Total joint arthroplasty in the extremely elderly: Hip and knee arthroplasty after entering the 89th year of life

https://doi.org/10.1016/S0883-5403(03)00338-3Get rights and content

Abstract

The goal of this study was to evaluate the complications and efficacy of total joint arthroplasty in the extremely elderly and compare the survival with the normal age-matched population. One hundred one joint arthroplasties (45 total knee arthroplasties [TKAs], 56 total hip arthroplasties [THAs]) were performed in 83 patients 89 years old and older. Over an average follow-up period of 2.5 years, 26 (31%) of the patients died. Three patients (3.6%) died within the first 2 months’ postoperatively. The perioperative medical complication rate (excluding deaths) was 14%. Significant improvements were noted in pain scores, Harris Hip Scores, and Knee Society Scores. The survival of patients in their nineties who undergo total joint arthroplasty is at least equal to the survival of an age-matched population for 2.5 years following surgery. With careful patient selection and patient care to minimize medical complications, total joint arthroplasty can be an excellent option for patients who are age 89 and older.

Section snippets

Materials and methods

We performed a retrospective review of our records for all patients who had primary or revision total hip arthroplasty (THA) or total knee arthroplasty (TKA) since 1978. Patients who had surgery after their 89th birthday were included in the study. Eighty-three patients with 45 TKAs and 56 THAs were identified for the study.

Data were collected as to postoperative complications; patient and implant survival; revisions; discharge disposition; length of inpatient hospitalization; use of ambulatory

Complications and deaths

The total complication rate was 14%. For TKA, there were 8 perioperative complications, including 1 each of decubitus ulcer, pneumonia, urinary tract infection, fractured patella, ileus, congestive heart failure (CHF), perforated gastric ulcer, and 1 patient who had both a subluxed patella and required a cholecystectomy. For THA, there were 4 complications. This included a single dislocation, 1 recurring dislocation (which did not require additional surgery), 1 fat embolus, and a fourth patient

Discussion

Pain relief and functional improvement occurred in this group of patients; however, a larger percentage of these patients compared with younger patients undergoing total joint arthroplasty required the use of an assist device, which is similar to findings in other studies in the elderly 4, 5, 6, 9, 10, 18, 19. The use of an assist device after surgery decreased from 86% to 72% for THAs and 74% to 51% for TKAs in this study. At 1 year following surgery, the average HHS improved from 38 points

References (20)

There are more references available in the full text version of this article.

Cited by (67)

  • Elective Total Hip Arthroplasties in Nonagenarians—Age Does Matter: A National Surgical Quality Improvement Program Study

    2022, Journal of Arthroplasty
    Citation Excerpt :

    Outcomes were defined by the following categories: (1) 30-day mortality: the patient perished during the first 30 days ensuing surgery; (2) major complications—life threatening: the patient experienced at least one of the following complications in the 30 days following surgery: pulmonary embolism, cardiac arrest, MI, unplanned intubation, sepsis, acute renal failure, and cerebrovascular accident; and (3) minor complications—not acutely life threatening: the patient experienced at least one of the following complications in the 30 days following surgery: urinary tract infection, deep vein thrombosis, pneumonia, renal insufficiency, superficial wound infection, and deep wound infection. The separation of complications into major and minor adverse events is based on previous literature using the NSQIP database [16,17]. The same patient was considered only once in the calculation of major or minor adverse events, regardless of whether that patient sustained more than 1 complication within 30 days of surgery.

  • Contemporary Mortality Rate and Outcomes in Nonagenarians After Primary Total Knee Arthroplasty

    2021, Journal of Arthroplasty
    Citation Excerpt :

    Fortunately, the most common medical complications were not catastrophic and mainly were urinary tract infections, urinary retention, and delirium. This is similar to the findings of others [1,10,21–23]. Among the surgical complications, intraoperative periprosthetic fractures (2 femoral and 1 tibia) and wound hematoma were particularly common, demonstrating the frailty of bone condition in this population and the necessity for a diligent bone preparation and hemostasis intraoperatively.

  • The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint Arthroplasty

    2021, Arthroplasty Today
    Citation Excerpt :

    However, complications after TJA are prevalent and still exist [2,3]. As the life expectancy in the United States continues to increase, TJA will be performed in older patients who may be subject to increased complications after these procedures [4–7]. One rare, yet potentially fatal, complication after TJA is gastrointestinal (GI) bleeding [3].

View all citing articles on Scopus

No benefits or funds were received in support of this study.

View full text