Analysis of the cost of periprosthetic joint infections after total knee and hip arthroplasty and the effect of revision methods on the cost

Abstract

Introduction. Periprosthetic joint infections (PJI) are known to increase medical costs, whereas the factors affecting this increase are variable. Aim. This retrospective case-control study aims to categorize and analyze the expenditures that increase costs in PJI and to evaluate the cost effect of revision methods. Material and methods. The patients who underwent primary arthroplasty or aseptic revision surgery of the knee or hip joints between January 2014-2018 in our center were screened retrospectively. Patients hospitalized with PJI were assigned as the PJI study group. The control group consisted at a 1:2 ratio and included patients matched for age, sex, prosthesis site, and the time from prosthesis implantation (years). All medical expenditures during the hospitalization period were determined and converted to United States dollar currency ($) according to annual average exchange rates. Results. Of the 4321 patients undergoing knee or hip arthroplasty in the mentioned timephrame, 87 patients had PJI, and 174 patients were enrolled as controls. The incidence of PJI was 2.1%. There was no difference between two groups in terms of demographic characteristics and comorbidities. The expenditures during hospitalization were $1,677 ($554.4-$13,605.2) per person in the PJI group and $494 ($269.3-$3,790.9) in the controls (p < 0.001). The expense per person was 3.4 times higher in the PJI group than in the controls. The cost increase varied between 2-622 fold between the arms. When costs per procedure were evaluated, debridement, antibiotics, and implant retention was associated with lower costs while no difference was observed between one-or two-stage revisions ($1,188, $1,987, vs $1,854, respectively p < 0.001). Conclusions. According to our study, antibiotics increase the cost more than surgical expenses in patients who develop PJI. In addition, cost should not be a factor in the decision of revision surgery.