Beyond the Surgery: Determinants of Infection, Dislocation, and Revision After Hip Hemiarthroplasty

Background Hip fractures are among the most common causes of morbidity and mortality in the elderly population. Hemiarthroplasty is frequently preferred for the surgical treatment of displaced femoral neck and unstable intertrochanteric fractures in older patients. However, postoperative complications such as infection, dislocation, and prosthesis-related failures remain significant concerns that may necessitate revision surgery and increase mortality rates. Methods  This retrospective descriptive study included 529 patients (177 males, 352 females; mean age 78.7 ± 8.7 years) who underwent hemiarthroplasty for proximal femoral fractures at a single tertiary center between 2012 and 2023. Demographic characteristics, fracture type, surgical approach, operative time, use of additional fixation materials, hospitalization period, intensive care unit follow-up, and mobilization status were recorded. Postoperative infection, dislocation, and revision rates were analyzed. Statistical comparisons were performed using the chi-square test, Fisher's exact test, and the Mann-Whitney U test. Results  Postoperative infection occurred in 35 patients (6.6%), with a significantly higher rate in those operated on via the posterolateral approach and in patients requiring additional fixation materials (p<0.05). Longer hospital stays and delayed mobilization were associated with an increased risk of infection. Dislocation was observed in 18 patients (3.4%), with 72.3% requiring revision surgery. Prolonged operative time was significantly correlated with dislocation and revision rates (p<0.05). Overall, 35 patients (6.6%) underwent revision surgery, most commonly due to infection (45.7%), followed by dislocation (34.2%), aseptic loosening (11.4%), and periprosthetic fracture (8.6%). Conclusion  Postoperative complications after hemiarthroplasty, particularly infection and dislocation, substantially contribute to morbidity and the need for revision surgery in elderly patients. Strategies such as minimizing the use of additional fixation materials, optimizing early mobilization, reducing hospital stay, and avoiding unnecessary prolongation of surgery may help lower complication and revision rates, thereby improving patient outcomes.