Stihsen Christoph, Springer Bernhard, Nemecek Elena, Olischar Boris, Kaider Alexandra, Windhager Reinhard, Kubista Bernd
Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria.
Centre for Medical Statistics, Informatics and Intelligent Systems, Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria.
J Arthroplasty. 2017 Jun;32(6):1923-1929. doi: 10.1016/j.arth.2017.01.029. Epub 2017 Jan 26.
Although several studies indicate excellent results for cementless implants, controversy persists regarding its use in elderly patients. We determined to evaluate the outcome on patients aged over 80 years who were treated with cementless total hip arthroplasty for primary osteoarthritis of the hip.
We assessed the data of 162 consecutive total hip arthroplasties in octogenarian patients (mean age 83 years, range 80-96 years). A control group was created, consisting of 342 patients aged younger than 80 years (mean age 65 years, range 37-79 years). The median follow-up of the cohort was 128.4 months (range 6-211).
Competing risk analyses revealed a cumulative implant survival of 98.1% at 5 and 10 years in the study group compared to 99.1% and 98.4% in the control group, taking system exchange as the end point. No differences in regard to system exchange could be detected between the groups. A significantly worsened complication-free survival rate was evident in the octogenarian group. Osteoporosis was the most powerful risk factor that proved to have a significant negative impact on development of complications.
Uncemented total hip arthroplasty is a viable option for the elderly patient. In this population sector, an excellent rate of implant survival can be expected. However, a significant increase of total complications in the octogenarian group could be detected, and was mainly caused by an elevated number of early postoperative complications. Osteoporosis turned out to be a strong risk factor in regard to complication-free survival. Surgeons should therefore be aware of this.
尽管多项研究表明非骨水泥型植入物效果良好，但对于其在老年患者中的应用仍存在争议。我们决定评估80岁以上因原发性髋关节骨关节炎接受非骨水泥型全髋关节置换术患者的治疗效果。
我们评估了162例连续的八旬老人全髋关节置换术的数据（平均年龄83岁，范围80 - 96岁）。设立了一个对照组，由342例年龄小于80岁的患者组成（平均年龄65岁，范围37 - 79岁）。该队列的中位随访时间为128.4个月（范围6 - 211个月）。
竞争风险分析显示，以系统更换为终点，研究组在5年和10年时的植入物累积生存率分别为98.1%，而对照组为99.1%和98.4%。两组之间在系统更换方面未检测到差异。八旬老人组的无并发症生存率明显恶化。骨质疏松是最有力的风险因素，被证明对并发症的发生有显著负面影响。
非骨水泥型全髋关节置换术对于老年患者是一种可行的选择。在这个人群中，可以预期有出色的植入物生存率。然而，在八旬老人组中可检测到总并发症显著增加，且主要由术后早期并发症数量增加所致。骨质疏松被证明是影响无并发症生存的一个强大风险因素。因此，外科医生应意识到这一点。
