Risk factors for early infection following hemiarthroplasty in elderly patients with a femoral neck fracture
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Periprosthetic joint infections (PJI) after hemiarthroplasty for geriatric femoral neck fractures are a devastating complication that results in serious morbidity and increased mortality. Identifying risk factors associated with early infection after HA for hip fractures may offer an opportunity to address and prevent this complication in many patients. The aim of this study was to evaluate preoperative risk factors for early PJI after HA in hip fracture patients.
From January 2010 to December 2015, 312 femoral neck fractures (AO/OTA 31-B) in 305 patients were included in this single-center, retrospective study. PJI was defined according to the Centers for Disease Control (CDC) definition of deep incisional surgical site infection. Early infection referred to a postoperative period of 4 weeks. Binary univariable and multivariable regression analysis with backward elimination was applied to identify predictors of PJI.
Median age of all patients was 83.0 (IQR 76–89) years. We identified 16 (5.1%) early PJI which all required surgical revision. Median length of in-hospital stay (LOS) was 20.0 (IQR 10–36) days after PJI compared to 10.0 (8–15) days without deep wound infection. In-hospital mortality was 30.8 vs. 6.6%, respectively. Preoperative CRP levels (OR 1.009; 95% CI 1.002–1.018; p = 0.044), higher BMI (OR 1.092; 95% CI 1.002–1.189; p = 0.044) and prolonged surgery time (OR 1.013; 95% CI 1.000–1.025; p = 0.041) were independent risk factors for PJI. Excluding infection following major revision due to mechanical complications identified preoperative CRP levels (OR 1.012; 95% CI 1.003–1.021; p = 0.007) and chronic glucocorticoid therapy (OR 6.314; 95% CI 1.223–32.587; p = 0.028) as risk factors, a clear trend was seen for higher BMI (OR 1.114; 95% CI 1.000–1.242; p = 0.051). A cut-off value at CRP levels ≥ 14 mg/l demonstrated a sensitivity of 69% and a specificity of 70% with a fair accuracy (AUC 0.707).
Preoperative serum CRP levels, higher BMI and prolonged surgery time are independent predictors of early PJI. Excluding PJI secondary to major revision surgery revealed chronic glucocorticoid use as a risk factor apart from preoperative CRP levels.
KeywordsFemoral neck fracture Hip fracture CRP Periprosthetic joint infection Surgical site infection Hemiarthroplasty Obesity Glucocorticoids
Compliance with ethical standards
Conflict of interest
The authors declare that no competing interests exist.
- 2.Papadimitropoulos EA, Coyte PC, Josse RG, Greenwood CE. Current and projected rates of hip fracture in Canada. CMAJ. 1997;157:1357–63.Google Scholar
- 3.Bhandari M, Devereaux PJ, Tornetta P 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, Schemitsch EH, Hanson BP, Koval K, Dirschl D, Leece P, Keel M, Petrisor B, Heetveld M, Guyatt GH. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87:2122–30.CrossRefGoogle Scholar
- 7.Buchheit J, Uhring J, Sergent P, Puyraveau M, Leroy J, Garbuio P. Can preoperative CRP levels predict infections of bipolar hemiarthroplasty performed for femoral neck fracture? A retrospective, multicenter study. Eur J Orthop Surg Traumatol. 2015;25:117–21. https://doi.org/10.1007/s00590-014-1449-5.CrossRefGoogle Scholar
- 10.de Jong L, Klem TMAL, Kuijper TM, Roukema GR. Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur. Bone Joint J. 2017;99-B:1088–94. https://doi.org/10.1302/0301-620X.99B8.BJJ-2016-1119.R1.CrossRefGoogle Scholar
- 14.Dripps RD. New classification of physical status. Anesthesiology. 1963;24:111.Google Scholar
- 17.Sedlár M, Kudrnová Z, Erhart D, Trca S, Kvasnicka J, Krska Z, Mazoch J, Malíková I, Zeman M, Linhart A. Older age and type of surgery predict the early inflammatory response to hip trauma mediated by interleukin-6 (IL-6). Arch Gerontol Geriatr. 2010;51:e1–e6. https://doi.org/10.1016/j.archger.2009.06.006.CrossRefGoogle Scholar
- 19.Fakler JK, Grafe A, Dinger J, Josten C, Aust G. Perioperative risk factors in patients with a femoral neck fracture - influence of 25-hydroxyvitamin D and C-reactive protein on postoperative medical complications and 1-year mortality. BMC Musculoskelet Disord. 2016;17:51. https://doi.org/10.1186/s12891-016-0906-1.CrossRefGoogle Scholar
- 22.Yoshikane H, Yamamoto T, Ozaki M, Matsuzaki M. Clinical significance of high-sensitivity C-reactive protein in lifestyle-related disease and metabolic syndrome. J Cardiol 2007;50:175–82.Google Scholar
- 23.Smektala R, Hahn S, Schräder P, Bonnaire F, Schulze Raestrup U, Siebert H, Fischer B, Boy O. Medial hip neck fracture: influence of pre-operative delay on the quality of outcome. Results of data from the external in-hospital quality assurance within the framework of secondary data analysis. Unfallchirurg. 2010;113:287–92. https://doi.org/10.1007/s00113-009-1674-2.CrossRefGoogle Scholar
- 29.Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 2013;95-B:1450–52.Google Scholar
- 30.Lübbeke A, Zingg M, Vu D, Miozzari HH, Christofilopoulos P, Uçkay I, Harbarth S, Hoffmeyer P. Body mass and weight thresholds for increased prosthetic joint infection rates after primary total joint arthroplasty. Acta Orthop. 2016;87:132–8. https://doi.org/10.3109/17453674.2015.1126157.CrossRefGoogle Scholar
- 34.Schmitt JW, Benden C, Dora C, Werner CM. Is total hip arthroplasty safely performed in lung transplant patients? Current experience from a retrospective study of the Zurich lung transplant cohort. Patient Saf Surg. 2016;10:17. https://doi.org/10.1186/s13037-016-0105-x (eCollection 2016).CrossRefGoogle Scholar
- 35.Chrastil J, Anderson MB, Stevens V, Anand R, Peters CL, Pelt CE. Is hemoglobin A1c or perioperative hyperglycemia predictive of periprosthetic joint infection or death following primary total joint arthroplasty? J Arthroplasty. 2015;30:1197–202. https://doi.org/10.1016/j.arth.2015.01.040.CrossRefGoogle Scholar