Timing of hip hemiarthroplasty and the influence on prosthetic joint infection

Abstract

Introduction Previous research suggested that patients have increased risk of infection with increased time from presentation with a femoral neck fracture to treatment with a hip hemiarthroplasty (HHA). The purpose of this study was to determine if rates of prosthetic joint infections within 3 months of surgery was affected by the time from patient presentation with a femoral neck fracture to the time of treatment with HHA. Materials and methods Acute hip fractures treated with HHA between 2005 and 2017 at three centres in Norway were enrolled in the study. Multi-trauma patients were excluded. Univariable analysis was performed to determine any significant effect of pre-operative waiting time on infection rate. Two pre-planned analyses dichotomizing pre-operative waiting time cutoffs were performed. Results There were 2300 patients with an average age of 82 (range, 48-100) years included of which 3.4% experienced a prosthetic joint infection within 3 months. The primary analysis found no significant difference in infection rate depending on time to surgery (OR = 1.06 (95% CI 0.94-1.20, p = 0.33)). The secondary analyses showed no significant differences in infection rates when comparing pre-operative waiting time of <24 hours vs �24 hours (OR = 0.92 (95% CI 0.58-1.46, p = 0.73)) and <48 hours vs �48 hours (OR = 1.39 (95% CI 0.81-2.38, p = 0.23)). Conclusion Based off of a large retrospective Norwegian database of hip fractures there did not appear to be a significant difference in infection rate based on pre-operative wait time to surgery.

Modes of failure of hip hemiarthroplasty for femoral neck fracture

“…1 , 9 , 14 – 16 Varied factors may contribute to increased complications and reoperation, including patient comorbidities, such as congestive heart failure and alcohol abuse; surgical technique; implant type; and fixation method, 3 , 9 , 14 , 16 – 22 whereas surgeon experience, operative volume and timing of surgery may or may not contribute to the frequency of complications and reoperation. 23 , 24 Although most hemiarthroplasties in the present study were uncemented unipolar and modular, variation of implant type has been reported, such as the common use of unipolar monoblock or modular stems in Australia 14 and bipolar stems in Norway, 25 with cemented fixation commonly used in Norway and the United Kingdom. 1 , 2 , 22 , 25 …”

“…implant type; and fixation method, 3,9,14,[16][17][18][19][20][21][22] whereas surgeon experience, operative volume and timing of surgery may or may not contribute to the frequency of complications and reoperation. 23,24 Although most hemiarthroplasties in the present study were uncemented unipolar and modular, variation of implant type has been reported, such as the common use of unipolar monoblock or modular stems in Australia 14 and bipolar stems in Norway, 25 with cemented fixation commonly used in Norway and the United Kingdom. 1,2,22,25 In our study, the most frequent cause of hemiarthroplasty failure necessitating additional operative (closed or open) procedures included periprosthetic femur fracture, dislocation, acetabular wear and infection.…”

Accuracy and agreement of national spine register data for 474 patients compared to corresponding electronic patient records

“…They found prevalence on the same level as we did in EPR, which supports our conclusion that comorbidity was underreported in NORspine. Moreover, previous studies have found low accuracy for orthopedic surgeons performing coding of diagnoses and indications for surgery, assessing cognitive function, and registering antibiotic use [23][24][25]. The discrepancy in the recorded prevalence of depression and anxiety in NORspine vs. EPRs may indicate that spine surgeons are not sufficiently aware of patients' mental health and how mental health may influence the clinical results (PROMs) after spinal surgery.…”

Management of Periprosthetic Joint Infections After Hemiarthroplasty of the Hip

“…Surgery-related factors associated with PJI after hip HA include both prolonged operative time (>90 minutes) and short operative time (<60 minutes) 48,49,53,54 , as well as inadequate preoperative antibiotic prophylaxis 48 . Whether surgeon experience and volume, or the delay between the admission to the hospital following hip fracture and the surgery, have an association with increased risk of PJI remains unclear 54-57 .…”