Is Elective Total Hip Arthroplasty Safe in Nonagenarians?

Abstract

Background: An increasing number of elderly patients are becoming candidates for elective total hip arthroplasty (THA). Conflicting results exist with regard to the safety of THA in nonagenarians. The aims of this study were to evaluate postoperative mortality and morbidity after THA in nonagenarians and underlying risk factors. We hypothesized that nonagenarians undergoing elective THA would show higher morbidity than younger patients and higher mortality than nonagenarians in the general population. Methods: This was an observational cohort study using data from the German Arthroplasty Registry (Endoprothesenregister Deutschland [EPRD]). Of 323,129 THAs, 263,967 (including 1,859 performed on nonagenarians) were eligible. The mean follow-up (and standard deviation) was 1,070 ± 641 days (range, 0 to 3,060 days). The exclusion criteria were age of <60 years at admission and nonelective THAs or hemiarthroplasties. The cohort was divided into 4 age groups: (1) 60 to 69 years, (2) 70 to 79 years, (3) 80 to 89 years, and (4) ≥90 years. Comorbidities representing independent risk factors for postoperative complications and mortality were identified via a logistic regression model. Mortality rates were compared with those from the general population with data from the Federal Statistical Office. The end points of interest were postoperative major complications, minor complications, and mortality. Results: Among the greatest risk factors for major and minor complications and mortality were congestive heart failure, pulmonary circulation disorders, insulin-dependent diabetes, renal failure, coagulopathy, and fluid and electrolyte disorders. Compared with younger groups, the risks of major and minor complications and mortality were significantly higher in nonagenarians. Mortality increased when major complications occurred. After 1 year, the survival rate in patients without a major complication was 94.4% compared with 79.8% in patients with a major complication. The mortality rates of nonagenarians in the study population were lower than those in the corresponding age group of the general population. The 1-year mortality rates at 90 years of age were 10.5% for men and 6.4% for women within the study group compared with 18.5% for men and 14.7% for women among the general population. Conclusions: Comorbidities favor the occurrence of complications after elective THA in nonagenarians and thus increase postoperative morbidity. In the case of complications, mortality is also increased. The fact that mortality is still lower than within the general population shows that this aspect can be controlled by careful patient selection and adequate preparation. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Influence of the type of stem and its fixation on revision and immediate postoperative mortality in elective total hip arthroplasty

“…A recent study showed that the mortality rates in patients aged > 90 years undergoing THA were lower than those in a corresponding age group of the general population, emphasizing the safety of THA. 31 Other studies confirmed similar early mortality rates for cemented and uncemented designs of stem, especially if the cohort of patients is for covariates. 15,32 The increased rates of mortality for cemented designs of stem, which have been described in the past, might be the result of a bias in the selection of patients and persistent confounding factors, rather than the type of fixation.…”

Hip & Pelvis

“…This study from Berlin (Germany) aimed to evaluate postoperative morbidity and mortality rates in nonagenarians undergoing elective THA and to identify associated risk factors. 5 The hypothesis tested was that nonagenarians would experience higher morbidity and mortality when compared to both younger patients and their nonagenarian counterparts in the general population. The authors reported their observational cohort study using data from the German Arthroplasty Registry.…”

Trends in Incidence of Hip Fracture and Hip Replacement in Denmark, 1996 to 2018

“…Health inequities pertaining to age are, however, ubiquitous and have been extensively documented. [2][3][4][5][6][7] A recent study 8 established that even among patients older than 90 years, elective total hip replacement (due to osteoarthritis) may be appropriately considered, if patients are carefully selected. Another recent study 9 recommended that, despite higher mortality compared with younger groups, nonagenarian patients should not be denied total hip replacement.…”