Femoral neck fractures in old age treated with hemiarthroplasty : Effects of preoperative waiting time and timing of surgery on the risk of periprosthetic infections.

Abstract

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 ahigh 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. 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. In this study 178 patients were included in the follow-up (114women and 64men). The median age of the patients was 83years (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 asignificantly longer hospital stay (17 vs. 10days, p < 0.001) and ahigher mortality (28% vs. 4.7%). No significant differences were found between the groups with respect to the time from admission to surgery. The occurrence of PJI after hip joint fractures treated with hemiarthroplasty in aged patients is associated with asignificant increase in mortality. Risk factors include alonger 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.