Article

High age is associated with increased postoperative
mortality, but the factors that predict mortality in older hip and knee
replacement recipients are not known. Methods : Preoperative clinical and operative
data on 1,998 primary total hip and knee replacements performed for
osteoarthritis in patients aged >/= 75 years in a single institution were
collected from a joint replacement database and compoared with mortality data.
Average follow-up was 4.2 (2.2-7.6) years for the patients who survived. Factors
associated with mortality were analyzed using Cox regression analysis, with
adjustment for age, sex, operated joint, laterality, and anesthesiological risk
score. Results Mortality was 0.15% at 30 days, 0.35% at 90 days, 1.60% at 1 year,
7.6% at 3 years, and 16% at 5 years, and was similar following hip and knee
replacement. Higher age, male sex, American Society of Anesthesiologists risk
score of > 2, use of walking aids, preoperative walking restriction (inability to
walk or ability to walk indoors only, compared to ability to walk > 1 km), poor
clinical condition preoperatively (based on clinical hip and knee scores or
clinical severity of osteoarthritis), preoperative anemia, severe renal
insufficiency, and use of blood transfusions were associated with higher
mortality. High body mass index had a protective effect in patients after hip replacement. Interpretation Postoperative mortality is low in healthy old joint
replacement recipients. Comorbidities and functional limitations preoperatively
are associated with higher mortality and warrant careful consideration before
proceeding with joint replacement surgery.

Langue : ANGLAIS