The Journal of Bone and Joint Surgery (American). 2008;90:1884-1890.
doi:10.2106/JBJS.G.00147
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Total Hip Replacement in Patients Eighty Years of Age and Older

Daisuke Ogino, PhD1, Hiroyuki Kawaji, MD2, Liisa Konttinen, MSc3, Matti Lehto, MD, PhD4, Pekka Rantanen, MD, PhD5, Antti Malmivaara, MD, PhD6, Yrjö T. Konttinen, MD, PhD1 and Jari Salo, MD, PhD7

1 Department of Medicine, Helsinki University Central Hospital, Biomedicum Helsinki, P.O. Box 700 (Haartmaninkatu 8), FIN-00029 HUS, Finland. E-mail address for Y.T. Konttinen: yrjo.konttinen{at}helsinki.fi
2 Department of Applied Physics, Kuopio University, P.O. Box 1627, FIN-70211 Kuopio, Finland
3 ORTON Orthopaedic Hospital, Invalid Foundation, Tenholantie 10, FIN-00280 Helsinki, Finland
4 COXA Hospital for Joint Replacement, Biokatu 6 b, P.O. Box 652, FIN-33101 Tampere, Finland
5 National Agency for Medicines, Finnish Arthroplasty Registry, Mannerheimintie 103 b, P.O. Box 55, FIN-00301 Helsinki, Finland
6 FinOHTA, the Finnish Office for Health Technology Assessment, Lintulahdenkuja 4, PL 220, FIN-00531 Helsinki, Finland
7 Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Topeliuksenkatu 5, FIN-00260 Helsinki, Finland

Investigation performed at COXA Hospital for Joint Replacement, Tampere; ORTON Orthopaedic Hospital, Invalid Foundation, Helsinki; National Agency for Medicines, Helsinki; and Department of Medicine and Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Sigrid Jusélius Foundation, EVO grants, and Finska Läkaresällskapet. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: The number of people eighty years of age and older in developed countries is increasing, with a concomitant increased demand for total hip replacement. We analyzed the outcomes of total hip arthroplasty for patients in this age group using data from the Finnish National Arthroplasty Registry.

Methods: Data from the Finnish Arthroplasty Registry on 6540 patients (6989 hips) who were eighty years of age or older at the time of a total hip arthroplasty, performed between 1980 and 2004, were evaluated with use of survival analyses. Factors affecting survivorship rates were sought, and the reasons for revision were identified.

Results: The mean age of the patients undergoing a primary total hip arthroplasty was 82.7 years. The mean longevity of 3065 patients who died following total hip arthroplasty was 5.1 years. With revision total hip arthroplasty for any reason as the end point, Kaplan Meier survivorship was 97% (95% confidence interval, 96% to 97%) at five years (2617 hips) and 94% (95% confidence interval, 93% to 95%) at ten years (532 hips). Of the 195 hip replacements that required revision, 183 had information on the reason for revision. Eighty-four (46%) were revised for aseptic loosening; thirty-six (20%), for recurrent dislocation; twenty-four (13%), for a periprosthetic fracture; and twenty-three (13%), for infection. Seven hundred and twenty-nine patients had undergone hybrid fixation (a cemented stem and a cementless cup). The survivorship of these replacements was significantly better than that for replacements with cementless fixation in 399 patients (p < 0.05).

Conclusions: In patients who had a total hip arthroplasty when they were more than eighty years old, the prevalence of aseptic loosening was less than that encountered in younger patients, but recurrent dislocation, periprosthetic fracture, and infection were more common in this age group. Cementation of the femoral stem demonstrated better long-term results than cementless fixation, indicating that it may provide better initial fixation and, therefore, longer life-in-service.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


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