Operatively managed prosthetic joint infections following hip and knee replacements generated more than five million euros in direct treatment costs at an Irish public trauma hospital over a five-year period, according to a retrospective investigation published in the Journal of Bone and Joint Infection. Researchers determined that treating 40 surgical infection episodes between September 2020 and September 2025 accumulated an aggregate healthcare expenditure of 5,005,339 euros, translating to an average direct burden of roughly one million euros each year. Across the entire patient cohort, the median expenditure reached 84,232 euros per clinical episode, driven predominantly by prolonged inpatient admissions and complex surgical procedures.
The study was conducted by Matthew Condon, Malak Alwaheed, Jillian O’Carroll, and Alan Molloy from the Trauma and Orthopaedics Department at St Vincent’s University Hospital in Dublin and the University College Dublin School of Medicine. The investigators reviewed all operative prosthetic joint infection cases managed at their tertiary trauma unit over the designated five-year window. The analyzed population comprised 40 individual patients with a median age of 72 years, including 21 women and 19 men. Among these cases, 22 followed total knee replacement procedures and 18 occurred following total hip replacements, all originally performed for osteoarthritis or acute trauma. Patients who had undergone primary joint arthroplasty to treat native joint septic arthritis were excluded from the analysis.
Clinical diagnostic standards followed the criteria established by the European Bone and Joint Infection Society alongside orthopaedic consultant decision-making to identify confirmed or likely infection cases requiring surgical intervention. The surgical strategies varied according to clinical presentation: 19 patients underwent debridement, antibiotics, and implant retention, while the remaining 21 patients required one or multiple major revision operations. The authors highlighted that recorded surgical interventions reflected management within the defined study window rather than definitive long-term eradication, as several patients remained under ongoing follow-up after the observation period concluded.
Timing of infection diagnosis relative to index joint replacement surgery revealed that late-stage infections dominated both case volume and overall resource consumption. A total of 21 patients—comprising 12 public index cases and nine private index cases—were diagnosed with late prosthetic joint infections, generating a combined direct expenditure of 2,908,340 euros. In contrast, five patients whose initial arthroplasties took place in private institutions were diagnosed with acute or delayed prosthetic joint infections, accounting for an aggregate treatment cost of 474,868 euros across the five-year evaluation period.
Hospital capacity utilization was substantial, with the 40 cases collectively requiring 1,796 inpatient bed days, corresponding to a median hospital stay of 21 days per patient. In parallel, the cohort utilized 1,855 days of outpatient parenteral antibiotic therapy, with a median therapy duration of 42 days, or six weeks, per individual. The authors emphasized that outpatient antibiotic programs provide critical financial mitigation for the health service, noting literature showing that outpatient parenteral antimicrobial administration saves the Health Service Executive an estimated 20 million euros annually in avoided inpatient bed occupancy.
Direct expenditures were modeled through standardized Health Service Executive cost instruments rather than retrospective hospital ledger billing. Inpatient hospital days were estimated at an official rate of 1,204 euros per day, while operative costs were assigned using the 2024 Health Service Executive Admitted Patient Price List. Debridement with implant retention was classified under intermediate complexity revision surgery, whereas full revision procedures were mapped to major complexity revision surgery. Annual price list updates between 2024 and 2025 indicated minimal cost shifts—specifically a 1.25 percent increase of 499 euros for total knee revision and a 0.16 percent rise of 100 euros for total hip revision—justifying the application of 2024 pricing benchmarks without historical inflation adjustments. Outpatient parenteral antibiotic therapy was conservatively modeled at 100 euros per day based on Irish national coordination data and European reference studies, while oral antimicrobial medications were excluded from primary totals due to minimal cost impact and coverage through outpatient prescription structures.
Financial requirements varied widely across individual clinical pathways depending on surgical trajectory and inpatient length of stay. The least expensive case in the cohort incurred a direct cost of 32,624 euros, involving a day-case admission, a single debridement and implant retention procedure, transfer to a private facility, and six weeks of outpatient antibiotic therapy. At the opposite extreme, the highest expenditure reached 744,044 euros for a patient who endured a 405-day hospital stay, three revision surgeries, an operative Girdlestone procedure, and 18 weeks of outpatient intravenous antibiotic treatment.
Analysis of surgical origin demonstrated that 18 patients received their primary joint replacement within the public hospital system, 14 underwent their initial procedure in private surgical hospitals, and seven patients lacked definitive institutional documentation regarding primary surgery origin. The 14 patients who received primary arthroplasty in private facilities accounted for 1,967,270 euros in publicly funded revision care over the five-year timeframe, representing an annual expenditure of 393,454 euros. Comparative statistical testing demonstrated no significant differences between private and public cohorts across primary clinical and economic parameters.
Specifically, the median cost for patients originating in private hospitals stood at 67,996 euros compared with 84,232 euros for public patients, representing a statistically insignificant variance (p = 0.633; overall cost distribution p = 0.747). The mean number of surgical procedures performed was 1.64 among private patients and 1.50 among public patients, reflecting no significant disparity (p = 0.897). Inpatient duration was likewise comparable, with private patients recording a median stay of 22 days versus 21 days for public patients (p = 0.633), a finding that remained non-significant even when excluding patients whose acute stays were shortened by post-operative transfer back to private facilities (p = 0.322).
The seven cases with unverified surgical origins accumulated 816,195 euros in direct treatment costs, with a median of 87,040 euros per patient, compared to 4,189,144 euros and a median of 82,628 euros across the 33 classified patients. The researchers noted that if all seven unconfirmed cases had undergone primary operations in the private sector, the total public healthcare burden attributable to complications arising from private arthroplasty would reach 2,783,465 euros, exceeding half of the total infection expenditure documented during the study period.
The authors contextualized their findings against previous literature, noting that their observation of clinical parity diverged from a 2026 study by Clausen and colleagues, which found that offsite primary knee arthroplasties resulted in higher mean operative expenditures, increased surgical interventions, and longer hospital stays. Condon and colleagues suggested that differing institutional sample sizes, regional consultant decision-making protocols, and distinct cost estimation models likely accounted for these contrasting results. They also noted that Dublin private centres routinely focus on elective primary arthroplasty with short inpatient turnarounds, lacking the critical care infrastructure or revision facilities required to manage complex joint infections when complications arise.
The investigators emphasized that managing approximately 360 inpatient bed days annually for prosthetic joint infections creates extensive operational pressure on public tertiary trauma units, where emergency bed occupancy can force cancellations of complex elective orthopaedic procedures. Citing wider health system data, the authors pointed to evidence showing that 17.3 percent of elective cancellations in United Kingdom hospitals stemmed from physical capacity deficits, while waiting list delays generate documented reductions in patient quality of life and considerable economic productivity losses. In discussing solutions, the authors suggested establishing formal cross-sector referral pathways, improving case-selection criteria, and exploring cost-sharing mechanisms or private insurance contributions to reimburse public facilities for managing major complications originating from elective private surgeries.
Subject of Research: Direct healthcare burden and costs of operatively managed prosthetic joint infections
Article Title: Direct healthcare burden and costs of operatively managed prosthetic joint infection in a public hospital setting
Article References: Condon, M., Alwaheed, M., O'Carroll, J., & Molloy, A. (2026). Direct healthcare burden and costs of operatively managed prosthetic joint infection in a public hospital setting. Journal of Bone and Joint Infection, 11(6), 667-672. https://doi.org/10.5194/jbji-11-667-2026
Image Credits: AI Generated
Keywords: prosthetic joint infection, orthopaedic surgery, hospital costs, arthroplasty complications, public healthcare, health economics, revision arthroplasty, outpatient antibiotic therapy, Direct, healthcare, burden, costs
News Source: Ophelia Keating. (November 6, 2026). Public Hospital Analysis Quantifies Financial Burden of Treating Prosthetic Joint Infections. Scienmag.
