ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper


Today’s Nonagenarians: Too Old for Arthroplasty?

Stephen Sizer, DO, Philadelphia, Pennsylvania UNITED STATES
Adam Rosen
Julie McCauley, MPHc, La Jolla, CA UNITED STATES
William Bugbee, MD, La Jolla, CA UNITED STATES

Scripps Clinic, La Jolla, California, UNITED STATES

FDA Status Not Applicable


In our matched cohort study, nonagenarians had higher rates of complications than younger patients following total joint arthroplasty.



Conventional wisdom suggests that nonagenarians may be “too old” and frail to undergo elective total joint arthroplasty (TJA). Historical studies have reported higher complication rates in nonagenarians. We questioned if this concept is still valid and hypothesized that today’s nonagenarians have equivalent outcomes to younger cohorts undergoing TJA.


One hundred seventy-four patients undergoing primary TJA between 2010 and 2017 were included; 58 nonagenarians (age 90+) were matched with 58 octogenarians (age 80-84) and 58 septuagenarians (age 70-74). Groups were matched by gender, diagnosis, surgeon, operative joint, and year of surgery. Within each group, 31 patients (53%) underwent total hip arthroplasty (THA) and 27 patients (47%) underwent total knee arthroplasty (TKA). Comorbidities, American Society of Anesthesiologist (ASA) physical status scores, and Charlson comorbidity index scores were captured preoperatively. Complications, readmissions, and mortality occurring within 90 days postoperatively were evaluated.


The overall total complication rate was 12% for septuagenarians, 22% for octogenarians, and 45% for nonagenarians (p<0.001). Nonagenarians were 3.1 times more likely than younger patients to have a complication, after controlling for arthroplasty type (THA vs. TKA), ASA score, Charlson comorbidity index, major medical comorbidities, and discharge disposition (home vs. skilled nursing facility) (p=0.040). When complications were classified as medical, nonagenarians had the highest rate (33%) compared to septuagenarians (3%) and octogenarians (14%) (p<0.001). Orthopedic (surgical) complications were similar between groups. Readmission occurred in 2% of septuagenarians, 5% of octogenarians, and 11% of nonagenarians (p=0.118). There were two deaths (both nonagenarians).


Nonagenarians were 3.1 times more likely than younger patients to have a complication following TJA. The incidence of medical complications was highest in nonagenarians compared to septuagenarians and octogenarians, but rates of orthopedic complications were similar. These results did not support our hypothesis that nonagenarians would have equivalent outcomes to younger cohorts undergoing TJA.

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