Direct Hospital Costs per Case of Periprosthetic Hip and Knee Joint Infections in Europe – A Systematic Review

BACKGROUND:The rise of periprosthetic joint infections (PJI) due to aging populations is steadily increasing the number of arthroplasties and treatment costs. This study analyzed the direct healthcare costs of PJI for total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Europe. METHODS:The databases PubMed, Scopus, Embase, Cochrane, and Google Scholar were systematically screened for direct costs of PJI in Europe. Publications that defined the joint site and the procedure performed were further analyzed. Mean direct healthcare costs were calculated for debridement, antibiotics and implant retention (DAIR), one-stage and two-stage revisions for hip and knee PJI, respectively. Costs were adjusted for inflation rates and reported in US-Dollar (USD). RESULTS:Of 1,374 eligible publications, 12 manuscripts were included in the final analysis after an abstract and full-text review. Mean direct costs of $32,933 were identified for all types of revision procedures for knee PJI. The mean direct treatment cost including debridement, antibiotics, and implant retention (DAIR) for TKA after PJI was $19,476. For two-stage revisions of TKA, the mean total cost was $37,980. For all types of hip PJI procedures, mean direct hospital costs were $28,904. For hip DAIR, one-stage and two-stage treatment average costs of $7,120, $44,594, and $42,166 were identified, respectively. CONCLUSION:Periprosthetic joint infections are associated with substantial direct healthcare costs. As detailed reports on the cost of PJI are scarce and of limited quality, more detailed financial data on the cost of PJI treatment are urgently required.