Department of Surgery and Orthopaedics, Kungälvs Hospital, Kungälv; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg; Swedish Arthroplasty Register, Gothenburg, Centre of Registers Västra Götaland, Gothenburg, Sweden.
Acta Orthop. 2023 Sep 22;94:477-483. doi: 10.2340/17453674.2023.18656.
Few studies have focused on nonagenarians treated with total hip arthroplasty (THA). We investigated 30- and 90-day postoperative mortality, patient-reported outcome measures (PROMs), reoperation rate, risk factors for reoperation, and relative patient survival in nonagenarians or older.
167,091 patients with primary cemented THA performed for osteoarthritis between 1992 and 2019 were identified in the Swedish Arthroplasty Register. Patients were divided into age groups based on age at time of surgery: 60-74 (n = 90,285), 75-89 (n = 75,421), and > 90 years (n = 1,385). Mortality rate, PROMs (pain-Likert scale, satisfaction-Likert scale, EQ-VAS, n = 67,553), reoperation rate, risk factors for reoperation, and relative patient survival were studied.
The nonagenarians had the highest postoperative mortality rate, 1.7% and 2.6% at 30 and 90 days, respectively. Nonagenarian females reported significantly lower pre- and postoperative EQ-VAS compared with patients aged 60-89 years but reported least pain and highest patient satisfaction 1 year after surgery. At 2 years the nonagenarians had highest reoperation frequency-2.7%-due to infection (1.5%), dislocation (0.8%), and periprosthetic fracture (0.4%). Increasing age, male sex, and polished stem were associated with higher risk of reoperation within 2 years. 8-year age- and sex-matched relative survival was highest among nonagenarians (study group/matched population: ≥ 90 years 3.4, 95% confidence interval [CI] 3.0-3.8; 75-89 years: 1.4, CI 1.4-1.4, and 60-74 years: 1.1, CI 1.1-1.1).
30- and 90-day postoperative mortality and reoperation rates were higher in nonagenarians but PROM data showed least pain and highest patient satisfaction 1 year after surgery with THA among female nonagenarians with primary osteoarthritis.
很少有研究关注接受全髋关节置换术（THA）治疗的 90 岁以上老年人。我们调查了 90 岁以上或更年长患者的 30 天和 90 天术后死亡率、患者报告的结局测量（PROM）、再次手术率、再次手术的风险因素以及相对患者生存率。
在瑞典关节置换登记处，我们确定了 1992 年至 2019 年间因骨关节炎行初次骨水泥 THA 的 167091 例患者。根据手术时的年龄将患者分为年龄组：60-74 岁（n=90285）、75-89 岁（n=75421）和>90 岁（n=1385）。研究了死亡率、PROM（疼痛李克特量表、满意度李克特量表、EQ-VAS、n=67553）、再次手术率、再次手术的风险因素以及相对患者生存率。
90 岁以上老年人的术后 30 天和 90 天死亡率最高，分别为 1.7%和 2.6%。90 岁以上女性患者在术前和术后的 EQ-VAS 评分均明显低于 60-89 岁患者，但在手术后 1 年报告疼痛程度最低，满意度最高。在 2 年内，90 岁以上老年人的再次手术频率最高-2.7%-原因是感染（1.5%）、脱位（0.8%）和假体周围骨折（0.4%）。年龄增长、男性和抛光柄与 2 年内再次手术的风险增加相关。8 年年龄和性别匹配的相对生存率在 90 岁以上老年人中最高（研究组/匹配人群：≥90 岁 3.4，95%置信区间[CI]3.0-3.8；75-89 岁：1.4，CI 1.4-1.4，60-74 岁：1.1，CI 1.1-1.1）。
90 岁以上老年人的 30 天和 90 天术后死亡率和再次手术率较高，但 PROM 数据显示，在原发性骨关节炎女性 90 岁以上患者中，THA 术后 1 年疼痛程度最低，患者满意度最高。
