80 岁以上老年人与 70 岁以上老年人行全髋关节翻修术的比较：是否存在真正的差异？
Revision Total Hip Arthroplasty in Octogenarians Compared with Septuagenarians: Is There a Real Difference?
机构信息
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Florida Atlantic University College of Medicine, Boca Raton, Florida.
出版信息
J Bone Joint Surg Am. 2023 Aug 16;105(16):1246-1251. doi: 10.2106/JBJS.22.00440. Epub 2023 May 19.
BACKGROUND
The increasing frequency of total hip arthroplasty (THA) as well as an aging population indicate that the need for revision THA will continue to grow, especially in older and potentially medically complex patients. The purpose of this study was to compare THA revision indications, perioperative complications, and readmissions between octogenarian and septuagenarian patients. We hypothesized that patients aged 80 to 89 years would have similar outcomes to patients aged 70 to 79 years undergoing revision THA.
METHODS
Between 2008 and 2019, 572 revision THAs were performed at a single tertiary care hospital. Patients were stratified by age group: 70 to 79 years (n = 407) and 80 to 89 years (n = 165). Indication for revision, perioperative medical complications, and 90-day readmission were identified for each patient. Chi-square tests and t-tests were used to compare the groups. Logistic regression was used to assess medical complications and readmissions.
RESULTS
Aseptic loosening was a more common indication for revision in patients aged 70 to 79 years (33.4% versus 26.7%; p < 0.001), while periprosthetic fracture was a more common indication for revision in those aged 80 to 89 years (30.9% versus 13.0%). Perioperative medical complications occurred more often in octogenarians (10.9% versus 3.0%; p = 0.001), with arrythmia being the most common type. Patients aged 80 to 89 years were at increased risk for medical complications (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.5 to 7.3; p = 0.004) and readmission (OR, 3.2; 95% CI, 1.7 to 6.3; p < 0.001) when adjusting for body mass index (BMI) and indication for revision. Octogenarians had a higher rate of reoperation following first-time revision than septuagenarians (10.3% versus 4.2%, p = 0.009).
CONCLUSIONS
Octogenarians more commonly underwent revision THA for periprosthetic fracture and had higher rates of perioperative medical complications, 90-day readmissions, and reoperations than septuagenarians. Such findings should be considered when counseling patients on both primary and revision THAs.
LEVEL OF EVIDENCE
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
背景
全髋关节置换术（THA）的频率不断增加以及人口老龄化表明，翻修 THA 的需求将继续增长，尤其是在年龄较大且可能存在医学复杂性的患者中。本研究的目的是比较 80 岁以上和 70 岁以上患者 THA 翻修的适应证、围手术期并发症和再入院情况。我们假设，80 至 89 岁的患者与 70 至 79 岁的患者进行翻修 THA 的结果相似。
方法
2008 年至 2019 年，一家三级护理医院共进行了 572 例翻修 THA。根据年龄组将患者分层：70 至 79 岁（n=407）和 80 至 89 岁（n=165）。为每位患者确定翻修的适应证、围手术期的医疗并发症和 90 天的再入院情况。使用卡方检验和 t 检验比较组间差异。使用逻辑回归评估医疗并发症和再入院情况。
结果
70 至 79 岁患者翻修的主要原因是无菌性松动（33.4%比 26.7%；p＜0.001），而 80 至 89 岁患者翻修的主要原因是假体周围骨折（30.9%比 13.0%）。80 岁以上患者围手术期的医疗并发症更常见（10.9%比 3.0%；p=0.001），心律失常是最常见的类型。调整体重指数（BMI）和翻修适应证后，80 岁以上患者发生医疗并发症（优势比[OR]，3.2；95%置信区间[CI]，1.5 至 7.3；p=0.004）和再入院（OR，3.2；95%CI，1.7 至 6.3；p＜0.001）的风险更高。初次翻修后，80 岁以上患者再次手术的比例高于 70 岁以上患者（10.3%比 4.2%，p=0.009）。
结论
与 70 岁以上患者相比，80 岁以上患者更常因假体周围骨折而行翻修 THA，且围手术期医疗并发症、90 天再入院率和再次手术率更高。在为患者提供初次和翻修 THA 的咨询时，应考虑到这些发现。
证据等级
预后 III 级。有关证据等级的完整描述，请参见作者说明。
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