Skip to main content
SpringerLink
Log in

The Incidence and Socioeconomic Impact of Periprosthetic Joint Infection: United States Perspective

  • Chapter
  • First Online:
Book cover Periprosthetic Joint Infections

Abstract

Periprosthetic joint infection (PJI) following total joint arthroplasty leads to prolonged hospitalization, considerable morbidity, loss of productivity in the workplace, and a significant financial burden. The incidence of PJI domestically is rising yearly at an alarming rate, and deep infection is among the most frequent indications for performing revision hip or knee arthroplasty in this country. Revision for infection has been shown to cost more than double that of a revision procedure performed for aseptic loosening or mechanical failure. Infection with resistant organisms has also becomes more prevalent, which is associated with worse treatment outcomes and a higher cost of care. The government is the primary payer for the majority of cases of PJI, through Medicare spending, and several proposals for various reimbursement strategies are on the horizon that will impact provider compensation for physicians and hospitals. This chapter explores the clinical and financial implications of the rising incidence of PJI in this country, and considers the future impacts these trends may have on the American healthcare system.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kurtz SM, Lau E, Watson H, Schimier JK, Parvizi J. Economic burden of periprosthtic joint infection in the United States. J Arthoplasty. 2012;27(8 Suppl 1):61–5.

    Article  Google Scholar 

  2. Berend KR, Lomardi AV, Morris MJ, Bergeson AG, Adams JB, Sneller MA. Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res. 2013;471(2):510–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg. 2005;87(8):1746–51.

    Article  PubMed  Google Scholar 

  4. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008;23:984–91.

    Article  PubMed  Google Scholar 

  5. Anderson DJ, Sexton DJ, Kanafani ZA, Auten G, Kaye KS. Severe surgical site infection in community hospitals: epidemiology, key procedures, and the changing prevalence of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 2007;28:1047.

    Article  PubMed  Google Scholar 

  6. Parvizi J, Ghanem E, Azzam K, Davis E, Jaberi F, Hozack W. Periprosthetic infection: are current treatment strategies adequate? Acta Orthop Belg. 2008;74:793.

    PubMed  Google Scholar 

  7. Bradbury T, Fehring TK, Taunton M, Hanssen A, Azzam K, Parvizi J, et al. The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty. 2009;24(6 Suppl):103–7.

    Google Scholar 

  8. Parvizi J, Azzam K, Ghanem E, Austin MS, Rothman RH. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res. 2009;467(7):1732–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. National Quality Measures Clearinghouse. Total hip arthroplasty (THA) and/or total knee arthroplasty (TKA): hospital 30-day, all-cause, unplanned risk standardized readmission rate (RSRR) following elective primary THA and/or TKA. Centers for Medicare & Medicaid Services/The Joint Commission. Endorsed 1/31/13, available online at http://www.qualitymeasures.ahrq.gov/content.aspx?id=46501#Section615, found 3/5/15.

  10. Centers for Medicare & Medicaid Services. Readmissions reduction program. Available online at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html, found 3/5/15.

  11. Patel A, Calfee RP, Plante M, Fischer SA, Arcand N, Born C. Methicillin-resistant Staphylococcus aureus in orthopaedic surgery. J Bone Joint Surg (Br). 2008;90:1401–6.

    Article  CAS  Google Scholar 

  12. Trampuz A, Widmer AF. Infections associated with orthopaedic implants. Curr Opin Infect Dis. 2006;19:349–56.

    Article  CAS  PubMed  Google Scholar 

  13. Jaekel DJ, Ong KL, Lau EC, Watson HN, Kurtz SM. The epidemiology of total hip and knee arthroplasty infection. In: Springer BD, Parvizi J, editors. Periprosthetic Joint Infection of the Hip and Knee, vol. 1. New York: Springer; 2013. p. 1–14.

    Google Scholar 

  14. Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468:45–51.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg. 2009;91:128–33.

    Article  PubMed  Google Scholar 

  16. Parvizi J, Pawasarat IM, Azzam KA, Joshi A, Hansen EN, Bozic KJ. Periprosthetic joint infection: the economic impact of Methicillin-resistant infections. J Arthroplasty. 2010;25(6-S):103–7.

    Article  PubMed  Google Scholar 

  17. Parvizi J, Adeli B, Zmistowski B, Restrepo C, Greenwald AS. Management of periprosthetic joint infection: the current knowledge. AAOS exhibit selection. J Bone Joint Surg. 2012;94:e104(1–9).

    Google Scholar 

  18. Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg. 2005;87-A(3):570–6.

    Google Scholar 

  19. Herbert CK, Williams RE, Levy RS, Barrack RL. Cost of treating an infected total knee replacement. Clin Orthop Relat Res. 1996;331:140–5.

    Article  Google Scholar 

  20. Hansen E, Tetreault M, Zmistowski B, Della Valle CJ, Parvizi J, Haddad FS, Hozack WJ. Outcome of one-stage cementless exchange for acute postoperative periprosthetic hip infection. Clin Orthop Relat Res. 2013;471(10):3214–22.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cockarell JR, Hanssen AD, Osmon DR, Morrey BF. Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg. 1998;80:1306–13.

    Google Scholar 

  22. Fisman DN, Reilly DT, Karchmer AW, Goldie SJ. Clinical effectiveness and cost effectiveness of two management strategies for infected total hip arthroplasty in the elderly. Clin Infect Dis. 2001;32:419–30.

    Article  CAS  PubMed  Google Scholar 

  23. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012;27(8-S):61–5.

    Article  PubMed  Google Scholar 

  24. Sculco TP. The economic impact of infected total joint arthroplasty. Instr Course Lect. 1993;42:349–51.

    CAS  PubMed  Google Scholar 

  25. Gutowski CJ, Bozic KJ. Chapter 8. Economic aspects of total hip arthroplasty. In: Parvizi J, editor. The hip. Towson: Data Trace Publishing; 2013.

    Google Scholar 

  26. Bozic KJ, Katz P, Certernas M, Ono L, Ries MD, Showstack J. Hospital resource utilization for primary and revision total hip arthroplasty. J Bone Joint Surg. 2005;87-A(3):570–6.

    Google Scholar 

  27. Inc, MA. Medicare physician payment up slightly. Orthopedic Network News. 2010;21(1).

    Google Scholar 

  28. Wilson NA, Schneller ES, Montgomery K, Bozic KJ. Hip and knee implants: current trends and policy considerations. Health Aff. 2008;27:1587–98.

    Article  Google Scholar 

  29. HCUP NIS database. http://hcupnet.ahrq.gov/HCUPnet.jsp?Id=791E0204CFD43716&Form=DispTab&JS=Y&Action= %3E%3ENext%3E%3E&__InDispTab=Yes&_Results=Newquery.

  30. Kurtz SM, Ong KL, Lau E, Bozic KJ. Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg. 2014;96:624–30.

    Article  PubMed  Google Scholar 

  31. Froimson MI, Rana A, White Jr RE, Marshall A, Schutzer SF, Healy WL, et al. Bundled payments for care improvement initiative: the next evolution of payment formulations. AAHKS bundled payment task force. J Arthroplasty. 2013;28(1-S):157–65.

    Article  PubMed  Google Scholar 

  32. Hackett DJ, Rothenberg AC, Chen AF, Gutowski C, Jaekel D, Tomek IM, et al. The economic significance of orthopaedic infections. J Am Acad Orthop Surg. 2015;23(Suppl):S1–7.

    Article  PubMed  Google Scholar 

  33. Ng VY, Lustenberger D, Hoang K, Urchek R, Beal M, Calhoun JH, et al. Preoperative risk stratification and risk reduction for total joint reconstruction: AAOS exhibit selection. J Bone Joint Surg. 2013;95:e191–5.

    Article  PubMed  Google Scholar 

  34. Bozic KJ, Rubash HE, Sculco TP, Berry DJ. An analysis of Medicare payment policy for total joint arthroplasty. J Arthroplasty. 2008;23:133–8.

    Article  PubMed  Google Scholar 

  35. Health policy brief: medicare hospital readmissions reduction program. Health Affairs. 12 Nov 2013.

    Google Scholar 

  36. Parvizi J. Just say ‘no’ to operating on patients at high risk for periprosthetic joint infection. Orthopedics Today. January 2012

    Google Scholar 

  37. Bumpass DB, Nunley RM. Assessing the value of a total joint replacement. Curr Rev Musculoskelet Med. 2012;5:274–82.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Christina J. Gutowski MD, MPH

  2. Department of Orthopaedic Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Antonia F. Chen MD, MBA

  3. Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St., Philadelphia, PA, 19107, USA

    Javad Parvizi MD, FRCS

Authors
  1. Christina J. Gutowski MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonia F. Chen MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Javad Parvizi MD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. HELIOS ENDO-Klinik Hamburg, Berlin, Germany

    Daniel Kendoff

  2. University Hospital of Wales, Cardiff, United Kingdom

    Rhidian Morgan-Jones

  3. University College London Hospitals, London, United Kingdom

    Fares S. Haddad

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Gutowski, C.J., Chen, A.F., Parvizi, J. (2016). The Incidence and Socioeconomic Impact of Periprosthetic Joint Infection: United States Perspective. In: Kendoff, D., Morgan-Jones, R., Haddad, F. (eds) Periprosthetic Joint Infections. Springer, Cham. https://doi.org/10.1007/978-3-319-30091-7_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-30091-7_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30089-4

  • Online ISBN: 978-3-319-30091-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation