Are hip hemiarthroplasty and total hip arthroplasty infections different entities? The importance of hip fractures

Abstract

Hip hemiarthroplasty (HHA) and total hip arthroplasty (THA) infections are usually considered as one entity; however, they may show important differences. We analyze these differences, as well as predictors of treatment failure (TF) and poor functional status among patients with prosthetic hip infections (PHIs). A multicenter cohort study of consecutive patients with PHIs was performed. The main outcome variable was TF after the first surgical treatment performed to treat the infection. Multivariate analysis was used to identify predictors of TF. A total of 127 patients with PHI were included (43 HHA, 84 THA). Patients with HHA infections were more frequently women (88% vs. 54%; p < 0.001), had comorbidities (86% vs. 67%, p = 0.02), and were older (median age 79 vs. 65 years, p < 0.001), and the reason for arthroplasty was more frequently a fracture (100% vs. 18%, p < 0.001). Failure of initial treatment and crude mortality were more frequent among HHA patients (44% vs. 23%, p = 0.01 and 28% vs. 7%, p = 0.001, respectively). However, HHA was not associated with TF in the multivariate analysis when hip fracture was considered; thus, variables independently associated with TF were hip fracture, inadequate surgical management, prosthesis retention, and higher C-reactive protein level. Failure of the first surgical treatment was associated with poorer functional status. HHA and THA infections showed significant differences in epidemiology, clinical features, and outcome. Although patients with HHA infections had a higher risk of TF, this was related to the reason for hip implant: a hip fracture. Success of the initial management of infection is a predictor of better clinical and functional outcome.

Early Peri-Prosthetic Joint Infection after Hemiarthroplasty for Hip Fracture: Outcomes of Debridement, Antibiotics, and Implant Retention

“…Kazimoglu et al [34] reported a DAIR treatment success rate of 41% in a multicenter retrospective study of 39 patients, and similarly, Guren et al [10] reported a success rate of 43% in a singlecenter retrospective study of 35 patients. Additionally, studies have reported increased failure rates arthroplasty for hip fracture compared with elective arthroplasty; Bergkvist et al [21] reported 35% increased failure rate, De Vries et al [35], 23%, and Del Toro et al [36], 21%. These results further support the concern that because of different host characteristics, evidence supporting the use of DAIR in elective arthroplasty cannot be extrapolated to apply to hip fracture patients.…”

Prosthetic joint infection—a devastating complication of hemiarthroplasty for hip fracture

“…Similar results have also been reported by others (44%) (del Toro et al. 2014). Studies conducted on patients with PJI following elective primary THA have shown better results (65–75%) (Tsukayama et al.…”

“…2012, del Toro et al. 2014). In PJI after hemiarthroplasty, however, a lower success rate has been reported (44%) (del Toro et al.…”

Prosthesis retention after an infected hip prosthesis: hip fractures versus primary total hip prosthesis, data from 1998 - 2015

“…The results showed that prosthesis survival was significantly lower after PJI in hip fracture patients compared to primary THR (65.2% vs 89.6% respectively). This could be explained by the fact that patients with a hip fracture are mostly frail elderly with multiple comorbidities and therefore less capable of recovering from a PJI 5 , 20 . This also resulted in higher mortality rates in this fragile patient group (34.8% after hip fracture surgery vs 2.1% after primary THR) as mentioned in other studies 6 , 12 , 19 .…”

“…Nevertheless, this consensus meeting was limited to primary hip and knee arthroplasty. Treatment protocols regarding PJI after hip fracture surgery are lacking, though there is a clear difference with patients after primary total hip replacement (THR): they have different baseline features due to the acute character of a hip fracture compared to the elective procedure for THR, like advanced age and comorbidities but also the acute stress and inflammatory states resulting from the fracture 5 , 10 . PJIs after hip fracture surgery are mostly early post-surgical, while among primary THR the percentage of late-chronic infections is higher (higher proportion of haematogenous infections) 10 .…”