title: In-hospital complications following primary total hip and knee arthroplasty in octogenarian and nonagenarian patients.
abstract: BACKGROUND
  As life expectancy of patients increases, more elderly patients are undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). There is a general perception of increased risk of complications in elderly patients. Our objective was to analyse the incidence of in-hospital medical and surgical complications following THA and TKA in octogenarian and nonagenarians.
  
  
  METHODS
  This was a prospective review of 202 consecutive patients aged more than 80 years who underwent total hip and total knee arthroplasty (101 THA, 101 TKA) over an 18-month period. In this single-centre observational study, collected data included patient demographics, American Society of Anethesiologists (ASA) grade, length of hospital stay and peri-operative medical and surgical complications during their hospital stay.
  
  
  RESULTS
  Median age of patients was 83 years. Median ASA grade was 3. Mean length of hospital stay was 7.5 days. There were 14 major systemic complications in the THA group and 13 in the TKA group. While 1 major local complication occurred in each group, there were 6 minor local complications in THA and 7 in the TKA group. All the complications occurred within 5 post-operative days. There was no in-hospital mortality.
  
  
  CONCLUSIONS
  In our study, we found that the incidence of peri-operative medical and surgical complications is higher in those over 80 years, compared to the published literature in patients of all age groups undergoing THA and TKA. Awareness of a higher incidence of major systemic complications should alert the treating surgeon to carry out comprehensive peri-operative management in this subset of patients, which could lead to better outcomes.
authors.affiliation: Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE, UK, shashikumartn@gmail.com.
authors.forename: Shashi K
authors.initials: SK
authors.lastname: Nanjayan
authors.forename: Girish N
authors.initials: GN
authors.lastname: Swamy
authors.forename: Sunil
authors.initials: S
authors.lastname: Yellu
authors.forename: Sachin
authors.initials: S
authors.lastname: Yallappa
authors.forename: Tarek
authors.initials: T
authors.lastname: Abuzakuk
authors.forename: Robert
authors.initials: R
authors.lastname: Straw
mesh_terms: D017677:Age Distribution; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome