Total Hip and Knee Arthroplasty in Patients Older Than 80 Years

We are grower older as a nation at a rapid rate. In fact, the fastest growing age group in the US includes people 65 years old and older. Between 2000 to 2010 the growth rate for this segment of the population was 15.1% while the rest of the population grew at a rate of 9.7%.

Among those age 65 and older, the subgroup that had the most rapid rate of growth includes those ages 85 to 94 years. This group grew from 3.9 million to 5.1 million (30%) between 2000 and 2010.

And growth rates for those 95 years old and older were also impressive.

From an orthopedic preceptive this means that there will likely be a hiphigher incidence of orthopedic conditions associated with age including osteoporosis and osteoarthritis.

It is predicted that demand for total knee replacements will increase 673% by the year 2030 and total hip replacement demand will increase 174%. It is also predicted at there will be an increase in the number of patients that undergo joint replacement surgery who are over the age of 80.

Perhaps not surprisingly, as we age, the risk and complication rate at the time of surgery tends to increase.

Authors Lee Rubin, M.D. et al. in the October 2016 American Academy of Orthopedic Surgeon Journal reported on total hip and knee arthroplasty in patients over a 80 years old.

Three major studies combined data comparing two large age groups and their respective post operative complication rates: over age 80 and under age 80. The researchers found that the mortality rate under age 80 was 0.3 – .08% compared to 3.2-17.1 percent for patients over age 80.

The incidence of heart attacks under age 80 was 0.5 – 0.8 percent compared to patients over age 80 at 1.1 – 1.8 percent.

The incidence of pneumonia was 0.3 – 0.4 percent for those under age 80 compared to the over age 80  group which is 0.5 – 0.9 percent.

Urinary tract infections also increased in the 80 year old group compared to the under age 80 year group at 1.7 – 2.0 percent compared to 2.6 – 4.4 percent.

The authors conclusion was that the orthopedic surgeon should partner with the hospitalist and geriatricians to help decrease the postoperative risks that are age related. They noted that with the team approach, patients over age 80 can successfully undergo primary total hip replacements, total knee replacements and revisions with excellent results. The orthopedic surgeon should always make the patient and the patient’s family aware that the risks and complication rates are higher in the older patient population, but a team approach will be utilized to make their surgical procedure as safe as possible