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Are hip hemiarthroplasty and total hip arthroplasty infections different entities? The importance of hip fractures

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Abstract

Hip hemiarthroplasty (HHA) and total hip arthroplasty (THA) infections are usually considered as one entity; however, they may show important differences. We analyze these differences, as well as predictors of treatment failure (TF) and poor functional status among patients with prosthetic hip infections (PHIs). A multicenter cohort study of consecutive patients with PHIs was performed. The main outcome variable was TF after the first surgical treatment performed to treat the infection. Multivariate analysis was used to identify predictors of TF. A total of 127 patients with PHI were included (43 HHA, 84 THA). Patients with HHA infections were more frequently women (88 % vs. 54 %; p < 0.001), had comorbidities (86 % vs. 67 %, p = 0.02), and were older (median age 79 vs. 65 years, p < 0.001), and the reason for arthroplasty was more frequently a fracture (100 % vs. 18 %, p < 0.001). Failure of initial treatment and crude mortality were more frequent among HHA patients (44 % vs. 23 %, p = 0.01 and 28 % vs. 7 %, p = 0.001, respectively). However, HHA was not associated with TF in the multivariate analysis when hip fracture was considered; thus, variables independently associated with TF were hip fracture, inadequate surgical management, prosthesis retention, and higher C-reactive protein level. Failure of the first surgical treatment was associated with poorer functional status. HHA and THA infections showed significant differences in epidemiology, clinical features, and outcome. Although patients with HHA infections had a higher risk of TF, this was related to the reason for hip implant: a hip fracture. Success of the initial management of infection is a predictor of better clinical and functional outcome.

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Acknowledgments

This study was funded by the Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III—co-financed by the European Development Regional Fund “A way to achieve Europe” ERDF, Spanish Network for the Research in Infectious Diseases (REIPI; RD12/0015), and by Consejería de Salud, Junta de Andalucia (grant PI0454-2012). We would like to thank the Sociedad Andaluza de Enfermedades Infecciosas (SAEI) for supporting the study.

Conflict of interest

The authors declare no conflicts of interest for this article.

Author information

Author notes

  1. P. Martín-Rico

    Present address: Hospital de Denia, Alicante, Spain

Authors and Affiliations

  1. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani 3, 41009, Sevilla, Spain

    M. D. del Toro, M. Á. Muniain & J. Rodríguez-Baño

  2. Unidad Clínica de Traumatología y Cirugía Ortopédica, Hospital Universitario Virgen Macarena, 41009, Sevilla, Spain

    I. Nieto

  3. Servicio de Medicina Interna, Hospital Universitario Puerta del Mar, 11009, Cádiz, Spain

    F. Guerrero

  4. Unidad Clínica de Enfermedades Infecciosas, Hospital de Valme, 41014, Sevilla, Spain

    J. Corzo

  5. Unidad Clínica de Enfermedades Infecciosas, Hospital Costa del Sol, 29603, Marbella, Málaga, Spain

    A. del Arco

  6. Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, 41013, Sevilla, Spain

    J. Palomino

  7. Unidad Clínica de Enfermedades Infecciosas, Hospital Virgen de la Victoria, 29010, Málaga, Spain

    E. Nuño

  8. Unidad Clínica de Enfermedades Infecciosas, Hospital Juan Ramón Jiménez, 21005, Huelva, Spain

    J. M. Lomas

  9. Unidad Clínica de Enfermedades Infecciosas, Hospital Reina Sofía, 14004, Córdoba, Spain

    C. Natera

  10. Unidad Clínica de Enfermedades Infecciosas, Hospital Infanta Elena, 21080, Huelva, Spain

    J. M. Fajardo

  11. Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, 41930, Bormujos, Sevilla, Spain

    J. Delgado

  12. Unidad Clínica de Enfermedades Infecciosas, Hospital Punta de Europa, 11207, Algeciras, Cádiz, Spain

    M. Torres-Tortosa

  13. Unidad Clínica de Enfermedades Infecciosas, Hospital de Puerto Real, 11510, Puerto Real, Cádiz, Spain

    A. Romero

  14. Unidad Clínica de Enfermedades Infecciosas, Hospital Carlos Haya, 29010, Málaga, Spain

    P. Martín-Rico

  15. Departamento de Medicina, Universidad de Sevilla, 41009, Sevilla, Spain

    M. D. del Toro, M. Á. Muniain & J. Rodríguez-Baño

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  1. M. D. del Toro
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  2. I. Nieto
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  3. F. Guerrero
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  14. P. Martín-Rico
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  15. M. Á. Muniain
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for the PJIG-SAEI/REIPI group

Corresponding authors

Correspondence to M. D. del Toro or J. Rodríguez-Baño.

Additional information

PJIG-SAEI: Prosthetic Joint Infection Group of Andalusian Society of Infectious Diseases. REIPI: Spanish Network for Research in Infectious Diseases.

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del Toro, M.D., Nieto, I., Guerrero, F. et al. Are hip hemiarthroplasty and total hip arthroplasty infections different entities? The importance of hip fractures. Eur J Clin Microbiol Infect Dis 33, 1439–1448 (2014). https://doi.org/10.1007/s10096-014-2091-1

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  • DOI: https://doi.org/10.1007/s10096-014-2091-1

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