Guidelines underline the importance of early surgery in elderly patients with proximal femoral fractures. However, most of these patients present a high number of comorbidities, some of which require the use of warfarin. Waiting for INR decrease is a cause of surgical delay, and this influences negatively their outcome. We retrospectively reviewed all patients with proximal femoral fracture admitted to our unit from March 2013 to March 2017 to determine whether warfarin therapy is associated with reduction of survival, delay of surgery, and increased blood loss. From 1706 patient, a total of 1292 fulfilled the eligibility criteria and were included. Data regarding general information (type of fracture according to AO/OTA classification), pharmacological history regarding anticoagulant therapy pre-admission, surgery (type of surgery and time to surgery), clinical findings (blood loss), and date of exitus were collected. We identified 157 patients with warfarin, 442 with antiplatelet agents (aspirin, clopidogrel, ticlopidin), and 693 in the control group. We observed a significant difference in the warfarin group regarding an increased ASA score, Charlson Comorbidity Index, and blood loss. Patients taking warfarin experience delay to the theater significantly more than the other groups. Patients in warfarin therapy have a 42% higher risk of death within 1 year from their surgery. Patients who underwent surgery after 48 h have 1.5 times higher risk of mortality with respect to the patients who underwent surgery within 48 h. Warfarin therapy at the time of proximal femoral fractures is associated with increased time to surgery, blood loss, and mortality.

Failure of proximal femur fixation is a rare but challenging complication. Hip replacement could be a safe and optimal salvage treatment option. However, serious complications could occur. The aim of our study is to retrospectively review all hip replacement performed after proximal femur fixation failure and to evaluate functional and radiographic outcomes. we reviewed all Total Hip Arthroplasty and Hemiarthroplasty performed from 2013 to 2020 in Our Departement. We evaluated latest follow-up x-rays for stem subsidence, varus-valgus stem position (>5°), limb lenght inequality (>1cm), dislocation, component loosening, heterotopic calcification classified according to Brooker, cement leakage. Harris Hip Score (HHS) and Hip WOMAC score were perfomed at the latest follow-up to estimate functional outcome. 14 THA had no complications with mean HHS 86.5 and WOMAC score 91,68. 1 periprosthetic infection was reported on THA, however after 2-stages revision functional and radiographic otucomes were satisfactory. 5 HA had rated mean HHS 65.8 and WOMAC score 70.18. 2 HA experienced dislocations which required surgical revision and conversion to THA. as a salvage surgery for failure of proximal femur fixation, Hip Replacement is safe and recommendable. THA reported better results than HA. Nonetheless, every patient should be carefully evaluated before undergoing surgery to detect possible complication risk factors.