Artroplastia total de cadera primaria electiva no cementada en octogenarios. Estudio de caso-control

Abstract

ObjectiveTo evaluate the results and efficacy of cementless total hip arthroplasty (THA) in octogenarians with osteoarthritis. Material and methodsMatched case-control study with ratio 1:2. Consecutive selection of 54 octogenarians (55 hips), and 106 control patients (110 hips) with age ranging from 70 to 79 years. Mean follow-up of 7 years (range: 5-12). Before 5 postoperative years, 1 and 4 patients, respectively, died and they were excluded. Clinical assessment was performed using ASA grade, comorbidities, and Harris and Merle D’Aubigné hip scores, and radiographic, complications, and mortality evaluations were made. ResultsThere were no perioperative deaths in either cohort. The rates of postoperative medical complications (P=.601) and survival (P=.360) were similar. The survival at 7 years was 89.8% in octogenarian and 95.3% in controls, with no influence of the preoperative variables. There were no differences in postoperative functional outcomes (P=.761), but improvement respect to the preoperative was higher in octogenarian (P=.002). In octogenarians there were 2 intraoperative fractures, 2 dislocations and 2 unstable stems, and in control patients 1 deep infection, 1 peri-prosthetic femoral fracture, 2 unstable cups and 4 unstable stems. The rates of aseptic complications, the need for revision, and arthroplasty survival (94% at 7 years) were similar in both cohorts. DiscussionDue to improvement in health status, the octogenarian may have a life expectancy of at least 10 years. The cost arguments and an arbitrary age should not influence the selection of candidates for cementless THA. ConclusionsCementless THA has been shown to be safe and effective in octogenarian patients with osteoarthritis. The notable increase found in functional outcomes justifies the continued use in these patients.