Timing and Tips for Total Hip Arthroplasty in a Critically Ill COVID-19 Patient with a Femoral Neck Fracture: A Case Report

Kaidi, Austin C.; Held, Michael B.; Boddapati, Venkat; Trofa, David P.; Neuwirth, Alexander L.

Expedited time to surgery following hip fracture is associated with decreased morbidity and mortality in appropriately optimized patients. However, the optimal timing of surgery in patients with novel coronavirus disease 2019 (COVID-19) infection remains unknown. This case report describes a patient with COVID-19 pneumonia complicated by multi-organ system failure requiring intubation who sustained a femoral neck fracture that required total hip arthroplasty (THA). This patient had a significant, deliberate delay in time to surgical intervention due to his critical state. When deciding the optimal timing for THA in COVID-19 patients we recommend utilizing inflammatory markers, such as procalcitonin and IL-6, as indicators of disease resolution and caution operative intervention when patients are nearing the 7-10(th) 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 multi-organ system failure. Close follow-up with medical doctors is recommended to minimize long-term sequelae and delay to baseline mobility.