Total hip replacement is safe for people in their 90s in reasonably good health, experts say.
Hip replacement surgery is on the rise, according to the – including among patients who are 75 and older. But is this major surgery a good idea for the oldest of the old – people in their 90s? Experts say is safe for 90-plus seniors in reasonably good health, and they deserve the same chance at pain relief and restored mobility as .
Encroaching Arthritis
Somebody over 90 would have the same reasons as others to consider hip replacement, says Dr. Alexander Miric, an at Kaiser Permanente in Los Angeles. One common cause is . The rate and severity of arthritis increases with age, he says, so it tends to be extremely advanced for arthritic patients in their 80s and 90s.
“The ability to walk, the ability to do tasks, to live their lives independently – that’s important to all of us, but particularly to people of that age,” Miric says. When people can no longer function because of pain and disability, he says, “joint replacement can have a profound effect.”
Hip-Fracture Fallout
A hip fracture is the other primary reason for hip replacement in elderly patients, says Dr. Sharat Kusuma, director of adult reconstruction at Grant Medical Center in Columbus, Ohio.
For somebody in their 80s or 90s, a broken hip “is an operative injury,” Kusuma says. “The hip bone is not the kind of bone that would heal on its own without some type of plates and screws, and some type of rod.”
When a fall results in hip trauma for an elderly patient, “a hip replacement is a pretty good option, because we can immediately get them up and walking the very next day after surgery, Kusuma says. Recovery is much longer if surgeons try to fix the broken hip, he adds.
Hip replacement after a bad fall presents a different scenario than elective surgery for arthritis cases, Miric says. “If someone has fallen and broken their hip, then surgery is a lifesaving procedure,” he says. “Because the mortality of broken hip without surgery is extremely, extremely high.”
Outlook for 90-Somethings
Last year, Miric looking at how patients in their 90s fared with total hip replacement compared to younger patients, using a Kaiser database of more than 43,000 procedures performed nationwide over a decade. Of those, 183 patients were in their 90s – believed to be the most such cases analyzed in a single study.
For patients in the 90-plus group, hospital stays afterward were slightly longer – about a half-day more than for the youngest patients. Readmission rates were higher for the oldest group within the first three months.
While all patients in their 90s survived the surgery and postoperative periods, their death rate was higher at one year after surgery, at 5.5 percent. In contrast, the one-year mortality rate was 3.2 percent for patients in their 80s and less than 1 percent for patients under 80. (For context, Miric notes that in the general population, people age 90-plus have higher one-year death rates than the study patients.)
In the study, for complications such as infections, deep vein blood clots or lung embolisms, surgical risks were no higher for patients in their 90s.
The 90-plus group of patients did better than expected from older studies with fewer patients. Improved surgical and anesthetic techniques, better medications and possibly all contribute, Miric says. For surgeons in the field, he adds, the study “confirms what many of us suspected – that these patients can do quite well.”
Medical Issues
“If you’re lucky enough to reach the age of 90, you are likely to have more medical issues,” Miric says. The oldest patients in Miric’s study were more prone to have heart conditions before surgery, for example – although less likely to have diabetes.
Older patients can be frail, Kusuma says, and with severe frailty comes a higher risk of complications. “Certainly, in that case we would offer nonoperative treatments, like injections,” he says. “But that decision should be made on an individual basis, not just a blanket decision based on their age.”
Brain health is a concern, he says, and would rule out a patient. “In terms of other organ systems, if [patients'] hearts and lungs are healthy, and they have no history of heart attack, or any types of lung problems or pneumonia, that would be a good candidate,” he says.
Limited mobility – from causes beyond the problem hip – would be a concern. “For example, somebody who’s had other fractures or musculoskeletal problems that prevent them from being mobile is clearly not a good candidate,” Kusuma says. But if a failing hip is their only barrier to getting around, that’s a different story.