JBJI Journal of Bone and Joint Infection JBJI J. Bone Joint Infect. 2206-3552 Ivyspring Göttingen, Germany 10.7150/jbji.23952 Prosthesis retention after an infected hip prosthesis: hip fractures versus primary total hip prosthesis, data from 1998 - 2015 de Lieke M.A. 1 Neve William C. 1 Steens Jeroen 1 Westfriesgasthuis, Department of Orthopaedic surgery, Maelsonstraat 3, 1624 NP Hoorn, The Netherlands. 10 06 2018 3 3 118 122 Copyright: © 2018 Lieke M.A. de et al. 2018 This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/ This article is available from https://jbji.copernicus.org/articles/3/118/2018/jbji-3-118-2018.html The full text article is available as a PDF file from https://jbji.copernicus.org/articles/3/118/2018/jbji-3-118-2018.pdf

<p class="p p-first" id="__p2"><strong>Background</strong>: A prosthetic joint infection (PJI) is a serious complication and specifically a burden for patients after hip fracture surgery, as they are mostly frail elderly patients with multiple comorbidities. Since treatment protocols are lacking there is a need to evaluate current practice.</p><p id="__p3"><strong>Aim:</strong> To evaluate the difference in prosthesis retention after an infected primary total hip replacement (THR) compared to PJI after hip prosthesis surgery performed for a hip fracture.</p><p id="__p4"><strong>Methods:</strong> We retrospectively collected data of patients who developed PJI after primary THR or after hip fracture surgery (THR or hemiarthroplasty) in the Westfriesgasthuis Hospital between 1998 and 2015. Main outcome variables were DAIR treatment and prosthesis retention.</p><p id="__p5"><strong>Findings:</strong> A PJI developed in 48 patients after primary THR and in 23 patients after hip fracture surgery. DAIR was performed in all patients after primary THR and in 87.0% of patients after hip fracture surgery (p&lt;0.05). In 11.4% of patients after primary THR, revision surgery was performed within 1 year after PJI compared to 34.8% after hip fracture surgery (p&lt;0.05). Only 2.1% of patients deceased within 1 year after infection of primary THR compared to 34.8% after hip fracture surgery (p&lt;0.05).</p><p class="p p-last" id="__p6"><strong>Conclusion:</strong> Our results showed that prosthesis retention in patients with a PJI after hip fracture surgery is 23% lower than in patients with a PJI after primary THR. This is probably due to the fact that patients who experience a hip fracture are mostly frail elderly with multiple comorbidities and therefore less able to conquer a PJI.</p>

 References Bergkvist M, Mukka SS, Johansson L, Ahl TE, Sayed-Noor AS, Sköldenberg OG. et al. Debridement, antibiotics and implant retention in early periprosthetic joint infection. Hip Int. 2016;26:138–143. Blomfeldt R, Kasina P, Ottosson C, Enocson A, Lapidus LJ. Prosthetic joint infection following hip fracture and degenerative hip disorder: a cohort study of three thousand, eight hundred and seven consecutive hip arthroplasties with a minimum follow-up of five years. Int Orthop. 2015;39:2091–2096. Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S. et al. Complications of hip fractures: a review. World J Orthop. 2014;5:402–411. [PMC free article] De Vries L, van der Weegen W, Neve WC, Das H, Ridwan BU, Steens J. The effectiveness of debridement, antibiotics and irrigation for periprosthetic joint infections after hip and knee arthroplasty. A 15 years retrospective study in two community hospitals in the Netherlands. J Bone Jt Infect. 2016;1:20–24. [PMC free article] del Toro MD, Nieto I, Guerrero F, Corzo J, del Arco A, Palomino J. et al. Are hip hemiarthroplasty and total hip arthroplasty infections different entities? The importance of hip fractures. Eur J Clin Microbiol Infect Dis. 2014;33:1439–1448. Duckworth AD, Philips SA, Stone O, Moran M, Breusch SJ, Biant LC. Deep infection after hip fracture surgery: predictors of early mortality. Injury. 2012;43:1182–1186. Gallardo-Calero I, Larrainzar-Coghen T, Rodriquez-Pardo D, Pigrau C, Sánchez-Raya J, Amat C. et al. Increased infection risk after hip hemiarthroplasty in institutionalized patients with proximal femur fracture. Injury. 2016;47:872–876. Guren E, Figved W, Frihagen F, Watne LO, Westberg M. Prosthetic joint infection - a devastating complication of hemiarthroplasty for hip fracture. Acta Orthop. 2017;88:383–389. [PMC free article] Kazimoglu C, Yalcin N, Onvural B, Akcay S, Agus H. Debridement, antibiotics, irrigation, and retention (DAIR) of the prosthesis after hip hemiarthroplasty infections. Does it work? Int J Artif Organs. 2015;38:454–460. Lora-Tamayo J, Euba G, Ribera A, Murillo O, Pedrero S, García-Somoza D. et al. Infected hip hemiarthroplasties and total hip arthroplasties: Differential findings and prognosis. J Infect. 2013;67:536–544. Mellner C, Eisler T, Knutsson B, Mukka S. Early periprosthetic joint infection and debridement, antibiotics and implant retention in arthroplasty for femoral neck fracture. Hip Int. 2017;27:349–353. Nijland LMG, Karres J, Simons AE, Ultee JM, Kerkhoffs GMMJ, Vrouenraets BC. The weekend effect for hip fracture surgery. Injury. 2017;48:1536–1541. PREZIES, PREventie van ZIEkenhuisinfecties door Surveillance. http://www.rivm.nl/Onderwerpen/P/PREZIES/Incidentieonderzoek_POWI/Definities. Accessed July; 2017. [Google Scholar] Noailles T, Brulefert K, Chalopin A, Longis PM, Gouin F. What are the risk factors for post-operative infection after hip hemiarthroplasty? Systematic review of literature. Int Orthop. 2016;40:1843–1848. Partridge JS, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing. 2012;41:142–147. Parvizi J, Gehrke T. Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection. First ed. Maryland, United States: Data Trace Publishing Company; 2013. [Google Scholar] Stambough JB, Nam D, Warren DK, Keeney JA, Clohisy JC, Barrack RL. et al. Decreased hospital costs and surgical site infection incidence with a universal decolonization protocol in primary total joint arthroplasty. J Arthroplasty. 2017;32:728–734. Weiser MC, Moucha CS. The current state of screening and decolonization for the prevention of staphylococcus aureus surgical site infection after total hip and knee arthroplasty. J Bone Joint Surg Am. 2015;97:1449–1458. Westberg M, Snorrason F, Frihagen F. Preoperative waiting time increased the risk of periprosthetic infection in patients with femoral neck fracture. Acta Orthop. 2013;84:124–129. [PMC free article] Yoon RS, Mahure SA, Hutzler LH, Iorio R, Bosco JA. Hip arthroplasty for fracture vs elective care: one bundle does not fit all. J Arthroplasty. 2017;32:2353–2358.