Total Hip Arthroplasty Improves the Quality-Adjusted Life Years in Patients Who Exceeded the Estimated Life Expectancy

Abstract

Listen

Translate article

BackgroundHip osteoarthritis is a leading cause of functional decline and disability in the elderly. Although patients older than 80 years could significantly benefit from an elective total hip arthroplasty (THA), they pose a significant challenge to both anesthesiologist and arthroplasty surgeon. The purpose of this study was to report the clinical outcomes, complication rate, mortality, and quality-adjusted life year (QALY) of THA in patients who already exceeded the average life expectancy. MethodsPatients treated with elective THA for debilitating hip osteoarthritis and already exceeded the average life expectancy in Switzerland (n = 100) were included. The complication rate, QALY, and 30-day, 1-year, and midterm mortality were assessed retrospectively. ResultsThe overall complication rate was 12%. The 30-day and 1-year mortality was 3% and 6%, respectively. The Harris hip score increased significantly from an average of 50 preoperative to 93 points postoperative. Most of the patients (98%) had an improvement in the Harris hip score that was above the threshold for minimally significant change, whereas 75% reported an increase that exceeded the moderate improvement threshold. The average QALY was 4 years. ConclusionTHA might be a safe and cost-effective procedure for improving pain, function, and quality of life with low mortality in selected elderly patients who already exceeded the average life expectancy. Hence, the arthroplasty surgeons should not hesitate to operate relatively active, independent, and cognitively intact elderly patients having debilitating hip osteoarthritis based only on the patient’s age. Nevertheless, careful patient selection, surgical indications, and aggressive perioperative optimization might be necessary to minimize the risk of preoperative complications.