Joint replacement in the geriatric orthopaedic patient

Abstract

Total hip arthroplasty and total knee arthroplasty are two of the most commonly performed orthopaedic procedures. With the tremendous success in relieving pain and restoring function, the indications for total joint arthroplasties (TJA) have been extended to the elderly patient. As the elderly portion of our population increases in both absolute and percentage terms we can expect an increased demand for TJA. This paper reviews the particularities of performing TJA on the elderly patient. The goal of this paper is to provide the orthopaedic surgeon with a framework within which to care for the elderly TJA patient. We discuss the nonoperative management of lower extremity arthritis. We review the orthopaedic preoperative assessment of the elderly patient and the role of medical internists and subspecialists to determine surgical risk and to identify and prevent potential postoperative complications. Specific surgical considerations are addressed for performing TJA on the elderly patient and techniques for both a hybrid total hip arthroplasty and a cemented total knee arthroplasty are discussed. Postoperative management considerations are then addressed.