by Elizabeth Hofheinz, M.P.H., M.Ed., September 12, 2019
Every patient needs and deserves an empathic physician, especially during periods of extreme stress. As fate would have it, patients often find the best listener in a physician who has walked a similar path. Such is the case with Thomas Fehring, M.D., Co-Director of the OrthoCarolina Hip & Knee Center in Charlotte, North Carolina. At one point, Dr. Fehring, a former President of The Knee Society and the American Association of Hip and Knee Surgeons, had to undergo a two-stage knee procedure to clear an infection that had been present since his days as a college athlete.
He told OSN: “That experience left me with a profound understanding of what my infection patients have to contend with. Given the devastating nature of a diagnosis of periprosthetic joint infection (PJI), and the fact that specialized infection treatment is not widely available, I, along with my colleagues, decided to open the OrthoCarolina Periprosthetic Joint Infection Center. Alongside me in this effort are Keith Fehring, M.D., Brian Curtin, M.D., Jesse Otero, M.D., and Bryan Springer, M.D.” 
“Because the majority of arthroplasty surgeons treat only a few PJI patients per year, not every surgeon is equipped to handle it when such problems arise. There are nearly one million total joint surgeries performed in the U.S. each year, with a PJI prevalence rate of 1%. That means that roughly 10,000 patients annually will need to find a treating physician who specializes in such infections.”
Reflecting the athlete in him, Dr. Fehring notes, “To treat one complex infection case you need several dedicated physicians…you need a team. At our facility, patients with a PJI are supported by a team of five arthroplasty surgeons, and two orthopedic/plastic physicians to help manage flaps and complex wound problems (Ryan Garcia, M.D., and Michael Gart, M.D.). Infectious disease consultants and hospitalists are at the ready to help manage any antibiotic and medical issues. And our hospital system showed its support by recently creating the Musculoskeletal Institute at Atrium Health, which provides OR and inpatient assistance to meet the needs of PJI patients.”
To advance the care of patients with these complex problems, these specialists go back to the lab in order to move things forward. “Our goal is to have the proper treatment protocols in place and work from those in order to tailor care to each individual patient. Working with the OrthoCarolina Research Institute, my colleagues and I are conducting several studies that will help us move toward that goal. For example, we are the principal investigators for a multicenter study comparing one stage versus two stage treatment for PJI. If infected joints could be removed and restored to the body safely on the same day, it would be real advantage for patients.”
And to assist patients and their caregivers in navigating the cumbersome treatment process, Dr. Fehring and his colleagues established a website: healingjoints.org. “One of my patients brought it to my attention that he and others needed reliable information on what to expect as far as how much to move after surgery, blood clot prevention, pain management, etc. Not only do we have information on mood changes, postoperative exercise, and more, but we offer confidential telephone and online coaching to help people through this experience.”
Dr. Fehring could have used such a website himself when he went through the process. Asked what he learned by going through the infection experience, Dr. Fehring noted, “I didn’t realize that sleep deprivation was a common side effect of PJI—or that it would hit me so hard. I now share that and more with my PJI patients about the day-to-day struggles of dealing with this condition. What I also realized was that IV antibiotic treatment can have some fairly significant side effects not too dissimilar to chemotherapy. I lost my appetite during my IV antibiotic treatment and subsequently lost 20 pounds in the process. I have discussed this with our infectious disease doctors as well as some of my patients and this loss of appetite is a frequent side effect that I was unaware of as a treating physician.”
You might say that Dr. Fehring is a regional—and even national—ambassador for proper PJI treatment. “Every three months I contact all the hip and knee surgeons in North and South Carolina to update them on our research studies and offer our services. I take calls from all over the country about specific patients and then do my best to give advice, see the patients, or direct them to an experienced colleague in their area.”
PJI treatment is indeed a team effort.