Outcomes in the elderly patient following enhanced recovery pathways for elective lower-limb arthroplasty surgery

Abstract

Introduction: Enhanced recovery pathways (ERPs) have been shown to reduce both morbidity and mortality, as well as length of stay, in very elderly patients undergoing joint replacement surgery. However, their impact on patient-reported outcome measures (PROMs) in this vulnerable cohort of patients has not previously been investigated.

Methods: Oxford Hip and Knee Scores were collected pre- and postoperatively for patients undergoing joint replacement surgery at Wrexham Maelor Hospital, along with data on patient demographics.

Results: Of the 646 who had total hip replacements, 32 (4.95%) were aged 85 years or over, and of the 875 who had total knee replacements, 39 (4.46%) were aged 85 years or over. Similarly to younger patients, those over the age of 85 years saw a benefit in the outcome at 6 months and 24 months following elective hip and knee arthroplasty on an ERP. This was reflected by a significant increase in the outcome scores at 6 months postoperatively in both age groups undergoing either a total hip replacement or total knee replacement.

Conclusions: We found no detrimental effect of ERPs on PROMs data in older patients. In fact, these patients saw a similar benefit in outcome following elective hip and knee arthroplasty as the younger cohort.

Keywords: elderly patient; enhanced recovery pathway; patient-reported outcome measures; total hip replacement; total knee replacement.