High 1-year THA survival seen in patients older than 90 years

Length of stay for the older patients was 25 days vs. the U.K. average of 4 days.

Issue: October 2013

Researchers found 95% survivorship of total hip arthroplasty at 1 year in elderly patients, according to a study presented at the EFORT Congress.

“You can do total hip replacement if the patient is fit for surgery, but the [overall] duration of stay is high, mortality is high in revision groups and patient satisfaction is good,” Jagan M.R. Velpula, DNB (Ortho), MRCS (Ed), Dip Sports Medicine, FRCS (T&O), of Good Hope Hospital, in West Midlands, United Kingdom, said.

To determine whether total hip arthroplasty (THA) should be performed on patients older than 90 years, Velpula and senior authors Mr. S. Jain and Mr. B. Banerjee retrospectively studied 26 patients who underwent THA between 2003 and 2012 (10 men and 16 women). The patients’ average age was 93 years and the average follow-up was 33 months.

The researchers replaced both hips in this patient.

Investigators used this radiographic view to follow up a patient with a cemented total hip implant in their series.

Velpula noted the patients were from an affluent district general hospital and belonged to a high socioeconomic class or working class.

Twenty patients underwent primary THA for osteoarthritis and six patients underwent revision THA and were converted from an Austin-Moore hemiarthroplasty. Surgeons used cement in all the procedures on both the acetabular and femoral sides, Velpula said.

Velpula reported there were no intraoperative complications. The overall average hospital stay was 24.72 days. The duration of stay was 21 days for patients with primary THA and 35 days for patients with a revision.

“It is high in revision,” Velpula said of the hospital stays. “[The] national average is 4 [days] in normal total hip replacement.”

Six patients died within 1 year of THA surgery. Of these six patients, five patients were in the group with a THA revision. Therefore, the investigators found 95% survivorship at 1 year for primary THA and 85% survivorship for revision THA.

“[There were] good functional outcomes, improved quality of life, decreased consumption of pain killers, significant improvement in mobility, and high patient satisfaction,” Velpula said. “We had to involve the multidisciplinary team and discuss with the rehab team. Preoperative counseling of the patients and family is important for the best outcome.” – by Renee Blisard Buddle

Reference:
Velpula J. Paper #13-4773. Presented at: EFORT Congress; June 5-8, 2013; Istanbul.

For more information:
Jagan MR Velpula, DNB (Ortho), MRCS (Ed), Dip Sports Medicine, FRCS (T&O), can be reached at Heart of England NHS Foundation Trust, Rectory Road, Sutton Coldfield, West Midlands B75 7RR, United Kingdom; email: orthojagan@gmail.com.

Disclosure: Velpula has no relevant financial disclosures.