Hip Replacement in the Very Elderly

Conclusion & Future Perspective

Elective THA is a safe and effective procedure that dependably improves the quality of life of very elderly patients. Advances in surgical techniques and medical management of patients having a hip replacement have led to a reduction of operating time, a reduction in the need for postoperative narcotics, more rapid ambulation and shorter hospital stays.

Patients with end-stage hip arthritis suffer quite terribly as their disease advances. The pain involved and the loss of function causes a significant impact on their quality of life. For very elderly patients this often translates into a loss of independence or loss of the ability to ambulate. In fact, joint replacement surgeons often hear their very elderly patients make comments implying that life is not worth living in their current state.

The current literature on patients having an elective hip replacement when older than 80 years of age reveals a low mortality rate of less than 2%. Even in patients over 90 years of age, a dramatic increase in mortality after surgery is not observed. Although the morbidity associated with THA increases with age, the majority of medical complications sustained perioperatively are transient and do not result in significant long-term effects. When appropriate medical precautions and preparations are considered, THA is a safe and effective procedure.

In the current healthcare climate, it is reasonable to question the cost–effectiveness of THA in the very elderly. To our knowledge, a rigorous analysis has not been completed, however, several authors have suggested that the dramatic improvement in quality of life and significant improvements in independence would likely balance or outweigh the cost of the procedure to the healthcare system.^[40,41] A rigorous study is needed to comment with accuracy on the cost–effectiveness of THA in the very elderly.

Most of the studies reporting on THA in the elderly were conducted more than 5 years ago, before the now common perioperative protocols gained widespread acceptance. These protocols have incorporated advances in anesthesia, surgical technique and pain and medical management that may further improve the success of THA in the very elderly population. Furthermore, many centers now have joint replacement programs that provide comprehensive preoperative and perioperative management protocols that may also improve outcomes. Contemporary studies are needed to accurately assess the improvements that have been realized in outcomes in the elderly population.

Aging Health. 2011;7(6):803-811. © 2011  Future Medicine Ltd.