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Study Of Hip And Knee Replacements Among Centenarians
02 Aug 2007
As edited by Joint-Pain-Forum.com
According to the U.S. Department of Census, the number of
centenarians could cross the 4 million mark by 2050. Although
approximately 40 percent of centenarians are functionally independent,
they are among those at the highest risk for disabling arthritis and
fractures due to osteoporosis. With increasing age, the safety and
desirability of performing hip and knee replacements (arthroplasty) may
be questioned with the idea that health care resources should be spent
on those who can potentially benefit from them the most, and such
procedures may be too hazardous for elderly patients. However, there
have been few studies on joint replacement among patients older than
90. A new study published in the August issue of Arthritis Care & Research
found that hip and knee replacements are very infrequent among this age
group, but that they should not be denied to these patients solely
because of short-term life expectancy. The study was the largest to
date of hip and knee replacements among centenarians.
Led by Eswar Krishnan, MD, MPH, of the University of
Pittsburgh, in Pittsburgh, PA, researchers analyzed 10-year data
(1993-2002) from the Healthcare Cost and Utilization Project Nationwide
Inpatient Sample, the largest hospital discharge data set in the world.
Of the 57 million hospitalization records during this period, 41,335
were for centenarians. The researchers identified 679 total hip
replacements and 7 total knee replacements in patients aged 100 or
older. "This relatively low frequency of elective surgery might be due
to physician and patient judgment that these individuals are at high
risk for poor outcomes and that the risk is not offset by the perceived
benefit in light of the relatively short life expectancy," the authors
state. Centenarians who underwent hip replacement were at a higher risk
for in-hospital mortality than nonagenarians. Among centenarians,
however, hospitalization for hip replacement compared to other causes
of hospitalization was associated with a lower risk of death.
Although frailty is known to increase
with age, some believe that with better medical care only the extremely
elderly are suffering its effects. The authors point out that
centenarians live to the century mark by delaying or even avoiding many
age-related diseases, and that among those suffering from such
conditions, many appear to do so with better functional status than
younger patients. As to the question of whether centenarians and
nonagenarians are able to reap the benefits of a new hip or knee, a
previous study indicated that one-quarter of the centenarian population
are cognitively intact and they appear to sustain their mental status
over time. Another study found that nonagenarians treated for hip
fractures did not have an increased risk of postoperative
complications.
Given the increasing trend of joint replacements over the last
decade in the U.S. and the growing centenarian population, such
procedures are likely to become more commonplace in the elderly
population. The authors conclude, "This study provides data that
suggest arthroplasty need not be denied to centenarians solely on
account of age and the concern of high in-hospital mortality risk."
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Article adapted by www.Joint-Pain-Forum.com from original press release.
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Article: "Primary Knee and Hip Arthroplasty Among Nonagenarians
and Centenarians in the United States," Eswar Krishnan, James F. Fries,
C. Kent Kwoh, Arthritis Care & Research, August 2007; (DOI: 10.2002/art.22888).
Source: Amy Molnar
John Wiley & Sons, Inc.
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