Should Folks Get Hip Replacements in Their 90s?
If you are in your 90s, is hip replacement surgery too dangerous for you?
That depends, new research shows: While elderly patients have more complications and higher death rates after such a procedure, the surgery can be “appropriately considered."
That's because the risks for total hip replacement depend not just on patients' age, but also on their overall health and fitness.
Dr. Vincent Leopold and his colleagues of the Charité-University Hospital in Berlin analyzed the characteristics and outcomes of more than 263,000 patients over 60 who had hip replacement surgery between 2012 and 2021.
Of this large group, 1,859 patients were in their 90s.
The analysis focused on how patient age and health status affected the risks of complications and death associated with hip replacement surgery.
Nonagenarians did have overall higher complication and death rates, compared with younger age groups.
The study found major complications for nearly 20% of patients in their 90s, compared with 10.7% for patients in their 80s, 6.2% in those in their 70s and 3.7% for those in their 60s.
Among these major complications were acute kidney failure, delirium and blood-clotting abnormalities.
The rate of minor complications also increased with age, up to 62.7% for nonagenarians. Patients in their 90s also had the highest death rate, at 26.5%. This compared to 11.8% for patients in their 80s, 6% in their 70s and 2.8% in their 60s.
Preexisting health issues have a major impact on risks.
The risk of major complications following hip replacement surgery was about 17 times greater for patients with clotting abnormalities, nine times greater for those with paralysis and nearly eight times greater for those with pulmonary/circulation disorders, the study found.
The highest risk factors for death were metastatic cancer, pulmonary circulation disorders, alcohol abuse, paralysis and congestive heart failure.
Complications had a major impact on death rate, the study showed.
One year after hip replacement surgery, the survival rate was 94.4% for nonagenarians without any major complications versus 79.8% for those with major complications.
Even for patients with complications, death rates for nonagenarians undergoing hip replacement surgery were lower than in the general population of people in their 90s.
"We believe that this was most likely because elderly patients who become candidates for elective THA [hip replacement] are healthier and biologically younger than the reference group of the general population; the resulting selection bias would be expected to lower the mortality of the nonagenarians in the study cohort," the researchers wrote.
The findings were published Aug. 25 in the Journal of Bone & Joint Surgery.
Risks in this patient age groups may be minimized through "careful patient selection and adequate preparation,” the authors said in a journal news release. "[E]lective THA can be appropriately considered by surgeons and patients when symptoms of hip osteoarthritis are present."
The American Academy of Orthopaedic Surgeons has more on total hip replacement.
SOURCE: Journal of Bone & Joint Surgery, news release, Aug 25, 2023
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