How old is too old to have a painful hip replaced (THR)? Kathleen Doheny, writing for Health Day Reporter, reports on a study that found that patients in their 90s can have results comparable to those of younger patients.
90 Not too Old for THR
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Alexander Miric, M.D., an orthopedic surgeon at Kaiser Permanente, in Los Angles, compared the results of hip replacement surgery in 183 patients who were aged 90 and above to the results of more than 43, 000 hip replacement surgeries performed on younger patients. The result? “Being in your 90s need not disqualify you from having a hip replacement surgery, ” Miric said.
For their study, according to Doheny, Miric and members of his team analyzed hip replacement surgeries done between April 2001 through December 2011.They compared patients from three age groups, those younger than 80, those 80 to 89 and patients 90 years old and older looking for differences in hospital stay, complications after surgery, readmissions to the hospital after 90 days and death rates.
None of the aged 90 and over patients had serious blood clots, though 1.2% of those in the 80 year range did. The 90-year-old patients stayed in the hospital an average of 3.4 days compared to 2.8 days for the younger than 80 group and 3.3 days for those in their 80s. The patients in their 90s were the group most likely to be readmitted to the hospital within three months following surgery. They also had the highest death rate within the 90 day follow-up period, totaling 2.7% compared with 1.3% for patients in their 80s and 0.2% for those under 80.
Doheny quoted Craig Della Valle, M.D., a professor of orthopedic surgery at Rush University Medical Center in Chicago, who reviewed but was not involved in the study, as saying, “Most folks who live to 90 years old and have symptomatic arthritis are generally a pretty hardy crowd. If they are healthy enough that their arthritis bothers them, it usually means they are active and can tolerate elective surgery.”
Doheny reported Miric as commenting, “If you are in your 90s, it is reasonable to have that conversation [about surgery] with your surgeon.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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