The National Hip Fracture Database (NHFD) publishes hospital-level risk-adjusted mortality rates following hip fracture surgery in England, Wales and Northern Ireland. The performance of the risk model used by the NHFD was compared with the widely-used Nottingham Hip Fracture Score. Data from 94 hospitals on patients aged 60 to 110 who had hip fracture surgery between May 2013 and July 2013 were analysed. Data were linked to the Office for National Statistics (ONS) death register to calculate the 30-day mortality rate. Risk of death was predicted for each patient using the NHFD and Nottingham models in a development dataset using logistic regression to define the models’ coefficients. This was followed by testing the performance of these refined models in a second validation dataset.Objectives
Methods
65 patients over the age of 80 years, who underwent a total knee arthroplasty between 1989 and 1994, were retrospectively reviewed, by means of questionnaire, phone call, clinical and radiological examination.Notes were reviewed for pre-existing medical conditions, pre-operative and post-operative Knee Society “Knee” and “Function” scores. They were then compared with 65 randomly selected patients in a different age group, 70 years and under.56 octogenarians were alive at 5 years and 50 available for full review. Elderly patients had more pre-existing medical conditions, with hypertension a ubiquitous diagnosis, required a longer in patient stay and more social services input before discharge, than the younger age groups. All patients in the elderly group suffered from osteoarthritis, unlike the younger age groups. Valgus deformity of the knees was only seen in the younger cohort. Previous surgery was more common in the octogenarians, with more octogenarians having undergone a tibial osteotomy and more youngsters undergoing arthroscopy. A reflection of changing surgical practice. “Knee” Scores were not significantly different between the age groups. However, the “function “ scores pre-operatively, were significantly lower in the over 80s and they made a more significant post-operative gain. Post-operatively, elderly male patients were more likely to go into retention post-operatively, than female patients and males in the younger age group. None of the prostheses had required revision in the elderly age group and only 5 patients had died since the surgery. None of the deaths were related to the surgery. We recommend pre-operative catheterisation of octogenarian patients, especially those with a history of prostatism. There would appear to be from this review no indication for denying elderly patients an arthroplasty on the basis of age.
