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Comparative Analysis of Periprosthetic Joint Infection Rates After Total Hip Arthroplasty Across Facility Types: A
Gregorio Baek1, Joydeep Baidya1, Rachel Huang1
1Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
The Journal of Arthroplasty
|July 4, 2026
Summary
Total hip arthroplasty (THA) performed in various facilities, including ambulatory surgical centers (ASC), shows similar periprosthetic joint infection (PJI) rates. Surgeons can confidently perform THA in outpatient settings without increased PJI risk.
Area of Science:
- Orthopaedic Surgery
- Infection Control
- Health Services Research
Background:
- Growing volume of total hip arthroplasty (THA) has led to a shift towards outpatient facilities.
- Previous studies investigated surgical site infections (SSI) and periprosthetic joint infections (PJI) by facility type, but lacked comprehensive comparison for THA.
- Limited research exists comparing PJI rates for THA across tertiary hospital centers (THC), community hospitals (CH), orthopaedic specialty hospitals (OSH), and ambulatory surgical centers (ASC) within a single health system.
Purpose of the Study:
- To compare periprosthetic joint infection (PJI) rates after primary total hip arthroplasty (THA) across different healthcare facility types.
- To identify if facility type is an independent predictor of PJI after THA.
- To inform surgical decision-making regarding optimal facility choice for THA.
Main Methods:
- Retrospective cohort study of 39,743 patients undergoing primary, elective THA between 2017 and 2024.
- Patients were stratified into four facility type cohorts: THC (n=16,286), CH (n=11,314), OSH (n=10,891), and ASC (n=1,252).
- Multivariable Cox regression analysis was used to identify predictors of PJI, controlling for patient demographics, surgical variables, and surgeon experience.
Main Results:
- The overall PJI rate across all facilities was 1.07%, with no statistically significant differences observed between facility types.
- Multivariable analysis, controlling for key variables, found no association between facility type and increased odds of developing PJI after THA.
- Specific comparison showed similar PJI odds for THAs performed at ASCs and THCs.
Conclusions:
- Total hip arthroplasty (THA) demonstrates comparable postoperative periprosthetic joint infection (PJI) rates regardless of the facility type where the procedure is performed.
- Ambulatory surgical centers (ASCs) and tertiary hospital centers (THCs) exhibit similar PJI risks for THA.
- Surgeons can consider performing THA in various outpatient settings, including ASCs, without a heightened risk of PJI.
