Risks and benefits of elective hip replacement in the octogenarian

We reviewed the records for 100 consecutive cases of elective hip replacement in 91 patients in their 80s (average age 82.8 years), all of whom lived in their own homes before surgery. In 92 cases the patients returned home, 59 within 3 weeks. The average duration of hospital stay was 20.1 days. In eight cases there were major complications, including three cases of myocardial infarction (one of them fatal) and two cases of pulmonary embolism (one of them fatal). In 15 cases there were moderate complications, including deep venous thrombosis (in 5) and urinary tract complications necessitating transurethral prostatectomy (in 2). In 44 cases there were minor complications, including the need for urinary catheterization (in 27) and brief periods of postoperative confusion (in 14). In 33 cases there were no complications; in 31 of these cases the patients returned directly home within 3 weeks. The preoperative risk rating of the American Society of Anesthesiologists (ASA) correlated well with the complication rates: the rates of major complications in cases with a rating of ASA class I, II or III were 0%, 6% and 15% respectively. In 49 of 52 cases in which the procedure had been performed more than 2 years previously, the patients were happy they had had the operation.