Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
J Arthroplasty. 2021 Apr;36(4):1373-1379. doi: 10.1016/j.arth.2020.10.040. Epub 2020 Oct 26.
Nonagenarians (90-99 years) have experienced the fastest percent growth in primary THA utilization recently. However, there are limited data on this population. This study aimed to determine the mortality rate, implant survivorship, clinical outcomes, and complications of primary THAs in nonagenarians.
Our institutional total joint registry was used to identify 144 nonagenarians who underwent 149 primary THAs for osteoarthritis only between 1997 and 2017. The mean age was 92 years, with 63% being female. Mortality, revision, and reoperation were assessed using cumulative incidence with death as a competing risk and Cox regression methods. Clinical outcomes were assessed using Harris hip scores (HHSs). Cemented femoral components were used in 68%. The mean follow-up was 4 years.
The mortality rates were 6%, 8%, 14%, and 49% at 90 days, 1 year, 2 years, and 5 years, respectively. The 5-year cumulative incidences of any revision and reoperation were 1% and 4%, respectively. The mean HHS improved significantly from 48 preoperatively to 76 at 5 years (P < .001). The 5-year cumulative incidence of any complication was 69%, with the most common being periprosthetic femur fracture (7) intraoperatively, delirium (25) early postoperatively, and periprosthetic femur fracture (10) later postoperatively. Uncemented stem fixation was associated with a higher risk for intraoperative femur fracture (Hazard ratio 5, P = .04) but not with a higher 5-year periprosthetic postoperative femur fracture risk (P = .19).
Nonagenarians undergoing primary THA had substantial mortality rates at 90 days (6%) and 1 year (8%). While the cumulative incidence of any revision and reoperations were low at 5 years, the high complication rate is mostly due to periprosthetic fractures.
Level IV, retrospective cohort.
最近，90 岁及以上人群（90-99 岁）经历了初次全髋关节置换术（THA）利用率的最快百分比增长。然而，关于这一人群的数据有限。本研究旨在确定仅患有骨关节炎的 90 岁以上人群初次 THA 的死亡率、假体存活率、临床结果和并发症。
我们的机构关节置换登记处用于确定 1997 年至 2017 年间，144 名 90 岁以上患者接受 149 例初次 THA 的患者，平均年龄为 92 岁，63%为女性。使用累积发生率（以死亡为竞争风险）和 Cox 回归方法评估死亡率、翻修和再手术。使用 Harris 髋关节评分（HHS）评估临床结果。使用骨水泥股骨假体的占 68%。平均随访 4 年。
术后 90 天、1 年、2 年和 5 年的死亡率分别为 6%、8%、14%和 49%。任何翻修和再手术的 5 年累积发生率分别为 1%和 4%。HHS 从术前的 48 显著改善到术后 5 年的 76（P<0.001）。任何并发症的 5 年累积发生率为 69%，最常见的是术中股骨假体周围骨折（7 例）、术后早期谵妄（25 例）和术后晚期股骨假体周围骨折（10 例）。非骨水泥固定的股骨假体与术中股骨骨折风险增加相关（风险比 5，P=0.04），但与术后 5 年股骨假体周围骨折风险增加无关（P=0.19）。
接受初次 THA 的 90 岁以上患者在术后 90 天（6%）和 1 年（8%）的死亡率较高。虽然 5 年时任何翻修和再手术的累积发生率较低，但高并发症率主要归因于假体周围骨折。
IV 级，回顾性队列研究。
