gms | German Medical Science

Objectives: Most femoral neck fractures (FNF) in the elderly population are treated with hemiarthroplasty. As a result of the higher average age, approximately 20 to 30% of the patients treated with endoprosthesis after FNF, die within the first year after surgical treatment. Prosthetic joint infection (PJI) is one of the severest complications of posttraumatic hemiarthroplasty and associated with a high mortality rate. Some authors postulate a risk for PJI in delayed operations regarding to the preoperative waiting time followed by hospital admission.

In this retrospective study, the incidence of PJI in elderly patients with FNF, treated with hemiarthroplasty, was evaluated to determine the influence of the time previous to surgical treatment also considering the approximate time until admission.

Methods: We evaluated the data of 180 patients suffering from a FNF, between January 2012 and December 2014. Age, sex, fracture classification, time to operative care (including and excluding the time prior to admission), time of surgery, duration of surgery, intraoperative complications, secondary diagnoses as well as anticoagulative medication were registered to further assess the outcome. Periprosthetic infections, general complications, revisions, postoperative bleedings, wound healing problems, nosocomial infections, hospitalization time, resumption to hospital and mortality were recorded.

Results and conclusion: 178 patients were included in the follow-up (134 women and 64 men). The median age of the patients was 83 years (55 to 105 years). The rate of PJI accounted for 3.9% (7/178). Mortality during the study period occurred to be 5.6% (10/178). Patients with early prosthesis infections after hemiarthroplasty had a significantly prolonged hospital stay (17 vs. 10 days, p <0.001) and a higher mortality rate (28% vs. 4.7%). The evaluation of the time after hospital admission and preceding the operative supply,revealed no significant differences among these groups. Furthermore, no significance was determined when analyzing the time of day, the surgical treatment was performed.

The occurrence of a periprosthetic infection after a hip joint fracture treated with hemiarthroplasty in elderly patients is associated with a significant increase in mortality. Risk factors include a longer surgery time, diabetes, intraoperative complications, postoperative bleeding or wound healing disorders (Table 1 [Tab. 1]). Early surgical treatment within the first 24 hours should be aimed for, but not at the expense of adequate patient preparation and also not by neglecting the patient's individual risk factors. The time of the intervention appears in our study to be insignificant.