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Femoral neck fractures in old age treated with hemiarthroplasty

Effects of preoperative waiting time and timing of surgery on the risk of periprosthetic infections

Hemiarthroplastik bei Oberschenkelhalsbruch im hohen Alter

Auswirkung der präoperativen Wartezeit und des Operationszeitpunkts auf das Risiko periprothetischer Infektionen

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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.

Zusammenfassung

Hintergrund

Die Hemiarthroplastik ist eine etablierte Behandlungsmethode bei einem Oberschenkelhalsbruch (Schenkelhalsfraktur, SHF) im hohen Alter, jedoch versterben 20–30 % der Patienten innerhalb eines Jahres nach der Operation. Periprothetische Gelenkinfektionen (PGI) stellen eine der schwersten Komplikationen dar und sind mit einer hohen Mortalitätsrate assoziiert. In dieser retrospektiven Studie zu Patienten fortgeschrittenen Alters mit SFH, die mit einer Hemiarthroplastik versorgt wurden, wurde die Inzidenz einer PGI hinsichtlich des Einflusses der Verzögerung der operativen Versorgung sowie des Operationszeitpunkts evaluiert.

Patienten und Methoden

Die Daten von Patienten mit SHF, die diesem Krankenhaus zwischen Januar 2012 und Dezember 2014 zugewiesenen worden waren, wurden ausgewertet. Demographische Daten, Operationszeitpunkt, intraoperative Komplikationen, PGI und andere allgemeine Komplikationen, Hospitalisationsdauer und Mortalität wurden erfasst.

Ergebnisse

In diese Studie wurden 178 Patienten in das Follow-up eingeschlossen (114 Frauen und 64 Männer). Das mittlere Alter der Patienten betrug 83 Jahre (Range: 55–105 Jahre). Die PGI-Rate lag bei 3,9 % (7/178), und die Mortalität bei 5,6 % (10/178). Patienten mit PGI nach Hemiarthroplastik hatten einen signifikant längeren Krankenhausaufenthalt (17 vs. 10 Tage; p < 0,001) und eine höhere Mortalitätsrate (28 % vs. 4,7 %). Es wurde keine signifikanten Unterschiede zwischen den Gruppen hinsichtlich der Zeit von der Einweisung bis zur Operation festgestellt.

Schlussfolgerung

Das Auftreten einer PGI nach Hüftgelenkfrakturen bei älteren Patienten, die mit einer Hemiarthroplastik versorgt wurden, ist mit einer signifikant höheren Mortalität assoziiert. Risikofaktoren sind eine längere Operationszeit, Diabetes, intraoperative Komplikationen, postoperative Blutungen und Wundheilungsstörungen. Eine operative Versorgung innerhalb der ersten 24 h sollte angestrebt werden, allerdings nicht auf Kosten einer adäquaten Vorbereitung des Patienten und unter Beachtung der individuellen Risikofaktoren.

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Abbreviations

AWMF:

Association of the Scientific Medical Societies of Germany

CI:

Confidence interval

DGU:

German Society of Trauma Surgery

FNF:

Femoral neck fractures

ICMPJI:

International consensus meeting on periprosthetic joint infection

ÖGU:

Austrian Society of Trauma Surgery

PJI:

Periprosthetic joint infections

RR:

Relative risk

SOP:

Standard operating procedures

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Acknowledgements

The authors thank the participating patients and the clinicians in the research network of the University of Leipzig.

Author contributions

C. Josten and A. Roth initiated the work. J. Behrens performed the data analysis. D. Zajonz and J. Behrens wrote the manuscript. A. G. Brand and A. Höch were significantly involved in the production of the figures and tables as well as the statistical analysis. D. Zajonz contributed to designing the statistical analysis. All authors were involved in the design of the study, interpretation of data, revision of the manuscript and all read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany

    Dirk Zajonz, Julia Behrens, Alexander Giselher Brand, Andreas Höch, Johannes K. M. Fakler, Andreas Roth, Christoph Josten & Mohamed Ghanem

  2. ZESBO – Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstraße 14, 04103, Leipzig, Germany

    Dirk Zajonz, Andreas Höch, Andreas Roth & Christoph Josten

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  1. Dirk Zajonz
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Correspondence to Dirk Zajonz.

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Conflict of interest

D. Zajonz, J. Behrens, A.G. Brand, A. Höch, J.K. M. Fakler, A. Roth, C. Josten and M. Ghanem declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors. All procedures reported in this article were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All participants gave written, informed consent within the scope of the treatment contract. The study was approved by the university ethics committee (number: 171-16/ek25042016).

Additional information

The authors D. Zajonz and J. Behrens contributed equally to the manuscript.

M. Ghanem and C. Josten are joint senior authors.

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The data and material are stored in the archive of the University of Leipzig within the framework of the legal provisions (data protection). They are available from the corresponding author on reasonable request.

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Zajonz, D., Behrens, J., Brand, A.G. et al. Femoral neck fractures in old age treated with hemiarthroplasty. Orthopäde 48, 224–231 (2019). https://doi.org/10.1007/s00132-018-03664-8

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