Age and THA- Associated Risk of Mortality
Limited strength evidence supports that increased age may be associated with a higher risk of mortality in patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty.

Rationale

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. 


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