You Are Never Too Old for a Hip Replacement to Improve Function

Researchers find it is cost-effective with no age limit for benefits to patients

June 18, 2008 – Senior citizens with osteoarthritis who undergo total hip replacement are twice as likely as those who do not to show improvements in physical functioning and increased ability to care for themselves, according to researchers at Duke University Medical Center. The study, which is the largest of its kind, found that there is no age limit on the benefits of hip replacement for patients.

Researchers studying Medicare records found that total hip replacements provide a cost savings to the health care system because reimbursement for the procedure (averaging $4,000 - $6,000) proves less costly than the long-term cost of health care for the disabled.

In addition to improved quality of life, health economists estimate savings associated with a year of a disability-free life at approximately $50,000, including all related health-care costs incurred by disabled patients such as hospital stays, nursing homes and home health care.

"We found that total hip arthroplasty improves everyday life for patients and is as beneficial to people in their 80s or 90s as it is for someone in their 60s," said Linda George, Ph.D., professor of Sociology and associate director of the Duke Center for the Study of Aging.

"While the number of surgeries conducted in the U.S. has increased dramatically over the last decade, fewer than 25 percent of patients who could benefit from the procedure elect to receive it."

Osteoarthritis of the hip is a progressive type of arthritis closely associated with aging and obesity. It affects about 10 million Americans, causing pain, decreased mobility and increased risk of falls and fractures.

Generally, non-surgical treatment is first recommended to reduce joint pain and inflammation and improve joint function. Hip replacements are performed when less invasive forms of treatment – medications and physical therapy – have failed.

"Osteoarthritis of the hip has a devastating impact on a patient's quality and length of life. Our study aimed to understand how total hip replacements affect tasks people do in their everyday lives, such as bathing, dressing, walking a few blocks, shopping and preparing meals," George said.

Patients who were disabled at the time of surgery had transitioned out of disability within one year of the procedure. Total hip replacement is an invasive treatment with a long rehabilitation period. According to Dr. George, this may help explain why physicians are less likely to present surgery as an option to those patients 85 years of age and older, and why there may be some reluctance among patients to choose the procedure.

"Physicians are less likely to present this option to the very old," George said, "but they should feel confident in recommending this procedure to those who are eligible for it."

"We know that hip replacements are relatively safe and reports have shown a very high rate of patient satisfaction due to reduced pain and increased range of motion," she added.

The study, published in the June issue of the Journal of the American Geriatrics Society, examined data from the Medicare Current Beneficiary Survey – a randomly selected group of Medicare beneficiaries who represent 96 percent of the U.S. population aged 65 and older – from 1992 to 2003.

Health data from 131 patients who received total hip replacement were compared to data from 257 patients who also had osteoarthritis of the hip but did not receive hip replacement surgery. Patients were interviewed three times each year for four years.

The research was supported by a grant from The Institute for Health Technology Studies (InHealth). The co-authors of this study are Frank Sloan, Ph.D. and David Ruiz, Jr., BS.