The burden of care in hip and knee prosthetic joint infections (PJI) in a regional unit

Prosthetic joint infection (PJI) is a serious complication of joint arthroplasty. Irish patients undergo joint arthroplasty in public and private hospitals both in Ireland and abroad. Patients with complications often present to their local Emergency Department, regardless of initial point of care. We hypothesised an additional burden placed on the public system by patients with PJI that had their index surgery in an outside institution possibly due to delays in presentation. Retrospective analyses of all total hip arthroplasty (THA) and total knee arthroplasty (TKA) PJI managed by a multidisciplinary PJI team over a 3-year period (December 2021—December 2024). The means of total estimated operative costs, number of operations, length of inpatient stay (LOS), antibiotic treatment duration, admissions and rates of single operative management were compared between patients whose index surgery was done offsite and those done locally. 88 PJIs were managed during the study period. Mean operative cost was lower for local PJI (€49,533) compared with offsite PJI (€77,996). Local PJI patients required fewer operations (1.26 vs. 1.85) and admissions (1.16 vs. 1.48). Among TKA-PJI, offsite cases incurred higher operative costs (€75,909 vs. €40,500), required more operations (2.27 vs. 1.23), had longer LOS (55.9 vs. 28.2 days), and more admissions (1.64 vs. 1.15). Single-operation management was achieved in 88% of local versus 45% of offsite TKA-PJI cases. Offsite TKA-PJI imposes a disproportionate burden on public healthcare resources and is less likely to be successfully managed with a single operation.