Revision total hip arthroplasty in octogenarians. A case-control study.

BACKGROUND: Revision total hip arthroplasty in the very elderly is believed to be associated with a high complication rate. We evaluated the early outcomes and prevalence of complications following revision total hip arthroplasty in patients older than eighty years of age and compared them with those in a younger patient population.

METHODS: We retrospectively reviewed the results of 170 revision total hip arthroplasties that had been performed in 159 octogenarians in our institute between 1992 and 1999. The mean patient age at the time of surgery was 83.8 years, and the mean follow-up time was 6.8 years. We then compared these results with those of 170 revision total hip arthroplasties, done with the same surgical technique and prosthesis, in 162 patients who were seventy years old or younger and followed for a mean of six years. The functional outcome and the quality of life following the arthroplasties were assessed with use of the Harris hip score and the Short Form-36 (SF-36), respectively. Risk factors for complications and mortality were identified, and Kaplan-Meier analysis was used to determine survivorship.

RESULTS: The octogenarians had a significant improvement in the mean Harris hip score, from 47 points preoperatively to 85 points at the time of the latest follow-up. In the control group, the Harris hip score also improved significantly, from a preoperative mean of 44.3 points to a mean of 87.9 points at the time of the latest follow-up. There was no significant difference between the two groups in the magnitude of improvement of the Harris hip score. There were 100 deaths (a rate of 58.8%) at a mean of 5.3 years postoperatively in the octogenarian group compared with twelve deaths (7.1%) in the control group (p < 0.0001). There were no intraoperative deaths in either group. Of the 100 octogenarian patients who died, 94% had a well-functioning hip at the time of death. Perioperative medical complications developed in thirty patients (thirty-eight hips [22.4%]) in the octogenarian group and in twenty-five patients (twenty-six hips [15.3%]) in the control group (p > 0.05). There were thirteen repeat revisions and four other types of reoperations in the octogenarian group and twenty-three repeat revisions and six other types of reoperations in the control group (p = 0.08). A dislocation was sustained by four patients in the octogenarian group and sixteen patients in the control group (p = 0.01).

CONCLUSIONS: Revision total hip arthroplasty can provide substantial clinical benefit to patients over eighty years of age. The medical complication rate for octogenarians may not differ significantly from that for patients seventy years of age or younger, and the prevalence of technical complications and dislocations can be expected to be lower than that for younger patients.