Hip implant selection for total hip arthroplasty in elderly patients

Total hip arthroplasty in patients 75 years and older should relieve pain, improve function, and last for the rest of the patient's life. The achievement of this goal depends on health status, response to anesthesia, surgical technique, hip implant selection, and recovery from surgery. Considerations regarding hip implant selection in the elderly include bone quality, morphologic features of bone, implant fixation, design of the joint articulation, wear of the joint bearing surface, and implant cost. Implant cost should be negotiated and controlled in the business office and the boardroom rather than the operating room. Two hundred twenty-eight primary hip replacements done in 204 patients 75 years or older were evaluated. Complete clinical and radiographic evaluations were available for 190 hips in 152 patients at a mean 4 years followup (range, 1-11 years). Significant improvement in pain scores and clinical hip scores was observed. Patient outcome criteria were improved consistently. One acetabulum was loose in one patient (acetabular loosening, 0.5%), and five femoral stems were loose in five patients (femoral loosening, 2.6%). Four patients (four hips; 2.1%) required revision operations. One cemented cup (0.5%) in one patient and no cementless cups were revised. Four cemented stems (2.1%) in four patients and no cementless stems were revised. Cemented and cementless hip implants provided reliable results in these patients. In 2002, the author prefers cementless hip implant fixation.