Cementless Tapered Femoral Stems for Total Hip Arthroplasty in Octogenarians.
The use of cementless femoral components has become the standard in younger patients due to increased implant survivorship and decreased loosening. However, it remains controversial whether these femoral stems can provide comparable results in elderly patients. Therefore, our purpose was to compare the (1) incidence of revisions; (2) clinical outcomes; (3) incidence of postoperative blood transfusions; and (4) differences in complications between the 2 cohorts.



Seventy-four consecutive patients (78 hips) aged 80 years or older, who underwent primary total hip arthroplasty using a cementless, tapered, femoral stem were retrospectively compared with a matched cohort of 76 patients (78 hips) who were less than 80 years. Mean age was 83 years (range, 80-91 years) vs 59 years (range, 17-79 years) for the matched group. Minimum follow-up was 2 years. Revision rates, clinical outcomes using the Harris Hip Score, incidences of complications, and postoperative transfusion rates were evaluated.



In the octogenarian cohort, the aseptic survivorship was 99%, compared with 95% in the matched group. There were 2 aseptic loosenings (2.6%): 1 femoral implant loosening (1.3%) and 1 acetabular loosening, but only 1 revision was performed, as one of the patients declined revision surgery. In the matched cohort, there were 6 revisions (7.7%). There were no significant differences in revision rates between the 2 cohorts, and no significant differences in final Harris Hip Score scores. The incidence of blood transfusion in the study group was 42% vs 19% in control group (P < .01).



The use of cementless, tapered, femoral stems yielded excellent results in the octogenarian group, although adequate patient preoperative optimization is necessary given the significantly higher transfusion incidence.
Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky.
Stephanie A
SA
Riley
Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky.
James R
JR
Spears
KOH Physicians Group, KentuckyOne Health, Louisville, Kentucky.
Langan S
LS
Smith
Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
Michael A
MA
Mont
Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
Randa K
RK
Elmallah
Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
Jeffrey J
JJ
Cherian
Adult Reconstruction Program, Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky.
Arthur L
AL
Malkani
D000077:Acetabulum / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011184:Postoperative Period; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
cementless; femoral component; octogenarian; tapered stems THA