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

BACKGROUND: The rise of periprosthetic joint infections (PJIs) due to aging populations is steadily increasing the number of arthroplasties and treatment costs. This study analyzed the direct health care costs of PJI for total hip arthroplasty 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 health care costs were calculated for debridement, antibiotics, and implant retention (DAIR), one-stage, and 2-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 DAIR for TKA after PJI was 19, 476. For 2-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 2-stage treatment average costs of 7, 120, 44, 594, and 42, 166 were identified, respectively. CONCLUSIONS: Periprosthetic joint infections are associated with substantial direct health care 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.