Moderate strength evidence supports that increased age is associated with lower functional and quality of life outcomes in patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty.


There are four moderate and two low quality articles that support increased age is associated with lower functional and quality of life outcomes in patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty.  Specifically, older age is associated with lower mental and physical component SF-36, EQ-5D, and WOMAC scores (Badure-Brzoza 2008, Fujita 2016 & Stevens 2012). Older age is also associated with less sustained improvement in SF-36 and WOMAC scores (Gandhi 2010).  There is a non-linear association of age and EQ-5D scores with peak of improvement at age 65 then steeply declining around age 70 (Gordon 2014). Additionally, there is worsening of Oxford hip scores in patients older than 70 (Judge 2013), and patients older than 80 had an average Oxford hip score 3.81 points lower than patients in the 60-70 years cohort. Nonetheless, the change in functional status between younger and older patients was similar (Judge et al 2011; Aranda,Villalobos; Jones et al 2012; McHugh 2013; Quintana et al 2009).

In regard to mortality, there was one moderate and one low quality article demonstrating increased mortality with increasing age in patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty. Whittle 1993 showed a proportional increase of a hazard ratio of 2.4 per 10 year increase in age, which corresponds to a 3.75% 90 day mortality among patients 85 years of age or older.  McMinn 2012 demonstrated a similar trend of increasing mortality with increasing age. 

Four low quality studies showed an increased risk of revision surgeries in younger patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty. For selected studies, age under 65 was associated with increased risk of revision for aseptic loosening with uncemented prostheses with hazard ratios of 3.21 (Corten 2011) and 2.29 (Visuri 2002). Conversely, Katz 2012 reported a 2% risk of revision in the first 18 months followed by 1% for every year thereafter.  Similarly, McMinn 2012 showed that revision risk decreases with increasing age. 

  1. Judge,A.; Cooper,C.; Arden,N.K.; Williams,S.; Hobbs,N.; Dixon,D.; Gunther,K.P.; Dreinhoefer,K.; Dieppe,P.A. Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres. Osteoarthritis Cartilage; 2011/6: 6
  2. Katz,J.N.; Wright,E.A.; Wright,J.; Malchau,H.; Mahomed,N.N.; Stedman,M.; Baron,J.A.; Losina,E. Twelve-year risk of revision after primary total hip replacement in the U.S. Medicare population. J Bone Joint Surg Am; 2012/10/17: 20
  3. McHugh,G.A.; Campbell,M.; Luker,K.A. Predictors of outcomes of recovery following total hip replacement surgery: A prospective study. Bone Joint Res; 2013: 11
  4. McMinn, D.J.; Snell,K.I.; Daniel,J.; Treacy,R.B.; Pynsent,P.B.; Riley,R.D. Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study. 2012: 0
  5. Quintana, J.M.; Escobar,A.; Aguirre,U.; Lafuente,I.; Arenaza,J.C. Predictors of health-related quality-of-life change after total hip arthroplasty. Clin Orthop Relat Res; 2009/11: 11
  6. Stevens,M.; Paans,N.; Wagenmakers,R.; van,Beveren J.; van Raay,J.J.; van der Meer,K.; Stewart,R.; Bulstra,S.K.; Reininga,I.H.; van,den Akker-Scheek,I The influence of overweight/obesity on patient-perceived physical functioning and health-related quality of life after primary total hip arthroplasty. Obes.Surg; 2012/4: 4
  7. Visuri,T.; Turula,K.B.; Pulkkinen,P.; Nevalainen,J. Survivorship of hip prosthesis in primary arthrosis: influence of bilaterality and interoperative time in 45,000 hip prostheses from the Finnish endoprosthesis register. Acta Orthop Scand.; 2002/6: 3
  8. Aranda,Villalobos P.; Navarro-Espigares,J.L.; Hernandez-Torres,E.; Martinez-Montes,J.L.; Villalobos,M.; Arroyo-Morales,M. Body mass index as predictor of health-related quality-of-life changes after total hip arthroplasty: a cross-over study. J Arthroplasty; 2013/4: 4
  9. Badura-Brzoza,K.; Zajac,P.; Kasperska-Zajac,A.; Brzoza,Z.; Matysiakiewicz,J.; Piegza,M.; Hese,R.T.; Rogala,B.; Semenowicz,J.; Koczy,B. Anxiety and depression and their influence on the quality of life after total hip replacement: preliminary report. Int J Psychiatry Clin Pract; 2008: 4
  10. Corten,K.; Bourne,R.B.; Charron,K.D.; Au,K.; Rorabeck,C.H. What works best, a cemented or cementless primary total hip arthroplasty?: minimum 17-year followup of a randomized controlled trial. Clin Orthop Relat Res; 2011/1: 1
  11. Fujita,K.; Makimoto,K.; Mawatari,M. Three-year follow-up study of health related QOL and lifestyle indicators for Japanese patients after total hip arthroplasty. J Orthop Sci; 2016/3: 2
  12. Gandhi,R.; Dhotar,H.; Davey,J.R.; Mahomed,N.N. Predicting the longer-term outcomes of total hip replacement. J Rheumatol.; 2010/12: 12
  13. Gordon, M.; Greene,M.; Frumento,P.; Rolfson,O.; Garellick,G.; Stark,A. Age- and health-related quality of life after total hip replacement: decreasing gains in patients above 70 years of age. Acta Orthop; 2014/6: 3
  14. Judge,A.; Arden,N.K.; Batra,R.N.; Thomas,G.; Beard,D.; Javaid,M.K.; Cooper,C.; Murray,D. The association of patient characteristics and surgical variables on symptoms of pain and function over 5 years following primary hip-replacement surgery: a prospective cohort study. BMJ Open; 2013: 3