Total hip arthroplasty in the very elderly: is it worthwhile?

Abstract

With an ageing population, more patients are being referred to orthopaedic department for possible total hip arthroplasty (THA). Many elderly patients have associated comorbidity factors and shorter life expectancy making the decision for surgery difficult. Rationalisation of the decision making process as to whether to proceed with THA in the very elderly hence can be extremely difficult. We attempted to analyse the mortality, morbidity and benefits after THA surgery in the very elderly population. Between 1987 and 2007, 58 patients over 90 years of age had THA surgery (male 19 and female 39). Patient’s notes were retrospectively analysed. The mean age at surgery was 91.9 years (range 90–95 years). There were 4 major and 11 minor post-operative complications with no immediate or late post-operative deaths. At the time of clinical follow up, the Harris Hip Score improved significantly (P < 0.0001) from a pre-operative mean of 18 points (range 10–44) to 38 points (range 30–75). The WOMAC Score improved significantly (P < 0.0001) from a pre-operative mean of 73 points (range 58–86) to 35 points (range 23–40). The mean age at death after THA was 96.1 years (95% CI 95.35–96.91) which was significantly longer (P < 0.001) when compared to the general population of similar age group. THA offers significant pain relief with better quality of life in the very elderly patients.