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Undergoing the rigors of hip or knee surgery at 90 years or older (nonagenarians) is, understandably, cause for concern and hesitation.

But a group of researchers in California decided to look at the data and determine, objectively, if these patients indeed have an increased risk of complications and hospital readmission as compared with octogenarians and septuagenarians.

Their work, “Hip and Knee Arthroplasty Outcomes for Nonagenarian Patients,” was published in the November 15, 2022, edition of the Journal of the American Academy of Orthopaedic Surgeons.  This study was reviewed in an article published by Orthopedics This Week (OTW).

Co-author William Bugbee, M.D. chief of the Joint Preservation and Cartilage Restoration Service at Scripps Clinic in La Jolla, told OTW, “As our population ages and more people are living active lives into their nineties and beyond, we are more and more frequently confronted with elderly patients that are suffering with life-defining arthritis of the hip or knee. These patients, like their younger counterparts, are seeking ways to improve the quality of their lives and maintain their independence and mobility and have not had success with nonsurgical care.”

It is now commonplace to perform joint replacement in patients in their seventies and eighties but much less common to do so when people are in their nineties. We felt that there was not enough data to guide us, as surgeons, to provide a clear risk, benefit counseling regarding joint replacement for these very elderly patients.”

Mining the Scripps database, the researchers identified patients aged 90 or older who had primary unilateral total joint arthroplasty (TJA) from 2010 to 2017 by one of five surgeons. A total of 58 nonagenarians were identified, with 31 undergoing total hip arthroplasty (THA) and 27 undergoing total knee arthroplasty (TKA). The researchers matched each nonagenarian with an octogenarian (age 80 to 84 years) and septuagenarian (age 70 to 74 years). The researchers noted complications – either medical or orthopedic – that occurred intraoperatively, during hospital admission, and after hospital discharge.

The team found that nonagenarians had the highest rate of medical complications (33%) compared with octogenarians (14%) and septuagenarians (3%). However, the rates of surgical (orthopedic-related) complications were not statistically different among nonagenarians (12%), octogenarians (9%), and septuagenarians (10%). Hospital readmission rates were highest in nonagenarian patients (11%) but were not statistically different compared with octogenarians (5%) or septuagenarians (2%).

“First, unsurprisingly, complication rates increased with age,” stated Dr. Bugbee to OTW. “Nonagenarians had a higher overall complication rate, but most of these were minor and resolved over time. Importantly, deaths were not more frequent in the oldest group.”

“Elderly patients are generally most worried about being either ‘more crippled’ or dying when undergoing elective orthopaedic surgery. We found here was no statistically significant difference in orthopaedic complications or mortality in the older cohort of patients in their nineties compared to patients in their seventies or eighties. Furthermore, these patients are just as happy with their outcome as any other group.”

I believe that this study demonstrates that age alone should not be an absolute contraindication to joint replacement surgery and that nonagenarians with severe hip or knee arthritis should be afforded the opportunity to choose surgical care as an alternative to the status quo of their lives. Surgical care involves risk at any age, but we can now better define that risk for this group of nonagenarian patients.”