Extreme Older THA Patients: Outcome Data

How different are total hip arthroplasty (THA) outcomes for extreme older patients as compared to younger THA patients? A new study from the Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, tackled this question and the results appear in a retrospective cohort study, “Patient outcomes after total hip arthroplasty in extreme elderly patients older than 80 years,” which appears in the July 1, 2020 edition of HIP International.

Wayne Moschetti, M.D., a member of the Department of Orthopaedics and Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine at Dartmouth College and co-author explained: “With the aging population we are seeing more elderly patients who are looking to maintain an active lifestyle. Dr. David Jevsevar and myself have published previously on, ‘The Cost-Effectiveness of Total Hip Arthroplasty in Patients 80 Years of Age and Older,’ and this study aimed to look at a similar topic.”

“Patients sometimes worry about ‘waiting too long’ before having their joint replaced and if they will have ‘the same result’ if they wait until they are older. This study aimed to answer that question and provide guidance to patients >80 years old who are entertaining the idea of having a hip replacement.”

The researchers obtained data from a large institutional repository of 2,327 consecutive THAs performed from April 2011 through July 2016. They looked for any associations between age and Patient-Reported Outcome Measurement Information System (PROMIS)-10 physical component summary (PCS) scores. They also measured the relationships between the magnitude of PCS change with length of stay (LOS), and facility discharge.

The authors enrolled patients older than 80 years who’d had 187 THAs (8.0%) and then compared their scores with 2,140 THA procedures performed on patients less than age 80. The team found that extreme elderly patients had similar adjusted odds of achieving clinically significant PCS improvement after THA and there were no statistical differences in adjusted postoperative PCS score improvements between the cohorts.

Importantly, the length of hospital stay for extreme elderly was just 0.68 days longer as adjusted and, the view of the research team, demonstrated higher adjusted odds of facility discharge following THA.

“For me, after conducting this study the results have been helpful in counseling patients older than 80 years considering hip replacement,” said Dr. Moschetti to OTW. “The message from our study is that extreme elderly patients (those >80 years old) had similar adjusted odds of achieving a clinically significant physical component summary (PCS) score from the Patient-Reported Outcome Measurement Information System (PROMIS)-10 after THA. Basically, they see a similar net improvement in their physical function as measured by the PROMIS-10 as those <80 years old. As one might expect, extreme elderly patients were associated with a slightly longer adjusted length of stay in the hospital and they had a higher adjusted odds of being discharged to a facility as opposed to home.”

“This study helps clinicians provide guidance to patients >80 years old who are entertaining the idea of hip replacement. We can inform patient choice by providing information in regards to expected physical function improvement, greater odds of non-home discharge as well as longer hospital stay. This can help with pre-operative planning for patients, families and clinicians. Studies like this also may help provide guidance when reimbursement and bundled payments get determined for joint replacement. This study relays that the value of joint replacement in this cohort of patients may be different compared to a younger cohort as the clinical improvement seen is similar but at a greater cost.”