Zink Thomas M, Babikian George M, Mackenzie Johanna M, Sturgeon Callahan, Rana Adam J, McGrory Brian J
Tufts University School of Medicine, Boston, MA, USA.
Tufts Medical Center, Boston, MA, USA.
Arthroplast Today. 2023 May 11;21:101125. doi: 10.1016/j.artd.2023.101125. eCollection 2023 Jun.
As the population ages, total hip arthroplasty has become more common in elderly patients including patients over the age of 90 years. Efficacy in this age group has been established, though literature regarding safety of total hip arthroplasty in nonagenarians is mixed. The anterior-based muscle-sparing (ABMS) approach, which exploits the intermuscular plane between the tensor fasciae latae and the gluteus medius, has proposed benefits of fast recovery, excellent stability, and reduced bleeding and may be adventitious among elderly, more fragile patients.
A total of 38 consecutive nonagenarians undergoing elective, primary total hip arthroplasty via the ABMS approach for any indication from 2013 to 2020 were identified, and information regarding operative outcomes and patient-reported outcomes was gathered from review of medical records and our institutional joint replacement outcomes database.
Included patients ranged from 90 to 97 years of age with the majority classified as American Society of Anesthesiologists score 2 (50%) or American Society of Anesthesiologists 3 (47.4%). The mean operative time was 74.6 minutes ± 13.6 minutes. Of all patients, 5 required a transfusion, 2 patients were readmitted within 90 days, and there were no major complications. The mean hospital length of stay was 2.8 days ± 0.8 days with 22 patients (57.9%) discharged to a skilled nursing facility. Limited patient-reported outcomes data showed statistically significant improvements in most outcomes scores at 6 months to 1 year postoperatively compared to preoperative scores.
The ABMS approach is safe and effective in nonagenarians who may benefit from decreased amounts of bleeding and recovery times associated with the ABMS approach, which is evident from the low complication rates, relatively short hospital lengths of stay, and acceptable transfusion rates compared to previous studies.
随着人口老龄化，全髋关节置换术在老年患者中越来越普遍，包括90岁以上的患者。该年龄组的疗效已得到证实，尽管关于非agenarians（90至99岁老人）全髋关节置换术安全性的文献参差不齐。基于前方的肌肉保留（ABMS）入路利用阔筋膜张肌和臀中肌之间的肌间隙，具有恢复快、稳定性好、出血少等优点，对于老年、更脆弱的患者可能有益。
确定了2013年至2020年期间通过ABMS入路接受择期初次全髋关节置换术的38例连续非agenarians患者，从病历审查和我们机构的关节置换结局数据库中收集了有关手术结局和患者报告结局的信息。
纳入患者年龄在90至97岁之间，大多数患者美国麻醉医师协会评分为2分（50%）或美国麻醉医师协会评分为3分（47.4%）。平均手术时间为74.6分钟±13.6分钟。所有患者中，5例需要输血，2例患者在90天内再次入院，无重大并发症。平均住院时间为2.8天±0.8天，22例患者（57.9%）出院后入住专业护理机构。有限的患者报告结局数据显示，与术前评分相比，术后6个月至1年时大多数结局评分有统计学显著改善。
ABMS入路在非agenarians中是安全有效的，这些患者可能受益于与ABMS入路相关的出血量减少和恢复时间缩短，这从低并发症发生率、相对较短的住院时间和与先前研究相比可接受的输血率中可见一斑。
