Uncemented total hip arthroplasty in octogenarian and nonagenarian patients
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While uncemented THA has proven benefits over cemented THA, the use of uncemented components in the elderly remains controversial. The purpose of this study was to compare functional outcomes and complication rates of uncemented THA in patients aged > 80 to patients aged < 80, and determine factors that independently influence functional outcomes.
The authors evaluated 411 consecutive uncemented THAs at a follow-up of 3.1 ± 0.9 years (range 1.8–5.2), using the Oxford hip score (OHS), EuroQol 5 Dimensions (EQ-5D) score, and noting any complications. The series was divided into two age groups: elderly group (> 80, n = 142) and control group (< 80, n = 269). Uni- and multi-variable regressions were performed to test associations between outcomes and patient age, BMI, American Society of Anaesthesiologists (ASA) score, canal bone ratio (CBR) and canal flare index (CFI).
The elderly group had femora with higher CBR (p < 0.001) and lower CFI (p = 0.002). The clinical scores were significantly worse for the elderly group, with a higher OHS (p = 0.039) and a lower EQ-5D score (p = 0.009), but there were no significant differences in overall complications rates (p = 0.500). Periprosthetic fractures were observed in three elderly patients (2.1%), compared to none of the younger patients (p = 0.041). Multi-variable regressions revealed that OHS was not correlated with any of the variables, while EQ-5D score was significantly associated with BMI (p = 0.015), ASA score (p = 0.024) and CBR (p = 0.019).
Clinical outcomes of uncemented THA do not depend on patient age per se, but on more specific preoperative characteristics such as ASA score, BMI and bone quality/morphology.
KeywordsTotal hip arthroplasty Uncemented components Elderly Periprosthetic fractures Bone quality Bone morphology
The authors are grateful to Mrs Alix Courouau and Sonia Dubreuil for their assistance with data collection, to Dr Aude Michelet for her help with manuscript redaction and to Mr Luca Nover for his support with tables formatting and submission.
Compliance with ethical standards
Conflict of interest
Authors LJ, JC and JCR have received fees for educational and promotional events from DePuy-Synthes. Authors LJ and JCR have received royalties from DePuy-Synthes. GT, HG and MS have received personal fees from Artro Institute.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
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