Hybrid total hip arthroplasty in patients aged over 75: Patient-reported outcomes and complication rates

As the number of total hip arthroplasties (THA) performed in elderly patients continues to rise, the optimal fixation strategy for individuals over 75 years remains debated. Hybrid constructs, combining a cemented femoral stem with an uncemented acetabular component, may offer a balance between immediate mechanical stability and durable biological fixation. This study aimed to evaluate clinical outcomes, complications, implant survivorship, and patient-reported satisfaction following hybrid THA in patients aged >75 years.

A retrospective multicenter study was conducted including patients ≥75 years who underwent primary hybrid THA between 2017 and 2023, with a minimum follow-up of 12 months. All procedures were performed using a mini-posterolateral approach within a standardized fast-track perioperative protocol. Patients were further stratified into two subgroups based on acetabular articulation: Group A, treated with a dual-mobility construct, and Group B, treated with a fixed-bearing liner. Outcomes included the Oxford Hip Score (OHS), patient satisfaction, complications, and Kaplan-Meier survivorship analyses using best- and worst-case scenarios.

A total of 642 patients were included (mean age 80.0 ± 4.0 years; 72.6 % female), with a mean follow-up of 39.9 ± 19.4 months. The OHS improved from 22.4 ± 3.3 preoperatively to 42.1 ± 2.8 at final follow-up. Overall satisfaction was high, with 93.5 % of patients reporting a score of 3 or 4 on a 5-point scale. Complication rates were low, including dislocation (1.2 %), periprosthetic fracture (0.5 %), infection (0.2 %), aseptic loosening (0.2 %), and reoperation (1.2 %). Thirty-day readmission was 0.8 %. Overall mortality during follow-up was 6.4 %, with no procedure-related deaths. Implant survivorship was 98.6 % in the best-case and 84.1 % in the worst-case scenario.

Hybrid THA in patients over 75 years provides excellent functional recovery, high satisfaction, and low complication rates, supporting its safety and effectiveness in the elderly population. Further long-term prospective studies are warranted.