Abstract
Introduction
Orthopaedic surgeons are frequently asked to perform a revision total hip arthroplasty (THA) in patients over 80 years of age. Our objective was to evaluate the outcomes after revision THA in patients 80 years or older and compare them to a cohort of patients less than 80 years of age.
Methods
We reviewed all revision THAs performed in our institution from 3/1996 to 12/2008. We compared intra- and post-operative complications (medical and orthopaedic), mortality, clinical outcomes and patient satisfaction between the two age groups. Peri-operative information and complications were collected prospectively, and clinical outcome data were obtained both pro- and retrospectively. The Merle d'Aubigné score, Harris Hip score, general health (SF-12) and patient satisfaction (visual analog scale) were assessed.
Results
Overall, 325 revision THAs were included, 84 (25.8%) in patients 80 years and 241 in patients <80 years. In both groups the reason for revision was aseptic loosening in 62% of the patients (mean interval primary THA - revision 142 vs. 97 months). The older group was more often revised for periprosthetic fractures and recurrent dislocation. Mean follow-up time was 4.3 years. Mortality (80 vs. <80 years) was 6% vs. 0% 3 months postoperative, 9.5% vs. 1.2% 1 year postoperative, and 31% vs. 8.3% 5 years postoperative. 3 (3.6%) re-revisions were performed in patients 80 years compared to 24 (10%) in the younger group. Postoperative medical complications developed in 22.6% compared to 6.6% in the younger group. There were one infection and 13 dislocations in patients 80 years vs. 12 infections and 22 dislocations in the other group. The Merle d'Aubigné score improved from 9.6 to 13.7 (p=0.001) in patients 80 years or older vs. 10.3 to 14.3 (p<0.001), and the Harris Hip score at last follow-up was 74.2 vs. 78.5. Patient satisfaction was significantly higher in the older group (8.4 vs. 7.5, mean difference 0.9, 95% CI 0.2;1.8)
Conclusion
Revision THA in patients over 80 years was associated with substantial clinical improvement, and patient satisfaction was greater than among the younger group. However, the medical complication rate and the 3-months-mortality were substantially higher.
