Revision Total Hip Arthroplasty Benefits Patients 80+
BY LAUREN UZDIENSKI, JANUARY 7, 2008
Testing a common belief that revision total hip arthroplasty is associated with a high complication rate in the very elderly, researchers at Philadelphia's Rothman Institute for Orthopedics retrospectively evaluated outcomes in over 300 THA patents.
There were two groups of patients pulled from the Institute's records: 170 revision THAs in 159 patients 80 and over, and 170 revision THAs in 162 patients who were 70 or younger. Patients' average ages were 83.3 years and 57.7 years, respectively. All procedures were performed between 1992 and 1999, and the 80+ group was said to be comparable to the control group on characteristics including gender, type of revision (revision of the femoral component, the acetabular component, or both), surgical approach, type of components, method of fixation (all uncemented) and surgeon. All patients were followed until the device failed, requiring a repeat revision, or death.
In the six months following surgery, 30 octogenarians experienced complications, compared with 25 controls. 96% and 93% of complications, respectively, developed during the hospital stay. Comorbidities were the strongest predictor of complications, correlating directly with the number of complications among octogenarians. Age at time of surgery did not correlate with overall medical complications.
In the control group, 16 hips dislocated; among the octogenarians, only four hips dislocated. There were also more repeat revisions in the control group than the octogenarian group; 23 compared to 13. There were also six other reoperations in the control group compared to four in the octogenarian group.
No patients died during the surgery, and each group had one patient die of a heart attack while in the hospital following the surgery. There was no significant difference between the two groups regarding in-hospital mortality; overall, 100 of the patients in the octogenarian group had died at the time of final follow-up, compared to 12 deaths in the control group. The authors add that among the 100 patients who died, 94% had a well-functioning hip at time of death.
In the paper, the authors refer to previously published data reflecting small populations and cemented components that led to the belief that patients 80 and older had a high risk for complications following a revision THA. These latest data, reflecting a large cohort, show that octogenarians and younger patients had a similar risk for complications, with younger patients having a higher prevalence of dislocation. The authors suggest that octogenarians were less likely to experience complications given that medical optimization for the octogenarian patients was more "stringent and extensive" than for younger patients, with very elderly patients receiving more rigorous medical tests (echocardiography, pulmonary function test, etc.) Additionally, medical surveillance for the octogenarian group was heightened compared to the control group.
The results indicate that revision THA for very elderly patients does not come with unusual risks, and is in fact a viable option to increase function and provide pain relief among patients 80+. As AAOS quotes the study's author, Javad Parvizi, MD, FRCS, "Our results show that age alone is not a contraindication for hip replacement."
