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. 2021 Feb 17;103(4):312-318.
doi: 10.2106/JBJS.20.00550.

Direct Inpatient Medical Costs of Operative Treatment of Periprosthetic Hip and Knee Infections Are Twofold Higher Than Those of Aseptic Revisions

Jie J Yao  1 , Mario Hevesi  2 , Sue L Visscher  2 , Jeanine E Ransom  2 , David G Lewallen  2 , Daniel J Berry  2 , Hilal Maradit Kremers  2
Affiliations

Direct Inpatient Medical Costs of Operative Treatment of Periprosthetic Hip and Knee Infections Are Twofold Higher Than Those of Aseptic Revisions

Jie J Yao et al. J Bone Joint Surg Am. .

Abstract

Background: Periprosthetic joint infections (PJIs) following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are associated with substantial morbidity. A better understanding of the costs of PJI treatment can inform prevention, treatment, and reimbursement strategies. The purpose of the present study was to describe direct inpatient medical costs associated with the treatment of hip and knee PJI.

Methods: At a single tertiary care institution, 176 hips and 266 knees that underwent 2-stage revisions for the treatment of PJI from 2009 to 2015 were compared with 1,611 hips and 1,276 knees that underwent revisions for aseptic indications. In addition, 84 hips and 137 knees that underwent irrigation and debridement (I&D) with partial component exchange were compared with 39 hips and 138 knees that underwent partial component exchange for aseptic indications. Line-item details of services billed during hospitalization were retrieved, and standardized direct medical costs were calculated in 2018 inflation-adjusted dollars.

Results: The mean direct medical cost of 2-stage revision THA performed for the treatment of PJI was significantly higher than that of aseptic revision THA ($58,369 compared with $22,846, p < 0.001). Similarly, the cost of 2-stage revision TKA performed for the treatment of PJI was significantly higher than that of aseptic revision TKA ($56,900 compared with $24,630, p < 0.001). Even when the total costs of aseptic revisions were doubled for a representative comparison with 2-stage procedures, the costs of PJI procedures were 15% to 28% higher than those of the doubled costs of aseptic revisions (p < 0.001). The mean direct medical cost of I&D procedures for PJI was about twofold higher than of partial component exchange for aseptic indications.

Conclusions: The direct medical costs of operative treatment of PJI following THA and TKA are twofold higher than the costs of similar aseptic revisions. The high economic burden of PJI warrants efforts to reduce the incidence of PJI. Reimbursement schemes should account for the high costs of treating PJI in order to ensure sustainable patient care.

Level of evidence: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: This research was supported by the National Institutes of Health (NIH) under grant P30AR76312. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and “yes” to indicate that the author had a patent and/or copyright, planned, pending, or issued, broadly relevant to this work (http://links.lww.com/JBJS/G210).

Figures

Figure 1.
Figure 1.
2018 adjusted mean direct hospital costs of irrigation and debridement (I&D) compared to aseptic partial component exchange in total hip arthroplasty (THA; Figure 1A) and total knee arthroplasty (TKA; Figure 1B)
Figure 1.
Figure 1.
2018 adjusted mean direct hospital costs of irrigation and debridement (I&D) compared to aseptic partial component exchange in total hip arthroplasty (THA; Figure 1A) and total knee arthroplasty (TKA; Figure 1B)
See this image and copyright information in PMC

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