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Are Age-based Cutoffs for THA Logically Consistent?

Joseph Bernstein1,2, Alexander Lee2, Leonid Kandel3

  • 1Corporal Michael Crescenz VA Medical Center, Philadelphia, PA, USA.

Clinical Orthopaedics and Related Research
|June 22, 2026
PubMed
Summary
This summary is machine-generated.

Surgeons should not hesitate to offer total hip arthroplasty (THA) to younger patients. Even accounting for revision risks, younger patients gain significantly more joint-adequate life years (JALYs) than older patients.

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Area of Science:

  • Orthopedic surgery
  • Health economics
  • Decision analysis

Background:

  • Total hip arthroplasty (THA) is common in patients 85+, but surgeons may avoid operating on younger individuals.
  • This study investigates if this hesitancy is based on consistent standards.

Purpose of the Study:

  • Quantify the expected utility (net benefit) of THA based on patient age and clinical variables.
  • Determine the revision cost threshold that would justify withholding THA from younger patients.

Main Methods:

  • A Markov model calculated expected lifetime joint-adequate life years (JALYs) for THA patients.
  • The model incorporated patient age, satisfaction fraction, prosthetic life expectancy, revision risks (catastrophic and wear), and a discount rate.
  • A benchmark of six JALYs (based on 85-year-olds' life expectancy) was used to assess the threshold for withholding THA from younger patients.

Main Results:

  • Forty-five-year-old males are projected to gain 25 JALYs under base assumptions with a revision penalty of five JALYs.
  • The expected benefit for this group remains above the six-JALY threshold until the revision penalty reaches 25 JALYs.
  • Sensitivity analyses confirmed the robustness of these findings across various plausible clinical parameters.

Conclusions:

  • Withholding THA from younger patients with hip disease is inconsistent with its use in older populations.
  • Younger patients, even considering revision risks, accrue substantially more lifetime benefit from THA.
  • Significant failure penalties, beyond plausible values, are required to justify denying THA to younger individuals.