Are Nonagenarians Too Old For Total Hip Arthroplasty? An Evaluation of Morbidity and Mortality Within a Total Joint Replacement Registry

Miric, Alexander; Inacio, Maria C.S.; Kelly, Mike; Namba, Robert S.

doi:10.1016/j.arth.2015.03.008

Cited by 45 publications

(40 citation statements)

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“…In patients older than 60 years at first intervention, the risk of revision decreases and by age 70 years the likelihood of revision surgery in some patients is less than 1 in 20. In this age group, 95% of patients will retain their prosthesis, suggesting that long term revision rates are not as high as they seem to be 3, 29…”

Section: Discussionmentioning

confidence: 97%

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The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study

et al. 2017

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SummaryBackgroundTotal joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on best-timing for surgery.MethodsWe did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total knee replacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery.FindingsWe identified 63 158 patients who had undergone total hip replacement and 54 276 who had total knee replacement between Jan 1, 1991, and Aug 10, 2011, and followed up these patients to a maximum of 20 years. For total hip replacement, 10-year implant survival rate was 95·6% (95% CI 95·3–95·9) and 20-year rate was 85·0% (83·2–86·6). For total knee replacement, 10-year implant survival rate was 96·1% (95·8–96·4), and 20-year implant survival rate was 89·7% (87·5–91·5). The lifetime risk of requiring revision surgery in patients who had total hip replacement or total knee replacement over the age of 70 years was about 5% with no difference between sexes. For those who had surgery younger than 70 years, however, the lifetime risk of revision increased for younger patients, up to 35% (95% CI 30·9–39·1) for men in their early 50s, with large differences seen between male and female patients (15% lower for women in same age group). The median time to revision for patients who had surgery younger than age 60 was 4·4 years.InterpretationOur study used novel methodology to investigate and offer new insight into the importance of young age and risk of revision after total hip or knee replacement. Our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group, and these data should be offered to patients as part of the shared decision making process.FundingOxford Musculoskeletal Biomedical Research Unit, National Institute for Health Research.

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Section: Discussionmentioning

confidence: 97%

“…In this age group, 95% of patients will retain their prosthesis, suggesting that long term revision rates are not as high as they seem to be. 3 , 29 …”

Section: Discussionmentioning

confidence: 99%

The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study

et al. 2017

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“…These calculations align with several previously described. Miric et al also found nonagenarians undergoing PTHA to have a longer length of stay than octogenarians (3.4 days vs. 3.3 days) [6]. Bozic et al and Gwam et al calculated the average lengths of stay of patients following RTHA to be 6.2 and 5.29 days respectively [13,14].…”

Section: Discussionmentioning

confidence: 99%

“…This study provided excellent insight into the perioperative and postoperative courses of these different age groups and specifically compared the outcomes of nonagenarians and octogenarians following primary. However, this group looked solely at the outcomes of patients undergoing primary THA and did not look at the outcomes of patients following revision total hip arthroplasty [6].…”

Section: Introductionmentioning

confidence: 99%

Comparing Inpatient Complication Rates between Octogenarians and Nonagenarians Following Primary and Revision Total Hip Arthroplasty in a Nationally Representative Sample 2010–2014

et al. 2019

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We compared inpatient postoperative complication rates between octogenarians and nonagenarians undergoing primary and revision total hip arthroplasty (THA). We used inpatient admission data from 2010–2014 from the Nationwide Inpatient Sample (NIS). We compared the rates at which nonagenarians and octogenarians developed each complication in the inpatient setting following both primary THA (PTHA) and revision THA (RTHA). A total of 40,944 inpatient admissions were included in our study which extrapolates to a national estimate of 199,793 patients. A total of 185,799 (93%) were octogenarians and 13,994 (7%) were nonagenarians. PTHA was performed on 155,669 (78%) and RTHA was performed on 44,124 (22%) of the patients. Nonagenarians undergoing PTHA required transfusions significantly more frequently (33.13% v. 24.0%, p < 0.001) and developed urinary tract infection (5.14% v. 3.92%, p = 0.012) and acute kidney injury (5.50% v. 3.57%, p < 0.001) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA required transfusions significantly more frequently (51.43% v. 41.46%, p < 0.001) and developed urinary tract infection (19.66% v. 11.73%, p < 0.001), acute kidney injury (13.8% v. 9.66%, p < 0.001), pulmonary embolism (1.24% v. 0.67%, p = 0.031), postoperative infection (1.89% v. 1.11%, p = 0.023), sepsis (3.59% v. 2.43%, p = 0.021) and other postoperative shock (1.76% v. 1.06%, p = 0.036) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA also had a significantly higher inpatient mortality rate (3.28% v. 1.43%, p < 0.001) than octogenarians. Orthopedic surgeons and primary care providers can use these findings to help counsel both their octogenarian and nonagenarian patients preoperatively when considering THA. Our analysis can help these patients better understand expected inpatient complication rates and assist them in deciding whether to pursue surgical intervention when applicable.

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“…Eventually, a total hip replacement has to be performed. 5 6 7 Therefore, novel and effective therapies against ONFH are urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Preclinical Study of Cell Therapy for Osteonecrosis of the Femoral Head with Allogenic Peripheral Blood-Derived Mesenchymal Stem Cells

Tang

Zhang

et al. 2016

Yonsei Med J

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PurposeTo explore the value of transplanting peripheral blood-derived mesenchymal stem cells from allogenic rabbits (rPBMSCs) to treat osteonecrosis of the femoral head (ONFH).Materials and MethodsrPBMSCs were separated/cultured from peripheral blood after granulocyte colony-stimulating factor mobilization. Afterwards, mobilized rPBMSCs from a second passage labeled with PKH26 were transplanted into rabbit ONFH models, which were established by liquid nitrogen freezing, to observe the effect of rPBMSCs on ONFH repair. Then, the mRNA expressions of BMP-2 and PPAR-γ in the femoral head were assessed by RT-PCR.ResultsAfter mobilization, the cultured rPBMSCs expressed mesenchymal markers of CD90, CD44, CD29, and CD105, but failed to express CD45, CD14, and CD34. The colony forming efficiency of mobilized rPBMSCs ranged from 2.8 to 10.8 per million peripheral mononuclear cells. After local transplantation, survival of the engrafted cells reached at least 8 weeks. Therein, BMP-2 was up-regulated, while PPAR-γ mRNA was down-regulated. Additionally, bone density and bone trabeculae tended to increase gradually.ConclusionWe confirmed that local transplantation of rPBMSCs benefits ONFH treatment and that the beneficial effects are related to the up-regulation of BMP-2 expression and the down-regulation of PPAR-γ expression.

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Are Nonagenarians Too Old For Total Hip Arthroplasty? An Evaluation of Morbidity and Mortality Within a Total Joint Replacement Registry

Cited by 45 publications

References 10 publications

The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study

The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study

Comparing Inpatient Complication Rates between Octogenarians and Nonagenarians Following Primary and Revision Total Hip Arthroplasty in a Nationally Representative Sample 2010–2014

Preclinical Study of Cell Therapy for Osteonecrosis of the Femoral Head with Allogenic Peripheral Blood-Derived Mesenchymal Stem Cells

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