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Video: Prognosis Split for Hip Fracture and Hip Replacement in the Elderly

Tuesday, September 2, 2008 General News J E 4
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ROSEMONT, Ill., Sept. 2 As the United States along withthe rest of the Western population continue to age, hip fractures and hipreplacements will become a more serious concern for patients, families, andhealthcare systems. Elderly patients can have positive outcomes following hipreplacement surgery, but the extremely elderly hip fracture patient may facemore challenges. Additional levels of support and care are now necessary,according to two studies published in the September 2008 issue of The Journalof Bone and Joint Surgery.

One study looked at the outcomes for patients age 80 or older whounderwent total hip replacement surgery. Researchers found that outcomes fortotal hip replacement in patients who were 80 or older at the time of theirfirst 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 periprostheticfractures

The elderly patients had:

-- less implant wear and less frequent loosening of the total hipcomponents than their younger counterparts. Elderly women in particular hadless loosening overall than the men.

"We expected that the overall prognosis in elderly patients would be muchworse than that of the younger patients," says Daisuke Ogino, Ph.D., seniorvisiting scientist in the Department of Medicine at Helsinki UniversityCentral Hospital and the primary author of the study. "It was a positivesurprise that elderly people do so well both with regards to complications andlong-term results. This is apparently due to the additional attention that ispaid to optimize the patient's condition before, during, and after theoperation and rehabilitation, coupled with already somewhat diminished demandsof physical activity at that age."

The other study focused on the outcomes following hip fractures inpatients age 95 or older. Compared to the control group of patients age 75 to89, the older patient group had:

-- higher mortality rates

-- longer hospital stays, and were less likely to return home or to returnto previous levels of mobility

This is partly due to the fact that the 95-and-older group was in poorerhealth before the fracture and was less likely to be independently mobile andmore 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 30and 120 days after the injury.

"Due to the anecdotal experience of many orthopaedic surgeons, we alwaysfelt that the extremely elderly with hip fracture were simply older hipfracture patients," says Graeme Holt, MBChB, MRCS, an orthopaedic surgeon atGlasgow 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 patientsat risk. An understanding of this is essential in providing support for thesepatients 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. Thissurgery is most often performed because of urgent or emergent circumstances.Even though hip fracture surgery does present complications for the extremelyelderly age group the surgery must be done because these patients have pooreroutcomes if it is not performed. Modern techniques and early mobilizationhave also helped to reduce the morbidity and complications associated with hipfractures within this age group.To view the Multimedia News Release, go to:http://www.prnewswire.com/mnr/aaos/34597/

SOURCE American Academy of Orthopaedic Surgeons
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