Primary total hip arthroplasty in elderly patients over 85 years old: risks, complications and medium-long term results

Abstract

Introduction: The elderly population candidate for total hip arthroplasty (THA) is increasing exponentially in developed countries, due to the high prevalence of osteoarthritis (OA). The objective is to identify the overall survival in patients over 85 years with primary OA who underwent THA.

Material and methods: Retrospective observational study in patients over 85 years with primary hip OA undergoing THA between 2012 and 2019. Demographic, clinical, comorbidity, complications, functionality and pain variables were collected. A descriptive analysis was performed, survival was estimated with the Kaplan-Meier method and the differences in pain and functionality before and after surgery with the McNemar-Bowker test.

Results: We included 66 patients, 40 women and 26 men with a mean age of 87.22 years, of whom 15 had high comorbidity (Charlson>2). Only 14 patients presented complications in the postoperative period, the most frequent was confusional syndrome (5); and the most serious was a death (1), with a median hospital stay of 8 days. Two cases of dislocation were detected over a mean follow-up of 3.61 years, without requiring revision surgery. Improvement of pain was evident after surgery (p<.0001). The median overall survival is 6.77 years, with no difference in survival adjusted by the Charlson index (p=.75) or by ASA anaesthetic group (p=.23).

Conclusions: With good patient selection, THA is a good option for patients over 85 years of age with functional limitations or pain due to OA.

Keywords: American Society of Anesthesiologists (ASA); Anciano; Artroplastia total de cadera; Charlson; Complicaciones; Complications; Elderly; Mobility; Morbilidad; Mortality rate; Octogenarian; Octogenario; Sociedad Americana de Anestesiólogos; Supervivencia; Survival; Tasa de mortalidad; Total hip replacement.