Weight-adjusted low molecular weight heparin with surgery morning dose administration: Impact on hip hemiarthroplasty early infections

doi:10.5312/wjo.v17.i2.112757

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World Journal of Orthopedics

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World J Orthop. Feb 18, 2026; 17(2): 112757
Published online Feb 18, 2026. doi: 10.5312/wjo.v17.i2.112757

Weight-adjusted low molecular weight heparin with surgery morning dose administration: Impact on hip hemiarthroplasty early infections

Daniel S Horwitz, Juan Bernate, Hemil Hasmukh Maniar, Ahmed M Nageeb Mahmoud

Ahmed M Nageeb Mahmoud, Juan Bernate, Daniel S Horwitz, Department of Orthopedic Surgery, Geisinger Medical Center, Danville, PA 17822, United States

Ahmed M Nageeb Mahmoud, Department of Orthopedic Surgery, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt

Hemil Hasmukh Maniar, Department of Orthopedic Surgery, Lawrence Memorial Hospital, Lawrence, KS 66044, United States

Author contributions: Nageeb Mahmoud AM and Horwitz DS contributed to the conceptualization and methodology; Nageeb Mahmoud AM, Maniar HH, and Bernate J contributed to the investigation; Nageeb Mahmoud AM, Maniar HH, and Bernate J participated in the data curation; Nageeb Mahmoud AM wrote the original draft; Nageeb Mahmoud AM, Horwitz DS, and Maniar HH reviewed and edited the manuscript; Horwitz DS and Maniar HH contributed to the supervision; All authors have read and agreed to the published version of the manuscript.

Institutional review board statement: The study was reviewed and approved by the Geisinger Institutional Review Board (Approval No. 2023-01156).

Informed consent statement: Patients were not required to give informed consent to the study because the retrospective analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data can be shared upon a request from the corresponding author after a data use agreement.

Corresponding author: Ahmed M Nageeb Mahmoud, Academic Fellow, Assistant Professor, Senior Research Fellow, Department of Orthopedic Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA 17822, United States. Ahmednageeb2011@gmail.com; Anmahmoud@med.asu.edu.eg

Received: August 6, 2025
Revised: September 9, 2025
Accepted: November 25, 2025
Published online: February 18, 2026
Processing time: 183 Days and 14.1 Hours

Abstract

BACKGROUND

Several studies have questioned the efficacy of the standard perioperative low-molecular-weight heparin (LMWH) dose in preventing venous thromboembolic complications and have recommended dose escalation to a weight-based regimen. Other studies, however, have cautioned that higher anticoagulation regimens may be associated with an elevated risk of wound complications and periprosthetic joint infections. This dichotomy underscores the need for identifying the safety of the thromboprophylaxis approach in surgical settings.

AIM

To analyze the effect of LMWH regimen modification to weight-based with dose administration the morning of surgery on the incidence of early (within 3 months) postoperative prosthetic joint infection (PJI) in patients with hip hemiarthroplasty (HA).

METHODS

At our multi-hospital health system, LMWH dose escalation to the weight-based regimen without holding the morning dose on the day of surgery started in mid-June 2019. We have reviewed all cases of HA performed at our institution from 2007 to 2024 and divided them into two groups: Before and after the dose modification protocol. The number of early PJI cases has been studied in each group.

RESULTS

A total of 33 HA early PJI cases fit the study selection criteria and were included in this study. Of the 1517 cases performed before the new protocol, 19 cases (1.25%) had early infections, while within the modified protocol (weight-based with morning dose), 14 cases (1.49%) had infections out of a total of 937 cases. The difference between the two groups was found to be not statistically significant (z = -0.5, P = 0.6).

CONCLUSION

Our results indicate that LMWH dose escalation to a weight-based regimen without withholding the LMWH morning dose on the day of surgery did not lead to a significant change in the rate of early PJI in this study. A larger, multicenter study would be ideal for providing stronger evidence.

Keywords: Prosthetic joint; Periprosthetic; Infection; Hematoma; Anticoagulant; Enoxaparin; Hip hemiarthroplasty

Core Tip: This study evaluated whether switching to a weight-based low-molecular-weight heparin (LMWH) regimen with morning-of-surgery dosing affects early prosthetic joint infection (PJI) rates in patients with hip hemiarthroplasty. No statistically significant difference in early PJI rates was observed between the standard and modified LMWH protocols. These findings suggest that LMWH dose escalation does not significantly impact early PJI risk, although larger studies are warranted.