Prosthesis retention after an infected hip prosthesis: hip fractures versus primary total hip prosthesis, data from 1998 - 2015

Background: 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. Aim: 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. Methods: 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. Findings: 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<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<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<0.05). Conclusion: 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.