Trends in Comorbidities and Complications Among Octogenarians and Nonagenarians Undergoing Primary Total Joint Arthroplasty in the United States.

Abstract

BACKGROUND With an aging population and gaining popularity of total knee and hip arthroplasty (TKA, THA), patients aged 80+ are likely to increase. These patients present unique challenges regarding perioperative risks. Large population data characterizing this group is lacking. The aim of this study was to offer an overview of trends in practices and outcomes among octogenarians and nonagenarians. METHODS We utilized the Premier Healthcare database to identify patients undergoing TKA and THA from 2006 to 2022. Patients 80 to 88 years and 89+ years old were compared to those aged 65 to 70, the typical age group for TKA/THA recipients. We evaluated trends of practice pattern, patient demographics, and comorbidity burden. Multivariable models were applied to compare major complications. RESULTS Neuraxial anesthesia was used more frequently among older patients undergoing TKA. Mean length of stay for both TKA and THA continuously decreased over time. Interestingly, octogenarian and nonagenarian TKA recipients had fewer comorbidities than 65- to 70-year-olds, while the reverse was observed among THA recipients. Multivariable analysis showed that among patients with similar comorbidity burden, octogenarian and nonagenarian patients had higher odds [95% CI] of major complications (TKA: OR 2.2 [2.0-2.4] and 2.7 [2.0-3.7] in 2006, OR 1.8 [1.6-2.1] and 2.0 [1.5-2.8] in 2022, respectively; for THA: OR 2.5 [2.1-3.0] and 3.7 [2.7-5.1] in 2006, OR 2.1 [1.8-2.4] and 2.7 [2.1-2.4] in 2022, respectively). CONCLUSIONS Although THA/TKA patients appear to be in good health relative to 65- to 70-year-olds, age remains a significant risk factor for increased morbidity.