Preoperative waiting time increased the risk of periprosthetic infection in patients with femoral neck fracture

Background and purpose Prosthetic joint infection (PJI) remains a devastating complication of arthroplasty. Today, most displaced femoral neck fractures in the elderly are treated with arthroplasty. We estimated the incidence of and risk factors for PJI in primary arthroplasty after femoral neck fracture.

Patients and methods Patients admitted for a femoral neck fracture in 2008 and 2009 were registered prospectively. We studied clinical, operative, and infection data in 184 consecutive patients.

Results 9% of the patients developed a PJI. Coagulase-negative staphylococci and Staphylococcus aureus were the most frequently isolated organisms. We found that preoperative waiting time was associated with PJI and also with urinary tract infection. The median preoperative waiting time was 37 (11–136) h in the infection group as opposed to 26 (4–133) h in the group with no infection (p = 0.04). The difference remained statistically significant after adjusted analysis. The success of treatment with debridement and retention of the prosthesis was limited, and 5 of the 17 patients with PJI ended up with a resection arthroplasty. The 1-year mortality rate was 21% in the patients with no infection, and it was 47% in the infection group (p = 0.03).

Interpretation We found a high incidence of PJI in this elderly population treated with arthroplasty after hip fracture, with possibly devastating outcome. The length of stay preoperatively increased the risk of developing PJI.