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

Two studies look at possible outcomes for older hip patients

ROSEMONT, Ill., Sept. 2 /PRNewswire/ -- 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.

To view the Multimedia News Release, go to:
http://www.prnewswire.com/mnr/aaos/34597/

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.
SOURCE American Academy of Orthopaedic Surgeons

Catherine Dolf, +1-847-384-4034, +1-847-894-9112 Cell, dolf@aaos.org, or
Lauren Pearson, +1-847-384-4031, +1-224-374-8610 Cell, lpearson@aaos.org, both
of American Academy of Orthopaedic Surgeons