Department of Orthopaedic Surgery, Auguste-Viktoria Clinic, Ruhr University Bochum, 32545, Bad Oeynhausen, Germany.
Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, 52064, Aachen, Germany.
Arch Orthop Trauma Surg. 2023 Jun;143(6):3551-3559. doi: 10.1007/s00402-022-04575-2. Epub 2022 Aug 26.
Hip arthroplasty is exposed to demographic change as patients age. Analysis of risk factors for surgical treatment decisions in the group of ≥ 80-year-old patients is crucial. Healthcare systems in developed countries are being tested medically and financially by the ageing population. Therefore, this study analysed the perioperative complications of cementless primary hip arthroplasty in octogenarians and compared them with patients aged ≤ 60 years.
A retrospective data analysis of the year 2017 was done in a maximum care hospital of General Orthopaedic Surgery. Patients aged ≥ 80 years or ≤ 60 years with primary cementless hip arthroplasty were included. The outcome of interest was surgery-related and systemic complications, the development of haemoglobin and the incidence of blood transfusion after cementless primary hip arthroplasty in octogenarians during the hospitalisation and the follow-up treatment. Chi-square tests and Fischer's exact test were used for nominal variables. The two-factorial variance analysis-mixed model was used for Hb analyses and the Welch test for group comparison for metric parameters.
There was a significantly increased incidence of systemic complications during hospitalisation in the ≥ 80-year-old patients (phi 0.26; Std. Ri - 0.8 (A), 2.2 (B); p = 0.007), as well as a significantly increased rate of blood transfusions (phi 0.403; Std. Ri - 1.3 (A), 3.2 (B); p = < 0.001). No clustered pre-existing conditions in the ≥ 80-year-old patients pointed out a significant association with the incidence of systemic complications. Surgery-related complications showed no significant difference during hospitalisation and follow-up treatment.
The study reveals that primary cementless hip prosthesis implantation is a safe procedure without increased incidence of surgery-related complications. Increased attention should be paid to interdisciplinary preoperative optimisation (adjustment of blood pressure, blood transfusions, if necessary, safe exclusion of urinary tract infections) and postoperative care of octogenarians (tight laboratory examinations, geriatric co-attendance).
髋关节置换术随着患者年龄的增长而面临人口结构变化的挑战。分析 80 岁以上患者手术治疗决策的风险因素至关重要。人口老龄化正在给发达国家的医疗保健系统带来医学和经济上的考验。因此，本研究分析了 80 岁以上患者行非骨水泥初次髋关节置换术的围手术期并发症，并与 60 岁以下患者进行了比较。
在一家综合骨科最大护理医院进行了 2017 年的回顾性数据分析。纳入年龄≥80 岁或≤60 岁行初次非骨水泥髋关节置换术的患者。主要研究终点为手术相关和全身并发症、血红蛋白变化以及非骨水泥初次髋关节置换术后 80 岁以上患者在住院期间和随访治疗期间的输血发生率。使用卡方检验和 Fisher 确切检验进行分类变量分析。采用双因素方差分析-混合模型进行 Hb 分析，采用 Welch 检验进行组间比较。
80 岁以上患者在住院期间全身并发症的发生率显著增加（phi 0.26；Std. Ri -0.8（A），2.2（B）；p=0.007），输血率也显著增加（phi 0.403；Std. Ri -1.3（A），3.2（B）；p<0.001）。80 岁以上患者中没有明显的聚集性术前合并症与全身并发症的发生率有显著关联。住院期间和随访期间手术相关并发症无显著差异。
该研究表明，非骨水泥髋关节假体植入术是一种安全的手术，手术相关并发症的发生率没有增加。应更加重视围手术期的多学科优化（调整血压、输血，如有必要，安全排除尿路感染）和 80 岁以上患者的术后护理（严格的实验室检查、老年科共同护理）。
