Five-year survival of nonagenerian patients undergoing total hip replacement in the United Kingdom

Abstract

Between January 2000 and December 2007, 31 patients 90 years of age or older underwent total hip replacement at our hospital. Their data were collected prospectively. The rate of major medical complications was 9%. The surgical re-operation rate was 3%. The requirement for blood transfusion was 71% which was much higher than for younger patients. The 30-day, one-year and current mortality figures were 6.4% (2 of 31), 9.6% (3 of 31) and 55% (17 of 31), respectively, with a mean follow-up for the 14 surviving patients of six years. Cox's regression analysis revealed no significant independent predictors of mortality. Only 52% of patients returned immediately to their normal abode, with 45% requiring a prolonged period of rehabilitation. This is the first series to assess survival five years after total hip replacement for patients in their 90th year and beyond. Hip replacement in the extreme elderly should not be discounted on the grounds of age alone, although the complication rate exceeds that for younger patients. It can be anticipated that almost half of the patients will survive five years after surgery.

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

“…Similar to previous studies [3,6], over half of the nonagenarians (66.1%) had an ASA score of 3 or greater at the time of their surgery. The nonagenarians in our study were comparable to previous reports with respect to average age (91.3 years old, previously reported 91.3-92 years old), percentage of female patients (64.5%, previously reported 64%-76%), BMI (24.9 kg/m 2 , compared to 24.3), and prevalence of hypertension (76.7%, previously reported 56.4%) [3][4][5][6].…”

“…Among the 183 individuals there were no intraoperative deaths. Not only is this rate lower than the intraoperative death rates for the younger age groups, it is also lower than the previously reported intraoperative mortality rates of 2.1%-6.4% for nonagenarian THA patients [3,5,6]. The one-year mortality rate of 5.5% among the nonagenarians of this study is less than a third of the 19.3% rate reported in a recent study following nonagenarian mortality [12].…”

“…Previous studies have suggested that THA in nonagenarians is associated with an increased risk of complications [3][4][5][6]. Furthermore, the majority of patients aged 90 and over have multiple medical conditions with ASA scores of 3 or greater [6].…”

“…In addition, reported perioperative mortalities of 2.1%-6.4% [3,5,6] indicate the potential severity of complications. Perhaps as a result of frailer health and increased perioperative complications, nonagenarian patients undergoing THA have reported length of hospital stays (LOS) ranging from 7.6 to 13 days [3][4][5][6].…”

“…Prior studies investigating primary THAs in nonagenarian patients have included small sample sizes [5], grouped together primary and revision THA procedures [3] or combined THA and TKA procedures [4,6]. The growing number of nonagenarians has provided an opportunity to evaluate a greater number of primary THAs within this patient population.…”