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Total joint replacement in patients older than 90 years old can be safe and reliable
Old age does not appear to be a contraindication to this type of surgery, researchers said.
Total joint replacement surgery may be beneficial for patients aged 90 years and older, according to results of a recently presented study.
According to Bishoy Youssef, FRCS(Tr&Ort), old age does not appear to be a contraindication to joint replacement surgery. He and his colleagues conducted the study to examine the outcome of joint replacement surgery in patients aged 90 years or older and to study the mortality rate associated with this operation and if the procedure was worth doing.
“We believe that age is not a contraindication for total joint replacement, but patients and their relatives need to be counseled about the increased risks,” Youssef told Orthopaedics Today Europe.
The complication rate among the patients in the study was high, Youssef said.
The investigation included 54 patients who had undergone primary total hip replacement (THR) or total knee replacement (TKR) from July 2007 to August 2011 and were aged 90 years or older. Their average age at the time of surgery was 92 years. Youssef and colleagues used The Royal Orthopaedic Hospital database for the study and tracked postoperative deaths among the study group with the patient’s National Health Service number.
Of the patients included, 51 patients were treated for symptomatic osteoarthritis. Some were treated for failed internal fixation and some patients had metastatic disease, but according to Youssef, there were no failed hemiarthroplasties in the cohort.
The average length of hospital stay was about 11 days and 37 patients were discharged to home and many patients used at-home support services.
“A significant proportion of the patients will develop complications from the surgery, with 25% of those undergoing a total hip replacement developing a complication,” Youssef said, noting that about 40% of patients required a blood transfusion.
Youssef said the mortality rate among the patients following these procedures compared favorably with the published data. There were no deaths at 90 days postoperatively, according to the abstract, but three patients died by 1 year postoperatively.
“Nearly 86% of patients were still alive after a year and would hopefully benefit from this type of operation and have good results from their total hip replacement,” Youssef said. “As what we expect in this age group, the survivorship plummeted quite rapidly after 3 years. After 5 years, only 33% could expect to survive.”
Youssef said that one limitation of the study was that they have not assessed their functional outcome. – by Robert Linnehan
- Reference:
- Youssef, B. Paper #61. Presented at: British Orthopaedic Association Annual Congress; Oct. 1-4, 2013; Birmingham, England.
- For more information:
- Bishoy Youssef, FRCS(Tr&Ort), can be reached at The Royal Orthopaedic Hospital, Northfield, Birmingham, United Kingdom; email: bishoy_youssef@hotmail.com.
Disclosure: Youssef has no relevant financial disclosures.