Perioperative outcome of primary total hip arthroplasty in octogenarians - A systematic review

Osteoarthritis (OA), a degenerative disease, frequently necessitates the replacement of the affected joint, commonly involving the hip. With increasing life expectancy and the anticipated rise in OA incidence, the demand for Total Hip Arthroplasty (THA) is expected to surge, particularly among Octogenarians. The elderly are often perceived as a vulnerable patient group, with concerns about their eligibility for THA primarily based on age alone.

Aims: There is a prevailing presumption that Octogenarians face an elevated risk of perioperative mortality, increased complication rates, and prolonged hospital stays.This systematic review aimed to compare perioperative outcomes after THA in Octogenarians, with primary outcomes being mortality and length of stay in hospital.

Methods: A systematic screening of 33,336 titles from the PubMed and Web of Science databases following Cochrane Handbook for Systematic Reviews and PRISMA guidelines was performed. Eight publications about THA met inclusion criteria for final analysis, Studies underwent evaluation for certainty of evidence according to GRADE criteria.

Results: Eight studies were included in this systematic review, covering data from 494,144 patients.Perioperative mortality rates varied between 0.33 % and 1.96 % in the older cohort. The duration of hospital stay was longer among Octogenarians compared to their younger counterparts across all publications. Surgical complications were similar in elderly and younger patients. Although elderly patients generally experienced higher rates of medical complications, differences were subtle.

Conclusion: Age alone should not hinder performance of THA in Octogenarians. This systematic review underlines that eligibility for a procedure should be based on comorbidities and overall health status. Important findings from international guidelines for improving safety in elderly undergoing THA were included, but further research is needed to ensure optimal perioperative management of risk factors and potential complications.