Periprosthetic joint infection after hemiarthroplasty for hip fracture is a distinct clinical entity associated with high mortality

Listen to Lisa and Brian discuss the paper 'Periprosthetic joint infection after hemiarthroplasty for hip fracture is a distinct clinical entity associated with high mortality' published in the November 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint, brought to you by the publishers of Bone & Joint Open. Today we're examining the paper, 'Periprosthetic joint infection after hemiarthroplasty for hip fracture is a distinct clinical entity associated with high mortality', published in November 2025 by D Lewis and colleagues. I am Brian and with me is my co-host Lisa.

Hello, Brian. Could you explain why this research was conducted?

Of course. Research into PJIs following hemiarthroplasty for hip fractures is quite sparse compared to elective arthroplasty. The study aimed to gain a better understanding of the epidemiology, risk factors, management, and outcomes of these infections.

Given the prevalence of hip fractures among the elderly and the common use of hemiarthroplasty, this study sought to illuminate the unique challenges and high-risk factors associated with hip hemiarthroplasty PJI.

The authors conducted a population-based multicentre retrospective [00:01:00] analysis on 1,852 patients who underwent hip hemiarthroplasty between January 2006 and December 2018.

They used international consensus criteria to define PJI and assess treatment success by the lack of return to the operating room and survival up to 90 days, following the initial surgery to treat the infection.

The results were quite striking. Out of 1,852 hip hemiarthroplasties, 2.3% developed a PJI. The median time to PJI diagnosis was a mere 26 days with a high 90-day mortality rate of 20.9%. Interestingly, 53% of these PJIs had polymicrobial growth and 41% involved multi-drug resistant organisms.

That's quite alarming. They also identified several significant risk factors for developing hip hemiarthroplasty PJI, such as younger age, chronic kidney disease, a [00:02:00] BMI over 35, perioperative urinary tract infections and dementia. It's worth noting that these risk factors are mostly unmodifiable making prevention quite challenging.

Indeed. The study also highlighted that hip hemiarthroplasty PJI patients exhibited different clinical features compared to those with the elective total hip arthroplasty PJIs. For instance, septic shock and dislocation were more common, underscoring the need for a high index of suspicion and tailored management strategies.

Regarding management, the treatment success rate was surprisingly low. Only 38% of infections were successfully treated with the most effective initial operations being revision arthroplasty and debridement with modular component exchange. However, the treatment decisions are complex due to the frailty and comorbid conditions of this patient cohort.

A key takeaway from this research is that our current antibiotic prophylaxis might not be [00:03:00] adequate, given the high incidence of multi-drug resistant organisms and polymicrobial infections. This calls for further research into optimized antibiotic protocols and tailored surgical interventions.

Absolutely. To summarize, hip hemiarthroplasty PJI is a distinctly high-risk condition with poor outcomes than elective arthroplasty infections. This study highlights the need for realistic surgical goals, multidisciplinary management, and targeted research to improve prevention and treatment strategies.

Well put, Lisa. That concludes our discussion for today. We hope these insights help our listeners better understand the complexities and challenges of managing PJIs in hip hemiarthroplasty patients. Thank you for tuning into AI talks with Bone & Joint.

Thank you for listening. If you found this episode insightful, do check out Bone & Joint Open for more groundbreaking research. Until next time!