How Old Is Too Old To Get Joint Replacement Surgery?

Arthroplasty (joint replacement surgery) involving theknee arthroplasties among centenarians, and 2,050 in
hip and knee is one of the most common orthopedicthe nonagenarian (older than 90 but less than 100
procedures performed in the United States.year old) group.
The technology has improved so that a good toEighty-three percent of 100 year old + patients who
excellent outcome is the usual result. Complicationsunderwent arthroplasties were women. Hip fractures
and side effects such as postoperative infection,were responsible for 94% of hip replacements
thrombophlebitis (blood clots), loosening of the jointamong nonagenarians and centenarians.
replacement, and persistent pain still occur butStatistical measurements showed that the 100+ year
fortunately aren't common.group had a higher mortality risk than the 90+ year
Patients younger than 50 still are operated on withgroup who underwent a similar procedure.
some reluctance because the chances are quite goodHospitalization for hip replacement surgery among
that they will require a revision arthroplasty- meaningthose over the age of 100 was associated with a
they will need to have the joint replacement replaced.lower risk of death when analyses were performed
And the more active a young patient remains,using the records of all patients older than 100 years.
particularly if they abuse the joint replacement, theAdjusted mortality rate was less for hip arthroplasty
shorter the life span of the joint prosthesis. Revisionhospitalizations compared with all other causes of
of an old joint replacement is a technically difficulthospitalizations combined.
procedure.The authors stated that the patients who get joint
At the other end of the spectrum, orthopedicreplacement die less frequently in the post-operative
surgeons have been reluctant to replace joints inperiod than comparable patients admitted to the
older people, particularly ones that are older than 100hospital for other reasons. The chief explanation is
years.that the patients are highly selected for joint
While hip and knee arthroplasty are rarely performedreplacements.
in patients older than 100 years, according to aThey went on to say that joint replacements for
recently published article, these patients should not beolder people will likely to be more frequent in the
denied the option of this surgery. (Krishnan E, et al.future, since these operations can improve functional
Arthritis Rheum 2007;57:1038-1042).status of elderly patients.
The authors point out that osteoarthritis (wear andTheir conclusion: Joint replacements should not be
tear arthritis) and hip fracture due to osteoporosisdenied to centenarians because of short-term
are "two major causes of disability among the olderpost-operative life expectancy estimates.
age group."Author's note: Since demographic data shows that life
The researchers examined epidemiologic andexpectancy is increasing and that people are staying
mortality data in regards to arthroplasty amongactive longer, these findings make a lot of sense.
people older than 100 years. The comparison groupAge itself should not be the determining factor when
were people in their 90's.it comes to joint replacement. Physiological status and
Adjustments were made for the presence ofoverall health is much more important.
concurrent illnesses such as congestive heart failure,Obviously though, the presence of co-morbid
neurologic diseases, including dementia and stroke,conditions (concurrent medical problems) weigh
kidney and liver diseases, obesity and other riskheavily in the mix when it comes to making a
factors.decision about this. However, as patients stay
A total of 679 hip arthroplasties were identifiedhealthier, quality of life becomes just as important as
among those older than 100 years, compared withlongevity in years.
33,975 among people in their 90's. There were only 7