Authors: Stephen Zak BA, Katherine Lygrisse MD, Alex Tang BS, Chelsea Sue Sicat MS, Morteza Meftah MD, William J. Long MD, Ran Schwarzkopf MD MSc
Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health
Abstract
Introduction
Over the coming decades, the number of octogenarians, nonagenarians, and even centenarians who will require a total hip arthroplasty (THA) and/or total knee arthroplasty (TKA) will rise disproportionally. Improvements in anesthetic/surgical technique, blood management, and postoperative opioid-sparing pain
pathways have made total hip arthroplasty in older populations increasingly successful. In a value-based system where operative outcomes are linked to hospital payments, it is necessary to assess the outcomes in this population.
Objective
The purpose of this study is to evaluate and compare patient reported outcomes and operative outcomes of
elective primary THA patients ≥80 years old to a younger cohort of patients <80 years old.
Methods
A retrospective review of 10,860 consecutive total hip arthroplasty (THA) cases from 2011-2019 was conducted. Any cause of 90-day postoperative complications including myocardial infarction, periprosthetic joint infection, dislocation, aseptic loosening, and mortality was recorded. 90-day postoperative emergency-department (ED) and non-emergency department (non-ED) readmission were also noted. Pre- and post-operative patient-reported outcome (PRO) scores including the Hip disability and Osteoarthritis Outcome Score (HOOS) and Forgotten Joint Score 12 (FJS-12) and their delta improvements (Δ) at 12-weeks
and 1-year postoperatively were collected. Multivariate linear regression analysis was utilized to account for demographic differences such as race and BMI
when assessing the differences in dependent variables between the two groups.
Results
10,251 patients younger than 80-years were identified with an average age of 61.60 ± 10.71 years. The older cohort had 609 patients with an average
of 84.25 ± 3.02 years. The older cohort had a statistically greater surgical
risk than the younger cohort as defined by: (1) A higher American Society of Anesthesiologists (ASA) score for physical status (2.74 ± 0.63 vs 2.30 ± 0.63; p<0.0001) (2) A higher Charleston Comorbidity Index (CCI) score (6.26 ± 1.71 vs 3.87 ± 1.98; p <0.0001).
The older cohort had a longer length of stay (LOS) (3.5 vs 2.5 days; p <0.0001). The younger cohort had a significantly higher rate of readmissions (3.88% vs 2.18%; p=0.048). There was no statistical difference in other clinical outcomes: 90-day ED visits, 90-day myocardial infarction (MI), 90-day prosthetic joint infection (PJI), and 90-day aseptic loosening. Controlling for demographic disparities, there was no significant difference between patient reported outcome (PRO) scores between cohorts.
Average pre-operative HOOS score for the younger was 50.75, while the average score for the older cohort was 51.12 (p=0.956). FJS scores were not collected preoperatively. Average FJS scores at 12-weeks for the younger cohort was 50.23 and 55.85 for the older cohort (p=0.367). There was no difference in preoperative to 12- week delta HOOS scores between groups (p=0.509). There was no difference in pre-operative to 1-year delta HOOS scores between groups (p=0.0152). There was also no difference in 12-week to 1- year delta HOOS scores between groups (p=0.413). The delta FJS-12 scores were also similar
between each group (p=0.840).