Infection after intracapsular femoral neck fracture – does antibiotic-loaded bone cement reduce infection risk after hemiarthroplasty and total hip arthroplasty?

Szymski, Dominik; Walter, Nike; Krull, Paula; Melsheimer, Oliver; Grimberg, Alexander; Alt, Volker; Steinbrueck, Arnd; Rupp, Markus

doi:10.1302/2046-3758.125.bjr-2022-0314.r1

Cited by 9 publications

(4 citation statements)

References 41 publications

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“…The registry includes crossvalidated insurance data to mitigate this limitation. However, the history of the registry currently prohibits follow-up beyond 7 years, although evidence suggests that most septic failures occur within this timeframe [27]. The calculation of the Elixhauser score used comorbidities coded at the time of initial hospitalization, which are potential confounders if coded incorrectly or inadequately.…”

Section: Limitationsmentioning

confidence: 99%

Low implantation volume, comorbidities, male sex and implantation of constrained TKA identified as risk factors for septic revision in knee arthroplasty: A register‐based study from the German Arthroplasty Registry

Szymski,

Walter,

Straub

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposePeriprosthetic joint infection (PJI) is a major cause of revision surgery after total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA). Patient‐ and hospital‐related risk factors need to be assessed to prevent PJI. This study identifies influential factors and differences in infection rates between different implant types.MethodsData were obtained from the German Arthroplasty Registry. Septic revisions were calculated using Kaplan–Meier estimates with septic revision surgery as the primary endpoint. Patients with constrained and unconstrained TKA or UKA were analysed using Holm's multiple log‐rank test and Cox's proportional hazards ratio. The 300,998 cases of knee arthroplasty analysed included 254,144 (84.4%) unconstrained TKA, 9993 (3.3%) constrained TKA and 36,861 (12.3%) UKA with a maximum follow‐up of 7 years.ResultsAt 1 year, the PJI rate was 0.5% for UKA and 2.8% for TKA, whereas at 7 years, the PJI rate was 4.5% for UKA and 0.9% for TKA (p < 0.0001). The PJI rate significantly increased for constrained TKA compared to unconstrained TKA (p < 0.0001). The PJI rate was 2.0% for constrained TKA and 0.8% for unconstrained TKA at 1 year and 3.1% and 1.4% at 7 years. Implantation of a constrained TKA (hazard ratio [HR] = 2.55), male sex (HR = 1.84), increased Elixhauser score (HR = 1.18–1.56) and implant volume of less than 25 UKA per year (HR = 2.15) were identified as risk factors for revision surgery; an Elixhauser score of 0 (HR = 0.80) was found to be a preventive factor.ConclusionsReduced implant volume and constrained knee arthroplasty are associated with a higher risk of PJI. Comorbidities (elevated Elixhauser score), male sex and low UKA implant volume have been identified as risk factors for PJI. Patients who meet these criteria require specific measures to prevent infection. Further research is required on the potential impact of prevention and risk factor modification.Level of EvidenceLevel III.

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Section: Limitationsmentioning

confidence: 99%

Low implantation volume, comorbidities, male sex and implantation of constrained TKA identified as risk factors for septic revision in knee arthroplasty: A register‐based study from the German Arthroplasty Registry

Szymski,

Walter,

Straub

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…A study from Germany aimed to compare the risk of infection in cemented and uncemented hemiarthroplasty (HA) and total hip arthroplasty (THA) following femoral neck fracture. 6 The researchers used a robust methodology to assess outcomes using a data set However, in the subpopulation of HA (which is naturally a more frail and comorbid population), the infection rate after one year was 1.9% for cemented HA and 2.8% for uncemented HA.…”

Section: To Cement or Not To Cement? The Best Approach In Hemiarthrop...mentioning

confidence: 99%

“…A study from Germany aimed to compare the risk of infection in cemented and uncemented hemiarthroplasty (HA) and total hip arthroplasty (THA) following femoral neck fracture. 6 The researchers used a robust methodology to assess outcomes using a data set from the German Arthroplasty Registry (EPRD), and employed Mahalanobis distance matching to pair patients based on age, sex, BMI, and the Elixhauser Comorbidity Index (ECI). Their analysis included 13,612 cases of intracapsular femoral neck fracture, consisting of 9,110 HAs (66.9%) and 4,502 THAs (33.1%).…”

Section: To Cement or Not To Cement? The Best Approach In Hemiarthrop...mentioning

confidence: 99%

Hip & Pelvis

2023

Bone &Amp; Joint 360

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The August 2023 Hip & Pelvis Roundup360 looks at: Using machine learning to predict venous thromboembolism and major bleeding events following total joint arthroplasty; Antibiotic length in revision total hip arthroplasty; Preoperative colonization and worse outcomes; Short stem cemented total hip arthroplasty; What are the outcomes of one- versus two-stage revisions in the UK?; To cement or not to cement? The best approach in hemiarthroplasty; Similar re-revisions in cemented and cementless femoral revisions for periprosthetic femoral fractures in total hip arthroplasty; Are hip precautions still needed?

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“…These limitations include the use of only a single centre, small sample sizes, or a sole focus on a specific anatomical location. 8 Recently this limitation has begun to be addressed, with a population-based epidemiological study examining age and sex trends in FRI. 9 This study highlighted an increasing incidence of FRI from 1.05% to 1.25% over the previous decade, particularly affecting those of older age, however the lack of linked clinical or health economic data hampers its utility.…”

Section: Introductionmentioning

confidence: 99%

A population-based epidemiological and health economic analysis of fracture-related infection

Foster,

Warren,

Vallmuur

et al. 2024

Bone Joint J

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AimsThe aim of this study was to perform the first population-based description of the epidemiological and health economic burden of fracture-related infection (FRI).MethodsThis is a retrospective cohort study of operatively managed orthopaedic trauma patients from 1 January 2007 to 31 December 2016, performed in Queensland, Australia. Record linkage was used to develop a person-centric, population-based dataset incorporating routinely collected administrative, clinical, and health economic information. The FRI group consisted of patients with International Classification of Disease 10th Revision diagnosis codes for deep infection associated with an implanted device within two years following surgery, while all others were deemed not infected. Demographic and clinical variables, as well as healthcare utilization costs, were compared.ResultsThere were 111,402 patients operatively managed for orthopaedic trauma, with 2,775 of these (2.5%) complicated by FRI. The development of FRI had a statistically significant association with older age, male sex, residing in rural/remote areas, Aboriginal or Torres Strait Islander background, lower socioeconomic status, road traffic accident, work-related injuries, open fractures, anatomical region (lower limb, spine, pelvis), high injury severity, requiring soft-tissue coverage, and medical comorbidities (univariate analysis). Patients with FRI had an eight-times longer median inpatient length of stay (24 days vs 3 days), and a 2.8-times higher mean estimated inpatient hospitalization cost (AU$56,565 vs AU$19,773) compared with uninfected patients. The total estimated inpatient cost of the FRI cohort to the healthcare system was AU$156.9 million over the ten-year period.ConclusionThe results of this study advocate for improvements in trauma care and infection management, address social determinants of health, and highlight the upside potential to improve prevention and treatment strategies.Cite this article: Bone Joint J 2024;106-B(1):77–85.

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Infection after intracapsular femoral neck fracture – does antibiotic-loaded bone cement reduce infection risk after hemiarthroplasty and total hip arthroplasty?

Cited by 9 publications

References 41 publications

Low implantation volume, comorbidities, male sex and implantation of constrained TKA identified as risk factors for septic revision in knee arthroplasty: A register‐based study from the German Arthroplasty Registry

Low implantation volume, comorbidities, male sex and implantation of constrained TKA identified as risk factors for septic revision in knee arthroplasty: A register‐based study from the German Arthroplasty Registry

Hip & Pelvis

A population-based epidemiological and health economic analysis of fracture-related infection

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