Prognosis Split for Hip Fracture and Hip Replacement in the Elderly

Newswise — As the United States along with the rest of the Western population continue to age, hip fractures and hip replacements will become a more serious concern for patients, families, and healthcare systems. Elderly patients can have positive outcomes following hip replacement surgery, but the extremely elderly hip fracture patient may face more challenges. Additional levels of support and care are now necessary, according to two studies published in the September 2008 issue of The Journal of Bone and Joint Surgery.

One study looked at the outcomes for patients age 80 or older who underwent total hip replacement surgery. Researchers found that outcomes for total hip replacement in patients who were 80 or older at the time of their first surgery were actually as good as in younger patients.

However, the elderly patients in the study did have more: "¢ recurrent dislocations, because of diminished muscle strength "¢ fractures around the artificial joint, known as periprosthetic fractures "¢ infections

The elderly patients had: "¢ less implant wear and less frequent loosening of the total hip components than their younger counterparts. Elderly women in particular had less loosening overall than the men.

"We expected that the overall prognosis in elderly patients would be much worse than that of the younger patients," says Daisuke Ogino, Ph.D., senior visiting scientist in the Department of Medicine at Helsinki University Central Hospital and the primary author of the study. "It was a positive surprise that elderly people do so well both with regards to complications and long-term results. This is apparently due to the additional attention that is paid to optimize the patient's condition before, during, and after the operation and rehabilitation, coupled with already somewhat diminished demands of physical activity at that age."

The other study focused on the outcomes following hip fractures in patients age 95 or older. Compared to the control group of patients age 75 to 89, the older patient group had: "¢ higher mortality rates "¢ longer hospital stays, and were less likely to return home or to return to previous levels of mobility

This is partly due to the fact that the 95-and-older group was in poorer health before the fracture and was less likely to be independently mobile and more likely to be in institutional care at the time of the fracture. However, when adjusting for those factors, this group still had higher mortality at 30 and 120 days after the injury.

"Due to the anecdotal experience of many orthopaedic surgeons, we always felt that the extremely elderly with hip fracture were simply older hip fracture patients," says Graeme Holt, MBChB, MRCS, an orthopaedic surgeon at Glasgow Royal Infirmary in the United Kingdom and co-author of the study. "This paper shows us that this is an even more compromised group of patients at risk. An understanding of this is essential in providing support for these patients and their families."

While total hip replacement surgery is often times an elective procedure, surgery for hip fracture, especially in the extremely elderly is not. This surgery is most often performed because of urgent or emergent circumstances. Even though hip fracture surgery does present complications for the extremely elderly age group the surgery must be done because these patients have poorer outcomes if it is not performed. Modern techniques and early mobilization have also helped to reduce the morbidity and complications associated with hip fractures within this age group.

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