Risk factors for implant-related infections after surgery for proximal femur fractures: retrospective analysis of 2572 patients.

INTRODUCTION Proximal femoral fractures (PFFs) are among the most common fragility fractures, with increasing incidence due to population ageing. Surgical treatment enabling early-mobilisation is the standard of care; however, implant-related infection (IRI), occurring in 1-7% of cases, remains a severe complication associated with increased mortality, prolonged recovery, and substantial healthcare costs. This study systematically evaluated risk factors for IRI using routine clinical data from a PFF cohort and compared the findings with existing literature. PATIENTS AND

Methods

This retrospective cohort study analysed electronic health records from a Swiss Level 1 trauma centre between 2009 and 2018. Patients aged ≥60 years undergoing surgery for PFF after low-energy trauma were included. IRIs were identified through chart review using consensus-based criteria. Clinical variables were extracted using a standardised protocol, and potential risk factors were evaluated using logistic regression. A structured review of previously reported risk factors was additionally performed.

Results

A total of 2,572 patients (1,391 pertrochanteric and 1,181 femoral neck fractures) were included. Infection rates were 1.15% for pertrochanteric fractures and 1.52% for femoral neck fractures. Higher body mass index (BMI), greater burden of comorbidity, diabetes and longer operative time were associated with increased infection risk. Literature comparison supported the observed relationships but showed inconsistent findings regarding preoperative waiting time to surgery.

Conclusions

IRI incidence was low, consistent with contemporary studies. Higher BMI, diabetes, and burden of comorbidity were associated with increased infection risk, highlighting the opportunity for targeted perioperative prevention strategies. LEVEL OF EVIDENCE IV; retrospective study.