title: Prosthetic joint infection-a devastating complication of hemiarthroplasty for hip fracture.
abstract: Background and purpose - Hemiarthroplasty is the most common treatment in elderly patients with displaced femoral neck fracture. Prosthetic joint infection (PJI) is a feared complication. The infection rate varies in the literature, and there are limited descriptive data available. We investigated the characteristics and outcome of PJI following hemiarthroplasty over a 15-year period. Patients and methods - Patients with PJI were identified among 519 patients treated with hemiarthroplasty for a femoral neck fracture at Oslo University Hospital between 1998 and 2012. We used prospectively registered data from previous studies, and recorded additional data from the patients' charts when needed. Results - Of the 519 patients, we identified 37 patients (6%) with early PJI. 20 of these 37 patients became free of infection. Soft tissue debridement and retention of implant was performed in 35 patients, 15 of whom became free of infection with an intact arthroplasty. The 1-year mortality rate was 15/37. We found an association between 1-year mortality and treatment failure (p = 0.001). Staphylococcus aureus and polymicrobial infection were the most common microbiological findings, each accounting for 14 of the 37 infections. Enterococcus spp. was found in 9 infections, 8 of which were polymicrobial. There was an association between polymicrobial infection and treatment failure, and between polymicrobial infection and 1-year mortality. Interpretation - PJI following hemiarthroplasty due to femoral neck fracture is a devastating complication in the elderly. We found a high rate of polymicrobial PJIs frequently including Enterococcus spp, which is different from what is common in PJI after elective total hip arthroplasty.
authors.affiliation: a Faculty of Medicine , University of Oslo.
authors.forename: Ellen
authors.initials: E
authors.lastname: Guren
authors.affiliation: b Orthopaedic Department , Bærum Hospital, Vestre Viken Hospital Trust.
authors.forename: Wender
authors.initials: W
authors.lastname: Figved
authors.affiliation: c Division of Orthopaedic Surgery , Oslo University Hospital.
authors.forename: Frede
authors.initials: F
authors.lastname: Frihagen
authors.affiliation: d Geriatrics Department , Oslo University Hospital , Oslo , Norway.
authors.forename: Leiv Otto
authors.initials: LO
authors.lastname: Watne
authors.affiliation: c Division of Orthopaedic Surgery , Oslo University Hospital.
authors.forename: Marianne
authors.initials: M
authors.lastname: Westberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D016983:Enterococcus; D005260:Female; D062785:Hemiarthroplasty / Q000009:adverse effects*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents