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Joint Diseases and
Related Surgery
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Original Article · Open access

The impact of reoperation after bipolar hemiarthroplasty for femoral neck fracture: A matched cohort comparison between septic and nonseptic causes

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Wei-Lin Chang

Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

ORCID: 0009-0004-2904-4549

Cheng-Yang Chang

Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

ORCID: 0009-0003-2653-3665

Jui-Chien Wang

Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

ORCID: 0000-0001-9743-9877

Shang-Wen Tsai

Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

ORCID: 0000-0002-2523-5012

Cheng-Fong Chen

Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

ORCID: 0000-0002-2485-6159

Po-Kuei Wu

Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

ORCID: 0000-0003-2515-8341

Wei-Ming Chen

Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

ORCID: 0000-0001-9939-6479

Abstract

Objectives: This study aims to compare the rates of medical complication and mortality following initial bipolar hemiarthroplasty (bHA) and reoperation procedures, as well as between different causes of reoperation (nonseptic vs. septic).

Patients and methods: The retrospective study included 118 patients undergoing reoperation after bHA for femoral neck fractures between January 2002 and December 2022. The primary outcomes included in-hospital complications, readmission, and mortality events, while secondary outcomes included length of hospital stay, transfusion rates, and estimated blood loss. These outcomes were compared between each patient’s initial bHA and their subsequent reoperation procedure. The two cohorts were matched using propensity scores based on age, sex, and Charlson Comorbidity Index to compare outcomes between nonseptic and septic causes of reoperation.

Results: Of the 118 patients, 64 were male and 54 were female. The mean age was 77.8 ± 7.9 years, with a range of 61 to 98 years. The in-hospital complication rate was higher after reoperation than after initial bHA (15.3% vs. 1.7%, p < 0.001). Conversely, the readmission rate was higher after the initial procedure (60.2% vs. 23.7%, p < 0.001), mainly due to surgical complications. Patients undergoing reoperation had longer hospital stays, higher transfusion requirements, and more frequently received general anesthesia compared to the initial procedure (p < 0.05). In the matched cohort, septic group had higher in-hospital complication rates than the nonseptic group (23.5% vs. 3.9%, p = 0.004), while readmission and mortality rates were comparable.

Conclusion: Reoperations after bHA carry a higher risk of medical complications. This risk is particularly pronounced in cases related to septic conditions, underscoring the greater impact of reoperation and careful clinical attention.

Declarations

Author Contributions

W.L.C., S-W.T.: Idea/concept, design, control/ supervision, critical review; C.Y.C., S.W.T., C.F.C.: Data collection and/or processing, analysis and/or interpretation, materials; P.K.W., C.F.C., W.M.C.: Literature review; W.L.C., S.W.T.: Writing the article; J.C.W., P.K.W., C.Y.C.: References and fundings.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

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