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. 2025 Mar 8;6(3):298-311.
doi: 10.1302/2633-1462.63.BJO-2024-0225.R1.

The health-economic burden of hip and knee periprosthetic joint infections in Europe : a comprehensive analysis following primary arthroplasty

Volker Alt  1   2 , Dominik Szymski  1 , Markus Rupp  1 , Andreas Fontalis  3 , Danguole Vaznaisiene  4 , Leonard C Marais  5 , Christof Wagner  6 , Nike Walter  1 ; on behalf the Country Delegates of the European Bone and Joint Infection Society*; Volker Alt  1 , Martin Clauss  7   8 , Matteo Carlo Ferrari  9 , Efthymia Giannitsioti  10 , Mathias Glehr  11 , André Grenho  12 , Tomislav Madjarevic  13 , Dirk J Moojen  14 , Kaisa Huotari  15 , Bedri Karaismailoglu  16 , Rik Osinga  7   17 , Jeroen Neyt  18 , Imre Sallai  19 , Andrea Sambri  20 , Pablo Sanz-Ruiz  21 , Ricardo Sousa  22   23 , Anna Stefansdottir  24   25 , Rihard Trebse  26 , Danguole Vaznaisiene  4 , Marianne Westberg  27 , Christof Wagner  28
Affiliations

The health-economic burden of hip and knee periprosthetic joint infections in Europe : a comprehensive analysis following primary arthroplasty

Volker Alt et al. Bone Jt Open. .

Abstract

Aims: Periprosthetic joint infections (PJIs) pose significant challenges to patients and healthcare systems worldwide. The aim of this study was to estimate the health-economic burden of reimbursement payment in Europe for PJIs following primary hip and knee arthroplasty.

Methods: The calculation was based on health-economic modelling using data on primary hip and knee arthroplasties for the year 2019 from the Statistical Office of the European Union (Eurostat) and published infection rates to estimate the total number of hip and knee PJIs in 30 European countries. Revision procedures were stratified into: 1) debridement, antibiotics, and implant retention (DAIR); 2) one-stage exchange; and 3) two-stage revision procedures. The cases were then multiplied by the respective healthcare system reimbursement payments. Payment data were acquired from a survey of 13 countries (Austria, Croatia, France, Germany, Italy, Lithuania, Netherlands, Norway, Portugal, Slovenia, Switzerland, Turkey, and the UK) and extrapolated for the remaining countries.

Results: In 2019, a total of 2,048,778 primary total joint replacements were performed (total hip arthroplasty (THA) = 1,147,316 and total knee arthroplasty (TKA) = 901,462), with an estimated 20,416 cases of PJIs (11,131 hip and 9,285 knee) in Europe. This results in an estimated total reimbursement burden of €346,262,026 for European healthcare systems. The breakdown for hip PJI reimbursement was €197,230,953 (€9,751,962 for DAIR procedures, €45,135,894 for one-stage revisions, and €142,343,097 for two-stage revisions). For knee PJIs, the analysis yielded a total reimbursement of €149,031,073 (€9,335,075 for DAIR procedures, €48,058,479 for one-stage revisions, and €91,637,518 for two-stage revisions).

Conclusion: This is the first study to evaluate the health-economic burden of PJIs in Europe, revealing a substantial impact on healthcare systems with an estimated case load of 20,414 cases and overall reimbursement of €346,262,026 for primary THAs and TKAs performed in 2019.

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Conflict of interest statement

A. Fontalis reports an EFORT Robotic Fellowship supported by Stryker, which is unrelated to this manuscript. L. Marais declares a South African National Research Foundation grant (no. RA210211585669); honorarium for lectures from Smith & Nephew and Orthofix; and being immediate past-president and board member of the South African Orthopaedic Association, all of which are unrelated. D. Vaznaisiene discloses being President of the Lithuanian Society for Infectious Diseases, and country delegate of the European Bone and Joint Infection Society, both of which are also unrelated.

Figures

Fig. 1
Fig. 1
Equations used for the health-economic modelling. Calculations were done for hip and knee periprosthetic joint infection (PJI), respectively. #Number and costs of revision procedures were calculated for debridement, antibiotics, and implant retention (DAIR), one-stage, and two-stage PJI procedures, respectively.
See this image and copyright information in PMC

References

    1. Springer BD, Cahue S, Etkin CD, Lewallen DG, McGrory BJ. Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplast Today. 2017;3(2):137–140. doi: 10.1016/j.artd.2017.05.003. - DOI - PMC - PubMed
    1. Rupp M, Lau E, Kurtz SM, Alt V. Projections of primary TKA and THA in Germany from 2016 through 2040. Clin Orthop Relat Res. 2020;478(7):1622–1633. doi: 10.1097/CORR.0000000000001214. - DOI - PMC - PubMed
    1. Rupp M, Walter N, Lau E, Worlicek M, Kurtz SM, Alt V. Recent trends in revision knee arthroplasty in Germany. Sci Rep. 2021;11(1):15479. doi: 10.1038/s41598-021-94988-7. - DOI - PMC - PubMed
    1. Walter N, Rupp M, Hierl K, et al. Long-term patient-related quality of life after knee periprosthetic joint infection. J Clin Med. 2021;10(5):907. doi: 10.3390/jcm10050907. - DOI - PMC - PubMed
    1. Slifka KJ, Yi SH, Reddy SC, Baggs J, Jernigan JA. 287. The attributable mortality of prosthetic joint infection after primary hip and knee arthroplasty among medicare beneficiaries, 2005–2012. Open Forum Infect Dis. 2018;5(suppl_1):S118. doi: 10.1093/ofid/ofy210.298. - DOI