The Economic Impact and Clinical Benefits of Intraosseous Injections in Total Knee Arthroplasty

Background: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) causes significant morbidity and incurs a substantial economic burden on the healthcare system. Recent studies have demonstrated that intraosseous vancomycin (IOV) can reduce the rate of PJI in both primary and aseptic revision TKA when compared to intravenous vancomycin (IVV). This study evaluated the economic impact associated with IOV and IVV administration during primary and aseptic revision TKA. Methods: Published institutional hospitalization cost data for PJI following TKA utilizing the Nationwide Inpatient Sample were adjusted to 2024 inflation rates to estimate the treatment cost of one knee PJI. Institutional costs for IOV and IVV were calculated using Medicare rates for current procedural terminology code 36680 as well as the costs of instrumentation, medications, and additional operating room time. Published PJI rates with (primary 0.54%, aseptic revision 1.86%) and without (primary 1.08%, aseptic revision 4.89%) IOV were used to calculate the number needed to treat to prevent one PJI. Results: The cost per case was $177.04 for IOV and $3.90 for IVV. The inflation-adjusted cost per PJI treatment was $33,295.70. The number needed to treat to prevent one PJI for primary TKA was 185.2 and 33.0 for aseptic revision TKA. For primary TKA, utilizing IOV resulted in a cost savings of $1230.17 to prevent one PJI. For aseptic revision TKA, utilizing IOV resulted in a cost savings of $27,582.08. Conclusions: Utilizing IOV during both primary and aseptic revision TKA was shown to be cost-effective. The economic impact of PJI may be greater if additional costs, such as specialist visits, postoperative rehabilitation, and quality of life factors, are factored in.