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Uncemented total hip arthroplasty in octogenarian and nonagenarian patients

  • Giuseppe Toro
  • Hugo Bothorel
  • Mo SaffariniEmail author
  • Laurent Jacquot
  • Julien Chouteau
  • Jean-Charles Rollier
Original Article • HIP - ARTHROPLASTY
  • 162 Downloads

Abstract

Purpose

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.

Methods

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).

Results

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).

Conclusion

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.

Keywords

Total hip arthroplasty Uncemented components Elderly Periprosthetic fractures Bone quality Bone morphology 

Notes

Acknowledgments

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.

Ethical approval

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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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Clinique d’ArgonayCentre le PériclèsAnnecyFrance
  2. 2.ReSurg SANyonSwitzerland
  3. 3.Artro InstituteAnnecy le VieuxFrance

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