March 24th, 2021

When a patient is scheduled for a joint replacement surgery, the odds are high that they will emerge from anesthesia and continue on a journey toward recovery and relief. But in about one percent of patients, the newly replaced joint becomes infected. The complex process of treating infected joints can take months, disrupt a patient’s life, and involve multiple painful surgeries.

Innovative research that finds solutions to best care for these patients is at the center of OrthoCarolina’s treatment strategy. The OrthoCarolina’s Periprosthetic Joint Infection (PJI) Clinic expertly cares for patients while learning more about this devastating complication. Through studies happening right now in partnership with the PJI Clinic and OrthoCarolina Research Institute (OCRI), physicians are advancing protocols to find out which is most effective in treating infections while also learning how to prevent the infections from developing in the first place.

The likelihood of a patient being alive five years after a total joint replacement becomes infected is worse than six of the eight most common types of cancers in the United States. Statistics like that, caught the attention of doctors at OrthoCarolina’s Hip and Knee Center.

The large volume of patients referred to the clinic from across the Southeast allows this team of physicians to formulate treatment plans with success rates over 90%.

Where do you go when surgery doesn’t go as planned?

Bob Mahovsky is among that one percent of patients who receives the news that their knee replacement is infected. His surgeon offered him the option of having his leg amputated, but he wanted another opinion. Like many patients hoping to salvage their leg, Mahovsky found himself at the OrthoCarolina PJI Clinic. What he didn’t know at the time is that one of his doctors is among the patients who’s received that very same diagnosis.

Thomas Fehring, MD
Thomas Fehring, MD

Thomas Fehring, MD has not only dedicated much of his professional career to researching and caring for patients with joint infections, a few years ago, he found himself on the other end of the surgery schedule as a patient.

“I have a unique perspective on this problem because a few years ago I went through a two-stage procedure myself to clear an infection that occurred as a collegiate athlete,” Fehring said. “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.”

The rest is history.

With years of expertise and research invested into treating PJI, this first-of-its-kind center has become a destination for care for complex infections similar to how a person would seek out specialized care for cancer, heart disease, or spinal cord issues.

When treating PJI, multiple specialists are required to successfully treat a patient. Because of the specialized knowledge and care for PJI patients happening within the Periprosthetic Joint Infection Center, a multidisciplinary team is established and ready to spring into action.

“It takes a team approach to treat these difficult cases successfully,” said Dr. Thomas Fehring. “Our team includes five arthroplasty surgeons, two plastic surgeons, a team of experienced infectious disease consultants as well as a research support staff.”

Periprosthetic Joint Infection Team
Featured from left to right: Thomas K. Fehring, MD, Keith A. Fehring, MD, Brian M. Curtin, MD, Bryan D. Springer, MD, Jesse E. Otero, MD, PhD

That team within OrthoCarolina’s Hip and Knee Center consists of Thomas Fehring, MD, Keith Fehring, MD, Brian Curtin, MD, Bryan Springer, MD, and Jesse Otero, MD.

“By streamlining the treatment process with experienced physicians [and] following established protocols, such consolidation allows for the most efficient and cost-effective care,” Fehring said.

While most physicians may treat one, maybe two, PJI patients per year, OCRI is in a unique position to observe and track the outcomes of multiple complex infection patients per week as patients are referred to the Periprosthetic Joint Infection Center from across the country. With the higher volume of PJIs to treat, OCRI is able to monitor patients to help determine which treatments and protocols are most effective.

This specialized approach to treating PJI continues to promote a collaborative atmosphere and facilitate research. In a current study involving multiple orthopedic research centers, OCRI is working to find better solutions to care for these patients. Instead of a patient going through months of painful procedures, we’re investigating whether or not a novel antibiotic delivery system will dramatically change how some total joint infections are treated.

The ultimate goal with these studies is to educate physicians so the best treatment plan can be executed to improve patient care and mobility.