• Esa Jämsen, Timo Puolakka, Antti Eskelinen, Pirkko Jäntti, Jarkko Kalliovalkama, Jyrki Nieminen, and Jaakko Valvanne.
• Coxa, Hospital for Joint Replacement, Finland. esa.jamsen@uta.fi
• Acta Orthop. 2013 Feb 1;84(1):44-53.

Background And PurposeHigh age is associated with increased postoperative mortality, but the factors that predict mortality in older hip and knee replacement recipients are not known.MethodsPreoperative clinical and operative data on 1,998 primary total hip and knee replacements performed for osteoarthritis in patients aged ≥ 75 years in a single institution were collected from a joint replacement database and compared with mortality data. Average follow-up was 4.2 (2.2-7.6) years for the patients who survived. Factors associated with mortality were analyzed using Cox regression analysis, with adjustment for age, sex, operated joint, laterality, and anesthesiological risk score.ResultsMortality was 0.15% at 30 days, 0.35% at 90 days, 1.60% at 1 year, 7.6% at 3 years, and 16% at 5 years, and was similar following hip and knee replacement. Higher age, male sex, American Society of Anesthesiologists risk score of > 2, use of walking aids, preoperative walking restriction (inability to walk or ability to walk indoors only, compared to ability to walk > 1 km), poor clinical condition preoperatively (based on clinical hip and knee scores or clinical severity of osteoarthritis), preoperative anemia, severe renal insufficiency, and use of blood transfusions were associated with higher mortality. High body mass index had a protective effect in patients after hip replacement.InterpretationPostoperative mortality is low in healthy old joint replacement recipients. Comorbidities and functional limitations preoperatively are associated with higher mortality and warrant careful consideration before proceeding with joint replacement surgery.

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