The Socioeconomic Impact of Musculoskeletal Infections

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Abstract
Musculoskeletal disorders are a leading cause of severe chronic pain and physical disability for millions of people around the globe. It is anticipated that their prevalence will increase dramatically in the future because of extended life expectancies and lifestyle changes toward more mobility and recreation1. Epidemiologic studies have linked population aging with future increases in the prevalence of age-related musculoskeletal conditions, such as fragility fractures and osteoarthritis2-8. The number of primary and revision total hip and total knee arthroplasties has increased steadily between 1990 and 2002, and these numbers are anticipated to further escalate over the next two decades9,10. The rate of deep infection following total hip arthroplasty and total knee arthroplasty has been reported to range between 1% and 4%11, and the rate of deep infection as a reason for revision is projected to increase at a faster rate for total knee arthroplasty than for total hip arthroplasty. Kurtz et al. used the U.S. Nationwide Inpatient Sample (1990-2003) to demonstrate that the number of infections after revision total hip arthroplasty is projected to increase from 3400 in 2005 to 46,000 in 2030, while infections after revision total knee arthroplasty are projected to increase from 6400 in 2005 to 175,500 in 203012. Infections with resistant pathogens, such as the community-acquired and the health-care-acquired methicillin-resistant Staphylococcus aureus, have become increasingly common over the past two decades13. Soft-tissue infections such as cellulitis, abscesses, and pyomyositis from community-acquired methicillin-resistant Staphylococcus aureus occur with increasing frequency in athletes, especially in those engaged in team sports14-16. Health-care-acquired methicillin-resistant Staphylococcus aureus generally affects acutely and chronically ill patients with central lines, indwelling catheters, and internal fixation devices, causing septic arthritis, osteomyelitis, and bacteremia17. In …

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