Cemented total hip arthroplasty revisions in patients of eighty years and older.

PURPOSE

It is often a difficult decision whether it is safe to perform revision hip surgery in a patient of 80 years and older. Therefore we evaluated the results of cemented revisions in these elderly patients.

METHODS

Clinical data, radiographs and complications of 49 consecutive cup and/or stem revisions in 48 patients were prospectively collected. The average age of the patients at surgery was 84 years (range, 80-92). We performed Kaplan-Meier (KM) analysis and also a competing risk (CR) analysis because in this series the presence of a competing event (i.e. death) prevents the occurrence of endpoint rerevision.

RESULTS

Twenty-nine patients (30 hips) died without rerevision during follow-up and their data was included. The average follow-up of the 16 surviving patients was eight years (range, six to 13). Six re-operations were performed, of which three were re-revisions. Eight-year survivorship was 91.6% (95% confidence interval (CI) 76-97%) for endpoint re-revision for any reason. With the CR analysis we calculated that due to the increasing number of competing events, the KM analysis overestimates the failure rate with 32% for this endpoint. The average Harris hip score improved from 49 to 74. Mortality within three months after surgery was 6%. One postoperative fracture occurred and six hips dislocated.

CONCLUSION

Cemented revisions can provide satisfying results in patient of 80 years and older with acceptable survivorship and complication rates.