Introduction and purpose: Infections of total hip prostheses are one of the most serious complications that beset this procedure. Their incidence in the world literature is of 1%. However this figure rises to 16% in the case of implants secondary to fractures in patients with multiple pathologies. In this study we conduct a descriptive analysis of the qualitative variables after the implementation of an action protocol to address this complication.

Materials and methods: A consecutive series of 694 patients was studied (420 females, 60.52%, and 274 males, 39.48%). Out of these 233 cases were secondary to fractures ( 60 males and 173 females), which meant that treatment was administered as an emergency (in the first 48 hours), and 461 were primary (241 males and 247 females). The variables related to an infection risk were studied, a distinction being made between an acute and a chronic infection based on CCD criteria. In acute cases, surgical cleaning was performed; in subacute cases, a two-stage replacement was chosen and for chronic infections we performed a resection arthroplasty if the two-stage replacement failed.

Results: We performed a frequency and exponential chi square study which yielded 37 cases (5.33%) of implant infection (11 males, 26 females).The most frequently isolated germ was Staphilococus Aureus. 74% of cases treated with surgical cleaning after a diagnosis of acute infection are now infection-free after a two-year follow-up. 60% of subacute cases, where a two-stage replacement was performed, show a satisfactory result. As regards resection arthroplasty, the success of treatment was around 92%,with a p< 0.005 value.

Conclusions: Careful patient selection and early diagnosis are fundamental to obtain good results in the treatment of THP infections.

Introduction and purpose: Cases of unstable extracapsular fractures of the proximal femur should be treated by endomedullary nailing; the PFN (Synthes) nail has proved to be a good option for this approach. The purpose of our paper is to make a descriptive study analyzing the medical and technical complications derived from the use of the PFN nail.

Materials and methods: This study reviews a consecutive series of 432 patients implanted with a PFN, out of whom 352 have had a follow-up longer than 6 months. Mean age is 76.3 years and the male/female ratio is 2:1. An analysis was made of the variables related to medical complications inherent in the fracture itself and in the patient characteristics (AO fracture type, ASA surgical risk, organic complications, infection risk factors, duration of hospital stay and mortality) and to secondary mechanical complications caused by implant design or the surgical technique chosen (implant protrusions, system cutting out, osteolysis and intraoperative and postoperative fractures propagated from the tip of the implant).

Results: We performed a frequency analysis and an exponential chi square study which told us that the most frequent fracture was type A2 (AO classification) and the most frequent patient type was ASA III (ASA classification). Mean hospital stay was 6.66 days. During follow-up, medical complications were 17.5% and mechanical ones 11%.

Conclusions: The PFN nail is an efficient means for treating extracapsular fractures of the proximal femur although its use is not free from complications, which could be minimized by employing a careful surgical technique. We found that there is a direct relationship between surgical success and patient ASA type.