What does infection cost? A comparative analysis of shoulder, hip, and knee two-stage revision procedures

Two-stage revision arthroplasty is a commonly used strategy for managing periprosthetic joint infection (PJI). This study aimed to quantify inpatient costs of two-stage revision for PJI after total hip (THA), total knee (TKA), and total shoulder arthroplasty (TSA) and to identify key drivers of cost differences when comparing joint and operative stage.

We performed a single-institution retrospective cohort study including patients who underwent completed two-stage THA, TKA, or TSA revision for PJI between September 2011 and October 2025. Demographic, clinical, microbiologic, and operative data were collected via electronic medical record review. Line-item inpatient costs were grouped into standardized categories (operating room, post-anesthesia care unit, hospital stay, laboratory and radiology, anesthesia administration, drug administration, medication, blood products, implants, other medical equipment, and robotics/technology costs), inflation-adjusted to December 2025, and reported as scaled multiples of an undisclosed constant (x) due to institutional policy. Operative costs included operating room time, anesthesia administration, implants, and technology. Comparisons were performed using univariate and multivariate analyses.

The cohort included 219 patients (62 THA, 79 TKA, 78 TSA). First-stage operative time was longest for THA and shortest for TSA (P < 0.001). Organism profiles differed by joint (P < 0.001), with Staphylococcus aureus predominating in THA and TKA and Cutibacterium acnes in TSA. Operative costs over both stages were similar between THA and TKA (P = 0.273) and significantly lower for TSA (P < 0.001). First-stage costs consisted primarily of hospitalization and medical management costs, while second stage costs were more heavily comprised of operative costs.

In this cohort, inpatient costs for two-stage septic revision varied by joint and procedural stage. This study helps fill a gap in the literature by including shoulder PJI, which is less well characterized than hip and knee PJI. These findings may inform patient counseling and institutional planning for resource utilization.