Direct healthcare burden and costs of operatively managed prosthetic joint infection in a public hospital setting

Prosthetic joint infection (PJI) following arthroplasty is associated with high morbidity and financial cost. Patients often undergo multiple complex procedures, prolonged inpatient stays and outpatient parenteral antibiotic therapy (OPAT). We aim to quantify the economic implications of the inpatient and OPAT costs of the management of private patients treated in the public healthcare system. Retrospective analysis of operative PJI cases between September 2020 and September 2025 was performed. Included patients were those who had primary total hip replacement (THR) or total knee replacement (TKR) for osteoarthritis or trauma. Data included inpatient stay, OPAT utilization, surgical procedures (debridement, antibiotics, and implant retention (DAIR); and revisions), and private/public status at index procedure. Costs were estimated using available Health Service Executive (HSE) information on operative costs and bed days. There were 40 operative PJI cases in our centre over the study period. There were 22 TKRs and 18 THRs. Eighteen had their initial surgery publicly, whereas 14 had their initial surgery privately. A total of 19 patients underwent DAIR while the rest underwent one or several revisions. Combined total length of stay was 1796 bed days. The operative PJI burden over that period was EUR 5 005 339 (median EUR 84 232 per episode) or approximately EUR 1 000 000 yr −1 . Fourteen private patients treated in our centre had publicly funded treatment at an estimated cost of EUR 1 967 270 over a 5-year period or EUR 393 454 yr −1 . Operative PJI imposes a substantial clinical and financial burden. Private patients treated in public hospitals contribute to the total costs, raising the justification for private healthcare contributions to publicly treated complications arising after private procedures.