Patient outcomes after total hip arthroplasty in extreme elderly patients older than 80 years

Daniel C Austin, Michael T Torchia, Wayne E Moschetti, David S Jevsevar, Benjamin J Keeney
Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy 2019 April 4, : 1120700019837943

BACKGROUND: While extreme elderly patients (age 80 and above) benefit from joint replacement, there is controversy about whether their physical function improves as much as younger individuals following total hip arthroplasty.

METHODS: We completed a retrospective cohort study comparing extreme elderly total hip arthroplasty (THA) patients to younger patients. We obtained data from a large institutional repository of 2327 consecutive THAs performed from April 2011 through July 2016 at an American academic medical centre. We performed multivariate regression analyses to determine associations between age group and clinically significant improvement in the Patient-Reported Outcome Measurement Information System (PROMIS)-10 physical component summary (PCS) score. Secondary outcomes included the magnitude of PCS change, length of stay (LOS), and facility discharge.

RESULTS: There were 187 THAs (8.0%) in patients age ⩾ 80 years compared to 2140 THA procedures in patients < age 80. Extreme elderly patients had similar adjusted odds of achieving clinically significant PCS improvement after THA ( p = 0.528) and there were no statistical differences in adjusted postoperative PCS score improvements between the cohorts. Extreme elderly patients were associated with a 0.68 day longer adjusted LOS ( p < 0.001) and demonstrated higher adjusted odds of facility discharge following THA (OR 8.96, p < 0.001).

CONCLUSIONS: Compared to younger patients, extreme elderly individuals had similar adjusted postoperative functional outcomes following THA but utilised substantially more resources in the form of increased time in the hospital and higher rates of facility discharges.

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