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Hip Replacement Safe, Effective for Octogenarians

Total hip arthroplasty is safe and effective for patients with arthritis of the hip who are over the age of 80, according to a recent American study.

It is well established that total hip arthroplasty (THA) is a safe and effective treatment for end-stage hip arthritis. However, few studies have looked at the specific outcome in patients 80 years and older, which - due to medical advances - is the fastest-growing group within the US population.

Furthermore, it has been estimated that 1 to 3% of people over 65 will require hip replacement to treat pain and disability due to arthritis, emphasizing the need for more specific information regarding treatment of this group.

L. Daniel Wurtz, MD, and colleagues at the Indiana University School of Medicine, Indianapolis, United States, conducted a retrospective analysis of the safety and efficacy of THA in patients over 80 years old at time of surgery.

Clinical and radiographic outcomes were assessed in 40 octogenarians with end-stage arthritis who had undergone elective THA. Follow up evaluations occurred between 1 and 128 months after surgery (average 3 to 4 years).

Clinical follow up indicated that 80% of hips did not experience pain and 70% of patients could walk without assistance. Furthermore, radiographic assessment showed that all implants were stable. No osteolysis and only minimal asymptomatic heterotopic ossification was observed.

Hospitalisation ranged from 2 to 30 days and patients presented with an average of 2.2 comorbidites, namely hypertension and heart disease.

About 28 and 15% of patients experienced a medical or hip-related complication, respectively. None of these were life threatening, but the most common were postoperative transient confusion and hip dislocation. The number of deaths occurring after surgery was similar to that estimated for an age-matched non-THA group.

Dr. Wurtz concludes that in patients over the age of 80, "THA is indeed a safe and effective procedure". Furthermore, "primary care physicians should not hesitate to refer an active, elderly patient to an experienced arthroplasty surgeon should their patient experience severe pain and limitation of function as a result of advanced hip arthritis."
J Gerontol A Biol Sci Med Sci. Vol 58, Number 5 (May), 2003:M468-471. "Elective primary total hip arthroplasty in octogenarians"

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