Hip Fracture, Replacement Outcomes Differ Among Elderly and Extreme Elderly Patients

Elderly patients can have positive outcomes following hip replacement surgery, but the extremely elderly hip fracture patient needs additional levels of support and care, according to 2 studies published in the September issue of The Journal of Bone and Joint Surgery.

The first study looked at the outcomes for patients aged 80 years or older who underwent total hip replacement surgery. Researchers found that outcomes for total hip replacement in these patients were actually as good as seen in younger patients. Elderly patients had less implant wear and less frequent loosening of the total hip components than their younger counterparts. Elderly women in particular had less loosening overall than the men. However, the elderly patients in the study did have more recurrent dislocations, because of diminished muscle strength, periprosthetic fractures, and infections.

“We expected that the overall prognosis in elderly patients would be much worse than that of the younger patients,” said lead author Daisuke Ogino, PhD, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. “It was a positive surprise that elderly people do so well both with regards to complications and long-term results. This is apparently due to the additional attention that is paid to optimise the patient’s condition before, during, and after the operation and rehabilitation, coupled with already somewhat diminished demands of physical activity at that age.”

The second study focused on the outcomes following hip fractures in patients aged 95 years or older. Compared to the control group of patients aged 75 to 89 years, the older patient group had higher mortality rates, longer hospital stays, and were less likely to return home or to return to previous levels of mobility. This is partly due to the fact that the older group was in poorer health before the fracture and was less likely to be independently mobile and more likely to be in institutional care at the time of the fracture. However, when adjusting for those factors, this group still had higher mortality at 30 and 120 days after the injury.

“Due to the anecdotal experience of many orthopaedic surgeons, we always felt that the extremely elderly with hip fracture were simply older hip fracture patients,” said co-author Graeme Holt, Glasgow Royal Infirmary, Glasgow, United Kingdom. “This paper shows us that this is an even more compromised group of patients at risk. An understanding of this is essential in providing support for these patients and their families.”

Source: American Academy of Orthopaedic Surgeons

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