Total hip arthroplasty for osteoarthritis in patients aged 80 years or older: influence of co-morbidities on final outcome.

BACKGROUND

In osteoarthritic patients aged 80 years or older, total hip arthroplasty (THA) offers well-established benefits; however this selective group of population is known to carry a high morbidity rate.

HYPOTHESIS

The higher morbidity rate carried by this group does benefit more from identification of risk factors than from improved surgical and anesthesia techniques.

MATERIALS AND METHODS

Seventy-two patients, operated between October 2003 and December 2006, were retrospectively analyzed. The interventions performed on the traction table, through an anterior approach, involved implantation of a cemented total prosthesis combined to a retentive, cemented acetabular component.

RESULTS

At an average delay of 31 months (minimum 5 months, maximum 54 months), no patient was lost to follow-up and no prosthesis had to be revised. In total, 19 patients presented 27 complications, which were not influenced by their American Society of Anesthesiology (ASA) score (p>0.1) nor by the presence of co-morbidities (p>0.5). No perioperative deaths or infection occurred. Twenty-eight patients required blood products transfusion. ASA score (p<0.03) and body mass index<25 (p=0.01) appeared to be risk factors for transfusion. Seventeen patients were pain-free and walked without restriction, and 19 had a Merle d'Aubigné score under 15. We noted two isolated dislocations (2.6%). Eleven patients were hindered in their walking ability by an associated orthopaedic condition and five by unrelated medical problems. Although preoperative ASA score did not seem to be of predictive value to the quality of surgical outcome (p>0.5), the occurrence of an associated orthopaedic condition (p<0.001) and, even more the patient's categorization in Charnley class B or C (p<0.001) strongly correlated to this outcome quality.

DISCUSSION

While THA for the treatment of osteoarthritis in patients older than 80 years exposed them to a complication rate of 27%, no specific risk factor was identified. Other neuro-orthopaedic disorders hampered the quality of the functional outcome. The use of a retentive cup could not eliminate the occurrence of two dislocations (2.6%).

LEVEL OF EVIDENCE IV

retrospective therapeutic study.