Total hip replacement in patients eighty years of age and older
Total hip replacement in patients eighty years of age and older
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DOI：
10.2106/jbjs.g.00147
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发表时间：
2008-09-01
影响因子：
5.3
通讯作者：
Salo, Jari
中科院分区：
文献类型：
--
作者：
Ogino, Daisuke;Kawaji, Hiroyuki;Salo, Jari
背景资料：在发达国家，80岁及以上的老年人数量正在增加，同时全髋关节置换术的需求也在增加。我们分析了全髋关节置换术的患者在这个年龄组的数据从芬兰国家关节置换Registry.Methods：数据从芬兰关节置换术登记处对6540例（6989髋关节）谁是80岁或以上的全髋关节置换术的时间，在1980年和2004年之间进行了评估，使用生存分析。影响生存率的因素进行了调查，并确定了翻修的原因。结果：接受初次全髋关节置换术的患者平均年龄为82.7岁。全髋关节置换术后死亡的3065例患者的平均寿命为5.1年。以任何原因的全髋关节置换翻修术作为终点，Kaplan Meier生存率在5年（2617例髋关节）时为97%（95%置信区间，96%-97%），在10年（532例髋关节）时为94%（95%置信区间，93%-95%）。在195例需要翻修的髋关节置换术中，183例提供了翻修原因的信息。84例（46%）因无菌性松动翻修; 36例（20%）因复发性脱位翻修; 24例（13%）因假体周围骨折翻修; 23例（13%）因感染翻修。729例患者接受了混合固定（骨水泥型股骨柄和非骨水泥型髋臼杯）。结论：80岁以上患者行人工全髋关节置换术后，无菌性松动发生率低于年轻患者，但复发性脱位、假体周围骨折和感染在该年龄组更常见。股骨柄骨水泥固定的长期结果优于非骨水泥固定，表明其可提供更好的初始固定，因此使用寿命更长。
Background: The number of people eighty years of age and older in developed countries is increasing, with a concomitant increased demand for total hip replacement. We analyzed the outcomes of total hip arthroplasty for patients in this age group using data from the Finnish National Arthroplasty Registry.Methods: Data from the Finnish Arthroplasty Registry on 6540 patients (6989 hips) who were eighty years of age or older at the time of a total hip arthroplasty, performed between 1980 and 2004, were evaluated with use of survival analyses. Factors affecting survivorship rates were sought, and the reasons for revision were identified.Results: The mean age of the patients undergoing a primary total hip arthroplasty was 82.7 years. The mean longevity of 3065 patients who died following total hip arthroplasty was 5.1 years. With revision total hip arthroplasty for any reason as the end point, Kaplan Meier survivorship was 97% (95% confidence interval, 96% to 97%) at five years (2617 hips) and 94% (95% confidence interval, 93% to 95%) at ten years (532 hips). Of the 195 hip replacements that required revision, 183 had information on the reason for revision. Eighty-four (46%) were revised for aseptic loosening; thirty-six (20%), for recurrent dislocation; twenty-four (13%), for a periprosthetic fracture; and twenty-three (13%), for infection. Seven hundred and twenty-nine patients had undergone hybrid fixation (a cemented stem and a cementless cup). The survivorship of these replacements was significantly better than that for replacements with cementless fixation in 399 patients (p < 0.05).Conclusions: In patients who had a total hip arthroplasty when they were more than eighty years old, the prevalence of aseptic loosening was less than that encountered in younger patients, but recurrent dislocation, periprosthetic fracture, and infection were more common in this age group. Cementation of the femoral stem demonstrated better long-term results than cementless fixation, indicating that it may provide better initial fixation and, therefore, longer life-in-service.