musculoskeletal Institute at Atrium Health, providing experienced help in the operating room and on the ward to help manage the unique needs of PJI patients. 

In order to have great outcomes, we need to have decision-making treatment protocols in place to help determine the best practice for each individual patient. Through the clinical research program at the OrthoCarolina Research Institute, we have multiple research studies in place that will allow us to determine which treatment protocols are most effective.

Q: What is your strategy for gaining multistate referrals?

TF: We established the OrthoCarolina Hip and Knee Center over 30 years ago as a tertiary center for patients with complex joint reconstructive problems. Through our clinical work as well as the research produced through the OrthoCarolina Research Institute, we already have a national reputation for revision total joint arthroplasty. The OrthoCarolina Periprosthetic Joint Infection Center is just an extension of the commitment we have made to help physicians and their patients in our region who need complicated subspecialty care for PJI. We expect this to continue and broaden as more people become aware of the center as a destination for multidisciplinary prosthetic joint infection care similar to other destination centers that care for other problems such as cancer, heart disease, spinal cord injuries, etc. 

Would you like to participate in future Q&As? Email Angie Stewart: astewart@beckershealthcare.com.

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