{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T17:18:05Z","timestamp":1740158285538,"version":"3.37.3"},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Given increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003\u20132016), we extracted data on total knee arthroplasty revisions (n\u2009=\u2009782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for all revisions and stratified by hospital teaching status (rural\/urban by teaching status), hospital bed size (\u2264299, 300\u2013499, and \u2265500 beds), and hospital region (Northeast, Midwest, South, and West). The Cochran\u2013Armitage trend test (PJI prevalence) and linear regression determined significance of trends. PJI prevalence overall was 25.5% (n\u2009=\u2009199,818) with a minor increasing trend: 25.3% (n\u2009=\u20097,828) in 2003 to 28.9% (n\u2009=\u200919,275) in 2016; p\u2009&lt;\u20090.0001. Median total hospitalization costs for PJI decreased slightly ($23,247 in 2003\u2013$20,273 in 2016; p\u2009&lt;\u20090.0001) while median per-day costs slightly increased ($3,452 in 2003\u2013$3,727 in 2016; p\u2009&lt;\u20090.0001), likely as a function of decreasing length of stay. With small differences between hospitals, the lowest and highest PJI prevalences were seen in small (\u2264299 beds; 22.9%) and urban teaching hospitals (27.3%), respectively. In stratification analyses, an increasing trend in PJI prevalence was particularly seen in larger (\u2265500 beds) hospitals (24.4% in 2003\u201330.7% in 2016; p\u2009&lt;\u20090.0001), while a decreasing trend was seen in small-sized hospitals. Overall, PJI in knee arthroplasty revisions appears to be slightly increasing. Moreover, increasing trends in large hospitals and decreasing trends in small-sized hospitals suggest a shift in patients from small to large volume hospitals. Decreasing trends in total costs, alongside increasing trends in per-day costs, suggest a strong impact of length of stay trends and a more efficient approach to PJI over the years (in terms of shorter length of stay).<\/jats:p>","DOI":"10.1055\/s-0040-1701516","type":"journal-article","created":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T00:18:13Z","timestamp":1583367493000},"page":"1110-1119","source":"Crossref","is-referenced-by-count":2,"title":["Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data"],"prefix":"10.1055","volume":"34","author":[{"given":"Robert","family":"Brochin","sequence":"additional","affiliation":[{"name":"Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7058-5102","authenticated-orcid":false,"given":"Jashvant","family":"Poeran","sequence":"additional","affiliation":[{"name":"Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York"},{"name":"Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, One Gustave L. Levy Place, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khushdeep S.","family":"Vig","sequence":"additional","affiliation":[{"name":"Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aakash","family":"Keswani","sequence":"additional","affiliation":[{"name":"Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Zubizarreta","sequence":"additional","affiliation":[{"name":"Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York"},{"name":"Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, One Gustave L. Levy Place, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leesa M.","family":"Galatz","sequence":"additional","affiliation":[{"name":"Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Calin","family":"Moucha","sequence":"additional","affiliation":[{"name":"Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,3,4]]},"reference":[{"issue":"388","key":"ref1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/00003086-200107000-00007","article-title":"Total knee arthroplasty using cruciate-retaining kinematic condylar prosthesis","author":"G S Sextro","year":"2001","journal-title":"Clin Orthop Relat Res"},{"key":"ref2","first-page":"237","article-title":"Cost effectiveness of revision total knee replacement","volume":"46","author":"C H Rorabeck","year":"1997","journal-title":"Instr Course Lect"},{"issue":"14","key":"ref3","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1001\/archinte.168.14.1576","article-title":"Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population","volume":"168","author":"J M Quintana","year":"2008","journal-title":"Arch Intern Med"},{"issue":"404","key":"ref4","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/00003086-200211000-00007","article-title":"Long-term followup of nonmodular total knee replacements","author":"E M Keating","year":"2002","journal-title":"Clin Orthop Relat Res"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1054\/arth.2002.32186","article-title":"The Insall-Burstein II prosthesis: a 5- to 9-year follow-up study in osteoarthritic knees","volume":"17","author":"P F Indelli","year":"2002","journal-title":"J Arthroplasty"},{"issue":"388","key":"ref6","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1097\/00003086-200107000-00010","article-title":"Long-term followup of the Miller-Galante total knee replacement","author":"R A Berger","year":"2001","journal-title":"Clin Orthop Relat Res"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","article-title":"Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030","volume":"89","author":"S Kurtz","year":"2007","journal-title":"J Bone Joint Surg Am"},{"issue":"452","key":"ref8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/01.blo.0000229356.81749.11","article-title":"The Chitranjan Ranawat Award: Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties","volume":"452","author":"M B Vessely","year":"2006","journal-title":"Clin Orthop Relat Res"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1302\/0301-620X.78B3.0780441","article-title":"Survivorship analysis of the Kinematic stabilizer total knee replacement: a 10- to 14-year follow-up","volume":"78","author":"K P Emmerson","year":"1996","journal-title":"J Bone Joint Surg Br"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3928\/01477447-20091124-10","article-title":"Early failures in unicondylar arthroplasty","volume":"33","author":"T K Fehring","year":"2010","journal-title":"Orthopedics"},{"issue":"404","key":"ref11","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/00003086-200211000-00003","article-title":"Insall award paper. Why are total knee arthroplasties failing today?","author":"P F Sharkey","year":"2002","journal-title":"Clin Orthop Relat Res"},{"issue":"446","key":"ref12","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/01.blo.0000214421.21712.62","article-title":"Current etiologies and modes of failure in total knee arthroplasty revision","volume":"446","author":"K J Mulhall","year":"2006","journal-title":"Clin Orthop Relat Res"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/S0968-0160(02)00054-6","article-title":"The incidence of revision of the metal component of total knee arthroplasties in different tibial-insert designs","volume":"9","author":"C H Huang","year":"2002","journal-title":"Knee"},{"issue":"11","key":"ref14","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1007\/s11999-011-2102-9","article-title":"New definition for periprosthetic joint infection: from the workgroup of the MusculoSkeletal Infection 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Arthroplasty"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies","volume":"46","author":"P C Austin","year":"2011","journal-title":"Multivariate Behav Res"},{"issue":"07","key":"ref23","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/j.arth.2013.02.012","article-title":"Descriptive analysis of the economic costs of periprosthetic joint infection of the knee for the public health system of Andalusia","volume":"28","author":"J Garrido-G\u00f3mez","year":"2013","journal-title":"J Arthroplasty"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.jiph.2015.12.014","article-title":"Incidence and economic burden of prosthetic joint infections in a university hospital: a report from a middle-income country","volume":"9","author":"E Alp","year":"2016","journal-title":"J Infect Public Health"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1016\/S0140-6736(14)60419-0","article-title":"Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales","volume":"384","author":"A D Liddle","year":"2014","journal-title":"Lancet"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1503\/cjs.002916","article-title":"Trends in revision hip and knee arthroplasty observations after implementation of a regional joint replacement registry","volume":"59","author":"J Singh","year":"2016","journal-title":"Can J Surg"},{"issue":"07","key":"ref27","doi-asserted-by":"crossref","first-page":"e014056","DOI":"10.1136\/bmjopen-2016-014056","article-title":"Description of the rates, trends and surgical burden associated with revision for prosthetic joint infection following primary and revision knee replacements in England and Wales: an analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man","volume":"7","author":"E Lenguerrand","year":"2017","journal-title":"BMJ Open"},{"issue":"07","key":"ref28","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1007\/s11999-014-3515-z","article-title":"Is changing hospitals for revision total joint arthroplasty associated with more complications?","volume":"472","author":"C J Dy","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"06","key":"ref30","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1097\/MLR.0000000000000710","article-title":"Episode-of-care characteristics and costs for hip and knee replacement surgery in hospitals belonging to the high value healthcare collaborative compared with similar hospitals in the same health care markets","volume":"55","author":"W B Weeks","year":"2017","journal-title":"Med Care"},{"issue":"18","key":"ref31","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.2106\/JBJS.K.00355","article-title":"Variability in costs associated with total hip and knee replacement implants","volume":"94","author":"J C Robinson","year":"2012","journal-title":"J Bone Joint Surg Am"},{"issue":"22","key":"ref32","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.2106\/JBJS.17.00203","article-title":"Reconsidering the affordable care act's restrictions on physician-owned hospitals: analysis of CMS data on total hip and knee arthroplasty","volume":"99","author":"P M Courtney","year":"2017","journal-title":"J Bone Joint Surg Am"}],"container-title":["The Journal of Knee 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