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Timing and Tips for Total Hip Arthroplasty in a Critically Ill Patient With Coronavirus Disease 2019 and a Femoral Neck Fracture.

ABSTRACT: Expedited time to surgery after hip fracture is associated with decreased morbidity and mortality in appropriately optimized patients. However, the optimal timing of surgery in patients with the novel coronavirus disease 2019 (COVID-19) infection remains unknown. This case report describes a patient with COVID-19 pneumonia complicated by multiorgan system failure requiring intubation who sustained a femoral neck fracture that required total hip arthroplasty. This patient had a significant, deliberate delay in time to surgical intervention because of his critical state. When deciding the optimal timing for total hip arthroplasty in patients with COVID-19, we recommend using inflammatory markers, such as procalcitonin and interleukin-6, as indicators of disease resolution and caution operative intervention when patients are nearing the 7-10th day of COVID-19 symptoms. Furthermore, implant cementation and spinal anesthesia in critically ill COVID-positive patients should be approached cautiously in the setting of pulmonary disease and multiorgan system failure. Close follow-up with medical doctors is recommended to minimize long-term sequelae and delay to baseline mobility.

SUBMITTER: Kaidi AC

PROVIDER: S-EPMC7359813 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Timing and Tips for Total Hip Arthroplasty in a Critically Ill Patient With Coronavirus Disease 2019 and a Femoral Neck Fracture.

Kaidi Austin C AC Held Michael B MB Boddapati Venkat V Trofa David P DP Neuwirth Alexander L AL

Arthroplasty today 20200714 3

Expedited time to surgery after hip fracture is associated with decreased morbidity and mortality in appropriately optimized patients. However, the optimal timing of surgery in patients with the novel coronavirus disease 2019 (COVID-19) infection remains unknown. This case report describes a patient with COVID-19 pneumonia complicated by multiorgan system failure requiring intubation who sustained a femoral neck fracture that required total hip arthroplasty. This patient had a significant, delib ...[more]

PMID: 32802926

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Project description:Mortality related to femoral neck fractures remains a challenging health issue, with a high mortality rate at 1 year of follow-up. Three modifiable factors appear to be under control of the surgeon: the choice of the implant, the use of cement and the timing before surgery. The aim of this research project was to study the impact on mortality each of these risk factors play during the management of femoral neck fractures. A large retrospective epidemiological study was performed using a national database of the public healthcare system. The inclusion criteria were patients who underwent joint replacement surgery after femoral neck fracture during the years 2015 to 2017. All data points were available for at least 2 years after the fracture. The primary outcome was mortality within 2 years following the surgery. We evaluated the association between mortality and the type of the implant hemiarthroplasty (HA) versus total hip arthroplasty (THA), cemented versus non cemented femoral stem as well as the timing from fracture to surgical procedure. A multivariate analysis was performed including age, gender, comorbidities/autonomy scores, social category, and obesity. We identified 96,184 patients who matched the inclusion criteria between 2015 and 2017. 64,106 (66%) patients underwent HA and 32,078 (33.4%) underwent THA. After multivariate analysis including age and comorbidities, patients who underwent surgery after 72 h intra-hospital had a higher risk of mortality: Hazard Ratio (HR) = 1.119 (1.056-1.185) p = 0.0001 compared to the group who underwent surgery within 24 h. THA was found to be a protective factor HR = 0.762 (0.731-0.795) p < 0.0001. The use of cement was correlated with higher mortality rate: HR = 1.107 (1.067-1.149) p < 0.0001. Three key points are highlighted by our study in the reduction of mortality related to femoral neck fracture: the use of hemiarthroplasty a surgery performed after 48 h and the use of cement for femoral stem fixation adversely affect mortality risk.

Dataset Information

Timing and Tips for Total Hip Arthroplasty in a Critically Ill Patient With Coronavirus Disease 2019 and a Femoral Neck Fracture.

Publications

Timing and Tips for Total Hip Arthroplasty in a Critically Ill Patient With Coronavirus Disease 2019 and a Femoral Neck Fracture.

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