Is There an Age Limit for THA?

Ninety is the new 60 — or 70, at least in regards to total hip arthroplasty.

A study published in The Journal of Arthoplasty concludes that nonagenarians should be considered for the procedure, despite their higher risk of co-morbidities compared with younger patients. 

Data revealed that patients aged 90 and older had comparable rates of deep vein thrombosis, infection and pulmonary embolism as their younger counterparts. However, investigators said higher readmission rates of the oldest patients warrant closer postoperative follow-up.

“The results of [total hip arthroplasty] THA among the nonagenarians in this study reveal improved outcome when compared to historical controls and suggest that this patient population should be given consideration for this procedure,” the Southern California Permanente Medical Group investigators wrote.

The researchers retrospectively studied Total Joint Replacement Registry data for 43,543 patients who underwent primary total hip arthroplasty. From this group, they identified 183 nonagenarians (aged 90 years or older), and compared them to 4,725 patients aged 80 to 89 years and 38,620 patients who were younger than 80 years. Outcomes of interest included surgical site infections (SSI) within 30 days, deep SSI within one year, pulmonary embolism (PE) and deep vein thrombosis (DVT) within 90 days, 30 to 90 day death and length of hospital stay.

In addition, researchers compared groups with regards to patient characteristics, comorbidities, and general health status and surgery indications. The American Society of Anesthesiologist (ASA) score was used to measure general health status for patients at time of surgery.

Findings showed groups were different with regards to gender, race, obesity and ASA scores. Patients aged 80 to 89 years had the greatest rates of osteoarthritis as a surgical indication, whereas in nonagenarians it was congestive heart failure and valvular disease, and diabetes in patients younger than 80 years.

Nonagenarians had the longest length of stay with 3.4 days followed by 3.3 days for the 80-year to 89-year-old group. The nonagenarian group had higher rates of death within 90 days, death within one year, deaths overall and readmission after 30 days compared with the other groups. The rates of deep SSI and PE were not significantly different among the age groups, with investigators noting “no events of superficial SSI, FVTs or intraoperative death occurred in patients who were 90 [years] or older.”