Aseptic Revision Total Hip Arthroplasty in the Elderly: Is There a Higher Incidence of Early Complications.

Abstract

The demand for revision total hip arthroplasty (rTHA) is increasing. There is conflicting evidence on whether rTHA in elderly patients (age ≥ 80 years) predisposes them to increased early complications compared to younger patients. Our goal was to compare 90-day complications, readmissions, and reoperations following aseptic rTHA between the two age groups. We retrospectively identified all patients who underwent aseptic rTHA at a single academic institution from 2002 to 2023. Patients who had a history of periprosthetic joint infection, less than 90-day follow-up, or missing data were excluded. A total of 124 patients aged ≥ 80 years were eligible and matched to 124 rTHA patients aged less than 80 years identified during the same time period, using 1:1 propensity score-matching based on revision type (modular exchange, single-component, or two-component revision), body mass index (BMI), sex, and American Society of Anesthesiologists (ASA) score. Demographic data and 90-day medical and surgical complications, readmissions, and all-cause reoperation were analyzed using nonparametric tests and multivariate regression models. The Charlson Comorbidity Index (CCI) was significantly higher in the ≥ 80 group (P < 0.001). No differences were observed in rTHA indications (all P > 0.132) or 90-day medical or surgical complications (all P > 0.052). Patients ≥ 80 years were more likely to undergo reoperation for dislocation (P = 0.035), though the difference was small and likely not clinically relevant. In the multivariate analysis, this cohort had statistically lower odds of infection (OR [odds ratio] 0.104 [0.011 to 0.937]; P = 0.044). No significant differences were observed in overall complications, readmissions, or reoperation rates at 90 days (all P > 0.222). Despite the higher CCI, patients ≥ 80 years overall had acceptable and mostly comparable odds of early postoperative outcomes following aseptic rTHA, although with statistically lower odds of infection, but higher odds of reoperation for dislocation. These findings suggest that aseptic rTHA can be safely performed in elderly patients if appropriately indicated and medically optimized before surgery.