Dirk Zajonz1,2, Julia Behrens3, Alexander Giselher Brand3, Andreas Höch3,4, Johannes K M Fakler3, Andreas Roth3,4, Christoph Josten3,4, Mohamed Ghanem3. 1. Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany. Dirk.zajonz@medizin.uni-leipzig.de. 2. ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstraße 14, 04103, Leipzig, Germany. Dirk.zajonz@medizin.uni-leipzig.de. 3. Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany. 4. ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstraße 14, 04103, Leipzig, Germany.
Abstract
BACKGROUND: Hemiarthroplasty is an established treatment for femoral neck fractures (FNF) in old age; however, approximately 20-30% of patients die within 1 year after surgery. Periprosthetic joint infections (PJI) are one of the severest complications and associated with a high mortality rate. In this retrospective study of aged patients with FNF treated with hemiarthroplasty, the incidence of PJI was evaluated with respect to the influence of the delay to and timing of surgical treatment. PATIENTS AND METHODS: The data of patients suffering from FNF and admitted to this hospital between January 2012 and December 2014 were evaluated. Demographic data, timing of surgery, intraoperative complications, PJI and other general complications, hospitalization time and mortality were recorded. RESULTS: In this study 178 patients were included in the follow-up (114 women and 64 men). The median age of the patients was 83 years (range 55-105 years). The rate of PJI was 3.9% (7/178) and mortality was 5.6% (10/178). Patients with PJI after hemiarthroplasty had a significantly longer hospital stay (17 vs. 10 days, p < 0.001) and a higher mortality (28% vs. 4.7%). No significant differences were found between the groups with respect to the time from admission to surgery. CONCLUSION: The occurrence of PJI after hip joint fractures treated with hemiarthroplasty in aged patients is associated with a significant increase in mortality. Risk factors include a longer surgery time, diabetes, intraoperative complications, postoperative bleeding and wound healing disorders. Surgical treatment within the first 24 h should be aimed for but not at the expense of adequate patient preparation or neglecting the patient's individual risk factors.
BACKGROUND: Hemiarthroplasty is an established treatment for femoral neck fractures (FNF) in old age; however, approximately 20-30% of patients die within 1 year after surgery. Periprosthetic joint infections (PJI) are one of the severest complications and associated with a high mortality rate. In this retrospective study of aged patients with FNF treated with hemiarthroplasty, the incidence of PJI was evaluated with respect to the influence of the delay to and timing of surgical treatment. PATIENTS AND METHODS: The data of patients suffering from FNF and admitted to this hospital between January 2012 and December 2014 were evaluated. Demographic data, timing of surgery, intraoperative complications, PJI and other general complications, hospitalization time and mortality were recorded. RESULTS: In this study 178 patients were included in the follow-up (114 women and 64 men). The median age of the patients was 83 years (range 55-105 years). The rate of PJI was 3.9% (7/178) and mortality was 5.6% (10/178). Patients with PJI after hemiarthroplasty had a significantly longer hospital stay (17 vs. 10 days, p < 0.001) and a higher mortality (28% vs. 4.7%). No significant differences were found between the groups with respect to the time from admission to surgery. CONCLUSION: The occurrence of PJI after hip joint fractures treated with hemiarthroplasty in aged patients is associated with a significant increase in mortality. Risk factors include a longer surgery time, diabetes, intraoperative complications, postoperative bleeding and wound healing disorders. Surgical treatment within the first 24 h should be aimed for but not at the expense of adequate patient preparation or neglecting the patient's individual risk factors.