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Mar 08, 2025;6 (3): 298-311.

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

Volker Alt, Dominik Szymski, Markus Rupp, Andreas Fontalis, Danguole Vaznaisiene, Leonard C Marais, Christof Wagner, Nike Walter, on behalf the Country Delegates of the European Bone and Joint Infection Society*, Volker Alt, Martin Clauss, Matteo Carlo Ferrari, Efthymia Giannitsioti, Mathias Glehr, Andr�� Grenho, Tomislav Madjarevic, Dirk J Moojen, Kaisa Huotari, Bedri Karaismailoglu, Rik Osinga, Jeroen Neyt, Imre Sallai, Andrea Sambri, Pablo Sanz-Ruiz, Ricardo Sousa, Anna Stefansdottir, Rihard Trebse, Danguole Vaznaisiene, Marianne Westberg, Christof Wagner
Author Information
  1. Volker Alt: Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany. ORCID
  2. Dominik Szymski: Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany. ORCID
  3. Markus Rupp: Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany. ORCID
  4. Andreas Fontalis: Division of Surgery & Interventional Science, University College London, London, UK. ORCID
  5. Danguole Vaznaisiene: Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania. ORCID
  6. Leonard C Marais: Orthopaedic Surgery, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa. ORCID
  7. Christof Wagner: Center for Orthopaedic and Trauma Surgery, Klinikum Ingolstadt GmbH, Ingolstadt, Germany.
  8. Nike Walter: Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany. ORCID
  9. Volker Alt: Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany.
  10. Martin Clauss: Center for Muskuloskeletal Infections (ZMSI), University Hospital Basel, Basel, Switzerland.
  11. Matteo Carlo Ferrari: Internal Medicine Unit, Istituto Clinico Citt�� Studi, Milan, Italy.
  12. Efthymia Giannitsioti: Department of Propaedeutic and Internal Medicine, Medical School National and Kapodistrian University of Athens, Athens, Greece.
  13. Mathias Glehr: Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria.
  14. Andr�� Grenho: Department of Orthopaedics, Hospital de Curry Cabral, Unidade Local de Sa��de de S��o Jos��, Lisbon, Portugal.
  15. Tomislav Madjarevic: University Hospital for Orthopaedic Surgery Lovran, Lovran, Croatia.
  16. Dirk J Moojen: Department of Orthopedic and Trauma Surgery OLVG, Amsterdam, the Netherlands.
  17. Kaisa Huotari: Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
  18. Bedri Karaismailoglu: Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey.
  19. Rik Osinga: Center for Muskuloskeletal Infections (ZMSI), University Hospital Basel, Basel, Switzerland.
  20. Jeroen Neyt: Department of Orthopedic Surgery, University Hospitals Ghent, Ghent, Belgium.
  21. Imre Sallai: Department of Orthopaedics, Semmelweis University, Budapest, Hungary.
  22. Andrea Sambri: Orthopaedic and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy.
  23. Pablo Sanz-Ruiz: Department of Orthopaedic Surgery and Traumatology and Hospital General Universitario Gregorio Mara����n, Madrid, Spain.
  24. Ricardo Sousa: Porto Bone Infection Group (GRIP), Orthopaedic Department, Centro Hospitalar Universit��rio do Porto, Porto, Portugal.
  25. Anna Stefansdottir: Department of Clinical Sciences Lund, Division of Orthopedics, Lund University, Lund, Sweden.
  26. Rihard Trebse: Orthopaedic Hospital Valdoltra, Ankaran, Slovenia.
  27. Danguole Vaznaisiene: Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania.
  28. Marianne Westberg: Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
  29. Christof Wagner: Department of Trauma Surgery, Hospital Ingolstadt, Ingolstadt, Germany.
PMID: 40054494 DOI: 10.1302/2633-1462.63.BJO-2024-0225.R1

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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Journal Article

Word Cloud

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