As more Americans are living well into their 90s, the number of nonagenarian total hip replacement (THR) candidates continues to increase. In the study, "Total Hip Arthroplasty Proves Safe for Nonagenarian Patients," presented at the at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), researchers reviewed patient characteristics and rates of postoperative morbidity, mortality and readmission among patients who underwent elective THR surgery between April 2001 and December 2011.
Of the 43,543 THRs performed during this period, only 183 were performed on nonagenarians (0.4 percent). Before surgery, nonagenarians had the highest prevalence of peripheral vascular disease, hypertension and valvular heart disease, increasing their risk of surgical complications. Nonagenarian patients had the highest incidence of death within 90 days (2.7 percent compared to the overall average of 0.4 percent), and the highest rate of readmission within 90 days (15 percent compared to 10.3 percent for patients aged 80 to 89, and 6.3 percent for those younger than 80).
Length of hospital stay was comparable for nonagenarians (3.4 days) to octogenarians (3.3 days), and the patients in their 90s showed no significant differences in the incidence of surgical site infection or pulmonary embolisms.
The authors of the study concluded that nonagenarian patients can safely undergo a THR, despite advanced age and a higher prevalence of comorbidities. Overall, the nonagenarian patients experienced a complication rate comparable to those of younger THR patients, and the higher mortality rate is well within expectations for individuals age 90 and older.