Predictors of mortality following primary hip and knee replacement in the aged

Abstract

Background and purpose High age is associated with increased postoperative mortality, but the factors that predict mortality in older hip and knee replacement recipients are not known.Methods Preoperative clinical and operative data on 1,998 primary total hip and knee replacements performed for osteoarthritis in patients aged ≥ 75 years in a single institution were collected from a joint replacement database and compoared with mortality data. Average follow-up was 4.2 (2.2–7.6) years for the patients who survived. Factors associated with mortality were analyzed using Cox regression analysis, with adjustment for age, sex, operated joint, laterality, and anesthesiological risk score.Results Mortality was 0.15% at 30 days, 0.35% at 90 days, 1.60% at 1 year, 7.6% at 3 years, and 16% at 5 years, and was similar following hip and knee replacement. Higher age, male sex, American Society of Anesthesiologists risk score of > 2, use of walking aids, preoperative walking restriction (inability to walk or ability to walk indoors only, compared to ability to walk > 1 km), poor clinical condition preoperatively (based on clinical hip and knee scores or clinical severity of osteoarthritis), preoperative anemia, severe renal insufficiency, and use of blood transfusions were associated with higher mortality. High body mass index had a protective effect in patients after hip replacement.Interpretation Postoperative mortality is low in healthy old joint replacement recipients. Comorbidities and functional limitations preoperatively are associated with higher mortality and warrant careful consideration before proceeding with joint replacement surgery.

Mortality after total hip replacement surgery

“…This was consistent with the study of Jämsen et al, 6 and although not statistically significant, the study of Bozic et al identified a trend towards reduced mortality in overweight patients. 16 …”

“…2,6,12,21,22,34,25,52 In Blom et al’s study, 49 risk of death was stratified by age. The 30-day mortality for the under 70 years age group was 0.00%, for the 70 to 79 year group it was 0.48%, and for the > 80 age group it was 1.43%.…”

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

“…Jämsen and colleagues 205 reported an increased risk of death in 1998 patients receiving knee or hip replacement with pre-operative anaemia compared with those without. In a multivariable analysis including patients with total hip or knee replacement, Greenky and colleagues 206 reported a greater risk of infection but not mortality.…”

“…Jämsen and colleagues 205 reported a multivariable analysis comparing mortality rates in 1998 patients with hip and knee replacement. After extensive adjustment for patient and clinical characteristics including other comorbidities, the hazard ratio for death was 1.47 (95% CI 1.08 to 1.99) in patients with pre-operative anaemia compared with those without.…”

The Association of Body Mass Index with Risk of Long-Term Revision and 90-Day Mortality Following Primary Total Hip Replacement

“…The highest rates of mortality were observed in the underweight group. This protective effect of increasing BMI was also seen in a single centre study of 756 primary THRs, although nonstandard groupings were used and the findings were not significant 23 . Data from the Danish registries demonstrated significantly higher mortality in underweight and normal BMI patients compared to overweight patients and suggested a BMI of 27-28 kg/m 2 was associated with the lowest risk of mortality 22 .…”