Total Hip Arthroplasty in the Older Population

Peter G. Passias, MD; James V. Bono, MD

Disclosures

Geriatrics and Aging. 2006;9(8):535-543. 

In This Article

Abstract and Introduction

Abstract

Total hip arthroplasty (THA) is one of the most commonly performed and successful operations in orthopedic surgery in terms of clinical outcome, implant survivorship, and cost-effectiveness. The average age for a patient undergoing a THA is 66 years. As life expectancy continues to increase in developed nations and the percentage of the population that is older than 65 years rises, THA surgery will be more frequently performed. This change in demographics is clinically relevant as the indications, risks involved, and outcomes are not identical to those of younger THA candidates. Osteoarthritis is by far the most common diagnosis among patients undergoing primary elective THA. Other common diagnoses include rheumatoid arthritis, other types of inflammatory arthritis, post-traumatic arthritis, and osteonecrosis of the femoral head. Patients that are candidates for THA have radiographic evidence of hip joint degeneration together with the clinical symptoms of disabling pain and functional limitation despite adequate nonsurgical management. The following article attempts to summarize some of the key issues regarding THA in an older population.

Introduction

Total hip arthroplasty (THA) has proven to be one of the most successful procedures performed in orthopedic surgery. This has been verified in numerous long-term studies that have reported clinical success rates in excess of 90% after a minimum of 10 years' follow-up. These studies used surrogates for clinical success rates that included patient satisfaction, pain reduction, functional improvement, and the absence of further surgery.[1] Total hip arthroplasty is also one of the most common elective surgeries performed in older adults. It is estimated that approximately 1-3% of the older adult population (those 65 years and older) will undergo THA at some point, with the average age being 66.[2] There are several distinct differences in terms of the prevalence of these underlying diagnoses in the older THA population compared with the younger THA population. There are also some potential indications for THA specific to the older population, such as displaced femoral neck fractures.

It is especially important in an older population to understand the risks and benefits that are involved when electing to proceed with a primary or revision THA. Although advances in anesthesia and surgical care have reduced complications for this age group, their complication rates remain higher when compared with younger patients.[3]

THA in the older population is becoming increasingly more relevant in the United States and Canada. As the population of these countries continues to age and life expectancy increases, older adults will constitute a larger segment of the population. A study by Mahomed et al.[4] looked at the epidemiology of both primary and revision total hip replacement in the U.S. Medicare population. They determined that primary THA was performed three to six times more often than revision THA. The rates of primary and revision THA increased with age until 75 years and 79 years, respectively. The rates of both procedures were higher among women than men, higher among whites compared to blacks, and higher in those with a higher income level. Table 1a and Table 1b are graphic presentations of the population of the United States (categorized by age and gender) in the year 2000 and projected values for 2050, respectively, according to the U.S. Census Bureau.

Figure 1 features an illustrated overview of THA, including its typical artificial components.

Figure 1.

Total Hip Arthroplasty

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