Our Summary

This research paper looks into the outcomes of joint replacements in people aged 90 and above (nonagenarians). The study was carried out at the Elective Orthopaedic Centre in Epsom, which keeps track of patient outcomes, including complications after surgery, and uses specific scores to measure hip and knee function and general health.

The researchers compared the results of joint replacement surgeries in nonagenarians with those in a group of patients aged 70-79, from April 2008 to October 2011. They found that the very elderly patients had lower hip and knee function before surgery, but they improved more in the first year after hip replacement surgery than the younger patients.

However, nonagenarians were more likely to need a blood transfusion after both hip and knee replacements, and they stayed in hospital longer after knee replacements. They also had higher death rates, but these were in line with what would be expected given their age.

Importantly, the study found that the overall outcome and satisfaction rates for hip or knee replacements in people aged 90 and above were similar to those in the 70-79 age group over a two-year period. In other words, very elderly people can benefit from these surgeries just as much as younger elderly people.

FAQs

  1. What were the main findings of the research on joint replacements in nonagenarians?
  2. How does the outcome of joint replacement surgeries in people aged 90 and above compare with those in the 70-79 age group?
  3. Are there any increased risks for nonagenarians undergoing hip or knee replacements?

Doctor’s Tip

A doctor might tell a patient considering hip replacement surgery to be aware of the potential need for a blood transfusion and a longer hospital stay, especially if they are in their 90s. However, they should also be reassured that the overall outcome and satisfaction rates for hip replacements in this age group are similar to younger patients, and that they can still benefit greatly from the surgery. It’s important to discuss any concerns or questions with your doctor before proceeding with the procedure.

Suitable For

Patients who are typically recommended hip replacement surgery are those who are experiencing severe hip pain, stiffness, and loss of mobility due to conditions such as osteoarthritis, rheumatoid arthritis, hip fractures, avascular necrosis, or other degenerative joint diseases. These patients may have tried non-surgical treatments such as medication, physical therapy, and assistive devices, but have not found adequate relief.

In general, candidates for hip replacement surgery are those who have:

  1. Moderate to severe hip pain that limits daily activities and affects quality of life.
  2. Hip pain that persists even at rest or during the night.
  3. Stiffness in the hip joint that limits range of motion.
  4. Failure of non-surgical treatments to provide relief.
  5. Radiographic evidence of severe joint damage or degeneration.

It is important for patients considering hip replacement surgery to undergo a thorough evaluation by an orthopedic surgeon to determine if they are suitable candidates for the procedure. Age alone is not a contraindication for hip replacement surgery, as evidenced by the study on joint replacements in nonagenarians. Ultimately, the decision to undergo hip replacement surgery should be based on a combination of factors including the individual’s overall health, functional status, and goals for surgery.

Timeline

Before hip replacement:

  • Patient experiences hip pain, stiffness, and limited mobility
  • Patient may have tried conservative treatments such as physical therapy, medications, and lifestyle modifications
  • Patient undergoes medical evaluation and imaging tests to determine if hip replacement is necessary
  • Patient discusses surgery with their doctor, including risks and benefits
  • Patient schedules surgery and prepares for the procedure

After hip replacement:

  • Patient undergoes surgery, typically lasting 1-2 hours
  • Patient spends a few days in the hospital for recovery and rehabilitation
  • Patient begins physical therapy to improve strength, flexibility, and mobility
  • Patient may experience temporary discomfort and swelling at the surgical site
  • Patient gradually resumes daily activities and returns to normal function
  • Patient follows up with their doctor for post-operative appointments and monitoring
  • Patient enjoys improved hip function, reduced pain, and increased quality of life.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with hip replacement surgery in someone of my age (90 and above)?
  2. How will my hip function and general health be assessed before and after the surgery?
  3. What specific measures will be taken to ensure a successful outcome for a hip replacement surgery in someone of my age?
  4. How long is the typical recovery period for a hip replacement surgery in someone of my age?
  5. What type of rehabilitation or physical therapy will be recommended after the surgery?
  6. Will I need assistance at home during the recovery period, and if so, for how long?
  7. Are there any specific lifestyle changes or modifications I should consider after the surgery?
  8. How often will follow-up appointments be necessary, and what signs or symptoms should I watch for that may indicate a complication?
  9. How will my overall quality of life be affected by a hip replacement surgery at my age?
  10. Are there any alternative treatments or interventions that may be more suitable for someone of my age, instead of hip replacement surgery?

Reference

Authors: Skinner D, Tadros BJ, Bray E, Elsherbiny M, Stafford G. Journal: Ann R Coll Surg Engl. 2016 Apr;98(4):258-64. doi: 10.1308/rcsann.2016.0095. Epub 2016 Feb 29. PMID: 26924477