What Are the Risk Factors for Infection in Hemiarthroplasties and Total Hip Arthroplasties?

Abstract

Background Late infection is the second most frequent early complication after total hip arthroplasty (THA) and the most frequent after hemiarthroplasty. Known risk factors for infection after THA include posttraumatic osteoarthritis, previous surgery, chronic liver disease, corticoid therapy, and excessive surgical time. However, risk factors for hemiarthroplasty are not clearly established. Questions/purposes We therefore determined the preoperative and intraoperative risk factors for late infection (more than 3 months after surgery) in patients with hemiarthroplasties and THAs. Methods We retrospectively compared 47 patients with a hip arthroplasty (23 hemiarthroplasties, 24 total hip arthroplasties) and late infection with 200 randomlyselected patients with primary arthroplasty (100 hemiarthroplasties, 100 total hip arthroplasties) during the same time period of time without any infection during followup. Potential risk factors were identified from medical records. Minimum followup was 12 months (mean, 27 months; range, 12-112 months) for the study group and 18 months (mean, 84 months; range, 18-144 months) for the control group. Results The following factors were more frequent in late infected hemiarthroplasties: female gender; previous surgery; obesity (body mass index greater than 30 kg/m 2 ); glucocorticoid and immunosuppressant treatments; prolonged surgical time; inadequate antibiotic prophylaxis; prolonged wound drainage; hematoma; dislocation; and cutaneous, urinary, and/or abdominal infections. The following were more frequent in infected total hip arthroplasties: posttraumatic osteoarthritis; previous surgery; glucocorticoids; chronic liver disease; alcohol and intravenous drug abuse; prolonged surgical time; prolonged wound drainage; dislocation; subsequent surgery; and cutaneous, urinary, respiratory and abdominal infections. Diabetes did not appear to be a risk factor. Conclusions Our data suggest there are specific risk factors for infection in hemiarthroplasties.

Are Antibiotics Necessary in Hip Arthroplasty With Asymptomatic Bacteriuria? Seeding Risk With/Without Treatment

“…After 1 year of followup, no patient in either group presented signs of arthroplasty infection (Table 3). Cordero-Ampuero and de Dios [6] reported urinary infection is a risk factor for deep prosthetic infection in hemiarthroplasties. Urinary catheterization, especially if longterm or repeated, is more frequent in PJIs in patients undergoing HA [7].…”

“…Urinary infection is a reported risk factor for hematogenous PJI [2,3,6,12,16,22,25,27,28,32]. A related but absolutely different clinical situation, asymptomatic bacteriuria, presents an increasing prevalence with age and female sex, from 1% among schoolgirls to [ 40% among women older than 80 years [4,11,14,18,19].…”

“…An arthroplasty infection was investigated in any patient if chronic moderate/severe pain, persistent regional inflam matory signs (erythema and/or swelling), wound drainage, wound dehiscence, fistula, leukocyte count (total and differential), CRP, ESR, and/or radiographic signs suggestive of infection were present at any time during followup [6]. Radiographic signs include periostitis (periosteal reaction), endosteal scalloping, and ring osteolysis (focal resorption); infection is likely if there is rapid onset of osteolysis or endosteal scalloping in the absence of obvious mechanical causes such as poorly implanted prostheses and/or excessive polyethylene wear [28][29][30][31]; early implant loosening may alert for a dormant underlying infection [21].…”

“…Urinary infection is reportedly a risk factor for hematogenous infection in hip arthroplasty [2,3,6,12,16,22,25,27,28,32], raising the risk by 2 to 18 [6,28]. Although perhaps a different clinical situation, the prevalence of Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”

Does Chronic Corticosteroid Use Increase Risks of Readmission, Thromboembolism, and Revision After THA?

“…There is currently a limited amount of data that describes the postoperative complications of THA associated specifically with chronic corticosteroid use. Some studies have found that patients who take corticosteroids chronically are at increased risk for readmission [16], implant failure [15] and postoperative infection [5,13,22] after THA. However, other studies found no increases in the likelihood of readmissions for complications, including periprosthetic joint infection [2] and implant failure [4], after THA in this population.…”