Infection triples the cost of a primary joint arthroplasty

Background: In Europe few studies have analyzed the costs of treating aseptic revisions and prosthetic joint infections with either debridement, antibiotics and implant retention or two-stage revision, as compared to the cost of a primary total joint arthroplasty.Methods: The purpose was to analyze the costs of total joint arthroplasties, aseptic revisions and prosthetic joint infections treated with debridement, antibiotics and implant retention or a two-stage revision. We conducted a retrospective cohort study of patients who had a total joint arthroplasty in the Oulu University Hospital during the three-year period from 2013 to 2015. The costs were divided to specific services (e.g. procedure costs, ward care costs, laboratory). Actual costs obtained from the hospital's financial database were used for analysis.Results: There were 1708 total joint arthroplasties without complications, 18 aseptic revisions and 42 prosthetic joint infections eligible for analysis. The mean cost of a total joint arthroplasty was Euro7200, the excess cost of an aseptic revision was Euro10,900 and the excess cost of a prosthetic joint infection was Euro18,900 (total joint arthroplasty vs. infection, p<.0001). The excess cost was Euro12,800 for debridement, antibiotics and implant retention treatment and Euro44,600 for a two-stage revision (p<.0001). The two most expensive services were ward care and procedures.Conclusions: Infection tripled the cost of a total joint arthroplasty. The cost of two-stage revisions were triple that of debridement, antibiotics and implant retention treatment.