Aims. As our population ages, the number of octogenarians who will require a total hip arthroplasty (THA) rises. In a value-based system where operative outcomes are linked to hospital payments, it is necessary to assess the outcomes in this population. The purpose of this study was to compare outcomes of elective, primary THA in patients ≥ 80 years old to those aged < 80. Methods. A retrospective review of 10,251 consecutive THA cases from 2011 to 2019 was conducted. Patient-reported outcome (PRO) scores (Hip disability and Osteoarthritis Outcome Score (HOOS)), as well as demographic, readmission, and complication data, were collected. Results. On average, the younger cohort (YC, n = 10,251) was a mean 61.60 years old (SD 10.71), while the older cohort (OC, n = 609) was 84.25 years old (SD 3.02) (p < 0.001). The OC had greater surgical risk based on their higher mean American Society of Anesthesiologists (ASA) scores (2.74 (SD 0.63) vs 2.30 (SD 0.63); p < 0.001) and Charlson Comorbidity Index (CCI) scores (6.26 (SD 1.71) vs 3.87 (SD 1.98); p < 0.001). While the OC stayed in the hospital longer than the YC (mean 3.5 vs 2.5 days; p < 0.001), there were no differences in 90-day emergency visits (p = 0.083), myocardial infarctions (p = 0.993), periprosthetic joint infections (p = 0.214), dislocations (p = 0.993), or aseptic failure (p = 0.993). The YC was more likely to be readmitted within 90 days (3.88% vs 2.18%, Β = 0.57; p = 0.048). There were no observed differences in 12-week (p = 0.518) or one-year (p = 0.511) HOOS scores. Conclusion. Although patients ≥ 80 years old have a greater number of comorbidities than younger patients, they had equivalent perioperative complication rates and PRO scores. This study demonstrates the safety and success of elective THA in octogenarians. Cite this article: Bone Jt Open 2021;2(7):535–539

Aims. Periprosthetic joint infection (PJI) in total hip arthroplasty in the elderly may occur but has been subject to limited investigation. This study analyzed infection characteristics, surgical outcomes, and perioperative complications of octogenarians undergoing treatment for PJI in a single university-based institution. Methods. We identified 33 patients who underwent treatment for PJIs of the hip between January 2010 and December 2019 using our institutional joint registry. Mean age was 82 years (80 to 90), with 19 females (57%) and a mean BMI of 26 kg/m. 2. (17 to 41). Mean American Society of Anesthesiologists (ASA) grade was 3 (1 to 4) and mean Charlson Comorbidity Index was 6 (4 to 10). Leading pathogens included coagulase-negative Staphylococci (45%) and Enterococcus faecalis (9%). Two-stage exchange was performed in 30 joints and permanent resection arthroplasty in three. Kaplan-Meier survivorship analyses were performed. Mean follow-up was five years (3 to 7). Results. The two-year survivorship free of any recurrent PJI was 72% (95% confidence interval (CI) 56 to 89; 18 patients at risk). There were a total of nine recurrent PJIs at a mean of one year (16 days to eight years), one for the same pathogen as at index infection. One additional surgical site infection was noted at two weeks, resulting in a 69% (95% CI 52 to 86; 17 patients at risk) survivorship free of any infection at two years. There were two additional revisions for dislocations at one month each. As such, the two-year survivorship free of any revision was 61% (95% CI 42 to 80; 12 patients at risk). In addition to the aforementioned revisions, there was one additional skin grafting for a decubitus ulcer, resulting in a survivorship free of any reoperation of 54% (95% CI 35 to 73; ten patients at risk) at two years. Mean Clavien-Dindo score of perioperative complications was two out of five, with one case of perioperative death noted at six days. Conclusion. Octogenarians undergoing surgery for PJI of the hip are at low risk of acute mortality, but are at moderate risk of other perioperative complications. One in two patients will undergo a reoperation within two years, with 70% attributable to recurrent infections. Cite this article: Bone Joint J 2023;105-B(2):135–139

Elective orthopaedic procedures, and particularly total hip arthroplasty (THA), in octogenarians and nonagenarians patients are burdened of several implications. Besides the comorbidities and the anesthesiological issues, legal and ethical implications are present. Some literature data show the clinical improvement of THA in elderly patient but the psychological aspects are not yet evaluated. Aim of this study is to evaluate the clinical aspects and the psychological impact in daily living in octogenarians and nonagenarians patients addressing THA. We conducted a retrospective evaluation of 81 THA in 81 patients of age more than 85 years with a minimum follow-up of 6 months. Clinical aspects were evaluated using the Hip disability and Osteoarthritis Outcome Score (HOOS). The psychological issues were evaluated with the Short Form 12 (SF-12) using both the Physical Component Summary (PCS) and the Mental Component Summary (MCS). From the starter cohort of 81 patients, 8 patients were died for causes unrelated to surgery, 13 were lost to follow-up, 1 patient was revised for periprosthetic fracture; 59 patients composed the final cohort. Mean HOOS rased from 18,07 ± 17,81 to 92,36 ± 5,74 with statistically significant distribution both in the global score than in all of the different subscales. The PCS raised from 26,81 ± 10,81 to 51,86 ± 4,45 and The MCS raised from 34,84 ± 10,81 to 56,70 ± 5,04, but none of them showed a statistically significant distribution. THA in octogenarians and nonagenarians patients could be a safe procedure with positive results for clinical and psychological aspects

Aims. The number of revision arthroplasties being performed in the elderly is expected to rise, including revision for infection. The primary aim of this study was to measure the treatment success rate for octogenarians undergoing revision total hip arthroplasty (THA) for periprosthetic joint infection (PJI) compared to a younger cohort. Secondary outcomes were complications and mortality. Methods. Patients undergoing one- or two-stage revision of a primary THA for PJI between January 2008 and January 2021 were identified. Age, sex, BMI, American Society of Anesthesiologists grade, Charlson Comorbidity Index (CCI), McPherson systemic host grade, and causative organism were collated for all patients. PJI was classified as ‘confirmed’, ‘likely’, or ‘unlikely’ according to the 2021 European Bone and Joint Infection Society criteria. Primary outcomes were complications, reoperation, re-revision, and successful treatment of PJI. A total of 37 patients aged 80 years or older and 120 patients aged under 80 years were identified. The octogenarian group had a significantly lower BMI and significantly higher CCI and McPherson systemic host grades compared to the younger cohort. Results. The majority of patients were planned to undergo two-stage revision, although a significantly higher proportion of the octogenarians did not proceed with the second stage (38.7% (n = 12) vs 14.8% (n = 16); p = 0.003). Although there was some evidence of a lower complication rate in the younger cohort, this did not reach statistical significance (p = 0.065). No significant difference in reoperation (21.6% (n = 8) vs 25.0% (n = 30); p = 0.675) or re-revision rate (8.1% (n = 3) vs 16.7% (n = 20); p = 0.288) was identified between the groups. There was no difference in treatment success between groups (octogenarian 89.2% (n = 33) vs control 82.5% (n = 99); p = 0.444). Conclusion. When compared to a younger cohort, octogenarians did not show a significant difference in complication, re-revision, or treatment success rates. However, given they are less likely to be eligible to proceed with second stage revision, consideration should be given to either single-stage revision or use of an articulated spacer to maximize functional outcomes. Cite this article: Bone Joint J 2024;106-B(8):802–807

Although total hip arthroplasty (THA) has been shown to be a cost-effective means of treating hip arthritis, there is some ambiguity within the literature as to its success in those over 80 years of age. With the rapid expansion of this population group and an estimated 40% rise in THA figures expected by 2026, this study aims to review the results of primary THA in the octogenarian population. A series of 510 consecutive cases was obtained from the local arthroplasty database, consisting of all patients aged 80 years and over who underwent primary THA between 1994 and 2004. A control group of 3404 individuals under 80 years was also established using the same database and inclusion criteria. Mean follow-up for the octogenarian group was 5.9 years. Pain scores were comparable five years post-operatively in both groups (P=0.479); in particular 81.5% of octogenarians and 80.2% of the control noted no pain. Pre-operatively, the mean Harris Hip Function and Harris Hip Score were significantly lower in the octogenarian group by 4.3 and 4.2 points (P< 0.001), respectively, and at five years follow-up were also lower by 8.4 and 8.0 points, respectively (P< 0.001). Median hospital stay was three days longer in the elderly population (12 cf 9, P< 0.001). More complications occurred in the octogenarian group (38.1% cf 28.7% of controls, P< 0.001) however fewer cases of revision were noted (1.4% cf 3.8%, P=0.005). Kaplan-Meier analysis found implant survival time to revision to be comparable in both groups (mean 16.4 years in control cf 14.3 years in octogenarian, P=0.17). Patient satisfaction was also similar (97.8% in octogenarians and 98.1% in controls, P=0.741). This study suggests that individuals over 80 years of age have comparable pain improvement and overall satisfaction, low revision rates, reduced functional improvement and are more prone to complications compared to younger patients

Purpose: Odontoid fractures are the most common cervical spine injuries in the elderly. Although octogenarians are the fastest growing age group, limited data exists on the natural history after they sustain odontoid fractures. Published mortality rates vary greatly, but are high enough to elicit comparisons to post-hip fracture mortality. It has also been suggested that halo-vest immobilization independently predicts mortality. Method: All traumatic odontoid fractures (type II or III) seen at our institution between 1996 and 2008 were identified and only patients who were ≥ 80 years of age were selected. A retrospective chart review was performed for injury characteristics, comorbidities, hospitalization details, treatment regimen and documented complications. Patients were stratified using the Charlson comorbidities index. The primary outcome was mortality at one year and was identified using a provincial database. Results: 72 cases were identified. Median age was 86 years (range 80 to 102). Patient treatment regimens included rigid neck collar, Halo vest orthosis, surgery or a combination thereof. 31% percent of the cohort (22 patients) was treated by Halo vest immobilization. Overall 1-year mortality rate was 15% (n=11) with only 1 Halo vest patient dying during this period. The majority of deaths (9 / 11) occurred in first 2 weeks following the injury. Conclusion: Mortality rate in the octogenarian population sustaining an odontoid fracture is high and approaches the 1-year hip fracture mortality rate. The utilization of a Halo vest was not associated with increased mortality rate in our study. Optimal treatment regimens, and strategies to minimize morbidity, particularly in the early post-injury phase, necessitate further study

Total hip arthroplasty (THA) and Total knee arthroplasty (TKA) are successful operations that predictably restore function and provide pain relief for up to 20 years. What happens if they fail in the elderly patient? The purpose of this review was to evaluate pain relief, function and quality of life (QOL) in octogenarian patients undergoing revision total joint arthroplasty (TJA). We reviewed our surgical database to find all patients who were 80 years or older at the time of revision surgery. From 1993 through 2008, there were 61 revision THAs (52 patients) and 33 revision TKAs (29 patients). This represented 3% and 8% respectively of all arthroplasties and revision arthroplasties done during the same period. Outcomes evaluated include Harris Hip Scores (HHS), Knee Society Scores (KSS), complications, and QOL. The average follow-up for revision THA patients with completed Harris Hip Evaluations was 27 months (range: 3 – 126 months). HHS improved from 47 pre-operatively to 74 at most recent follow-up. Pain Scores improved from 20 to 39, Function Scores from 11 to 16, Activities Scores from 9 to 10, Deformity Scores from 2 to 4 and ROM Scores from 5 to 6. Complications occurred in 34% of these cases. The average follow-up for revision TKA patients with completed Knee Society Evaluations was 38 months (range: 11 – 98 months). KSS improved from 48 preoperatively to 84 at the most recent follow-up. Pain Scores improved from 22 to 43 and Function Scores from 20 to 34. Complications occurred in 47% of these cases. Total HHS and KSS greatly improved postoperatively with the most notable improvement in the Pain category. Complications were common, although most were considered minor. More severe complications occurred when revisions of all components were needed, more likely in TKA than THA. With careful selection, patient education and preoperative planning, revision TJA can be done safely and provide benefit for the elderly patient

We compared the reoperation rate after internal fixation for minimally displaced or impacted intracapsular fractures of the femoral neck in patients aged 80 years and above with that in similar patients aged 65 to 79 years. We also compared the results of internal fixation with those of hemiarthroplasty for displaced intracapsular fracture in an age- and sex-matched group of elderly patients. We found that a significantly greater proportion of the older patients treated by internal fixation required reoperation than either the younger group or the age-matched group treated by hemiarthroplasty. Our results indicate that internal fixation may not be the best treatment for extremely elderly patients with minimally displaced or impacted intracapsular fractures of the femoral neck.

Aims

The aim of this study was to compare the rate of perioperative complications following aseptic revision total hip arthroplasty (THA) in patients aged ≥ 80 years with that in those aged < 80 years, and to identify risk factors for the incidence of serious adverse events in those aged ≥ 80 years using a large validated national database.

Background. As life expectancy increases, the number of octogenarians requiring primary and revision total knee arthroplasty (TKA) is increasing. Recently, primary TKA has become a common treatment option in octogenarians. However, surgeons are still hesitant about performing revision TKA on octogenarians because of concerning about risk- and cost-benefit. The purpose of this study was to investigate postoperative complications and mid-term survival in octogenarians following primary and revision total knee arthroplasty (TKA). Methods. We retrospectively reviewed 231 primary TKAs and 41 revision TKAs performed on octogenarians between 2000 and 2016. The mean age was 81.9 for primary TKA and 82.3 for revision TKA (p=0.310). The American Society of Anesthesiologists (ASA) score was not different, but the age-adjusted Charlson comorbidity index was higher in revision TKA (4.4 vs. 4.8, p=0.003). The mean follow-up period did not differ (3.8 vs. 3.5 years, p=0.451). The WOMAC scores and range of motion (ROM) were evaluated. The incidence of postoperative complication and survival rate (end point; death determined by telephone or mail communication with patient or family) were investigated. Results. The postoperative WOMAC and ROM were better in primary TKA (33.1 vs. 47.2, p<0.001; 128.9° vs. 113.6°, p<0.001). The most common postoperative complication was delirium in both groups (7.4% vs. 14.6%, p=0.131). There were no differences in the specific complication rates between the two groups. The 5- and 10-year survival rates were 87.2% and 62.9%, respectively, in primary TKA and 82.1% and 42.2%, respectively, in revision TKA (p=0.017). Conclusions. Both primary and revision TKAs are viable options for octogenarians when considering the clinical results and mid-term survival. Delirium needs to be managed appropriately as the most common complication in both primary and revision TKAs for octogenarians

Background. In the United Kingdom (UK), the fastest growing population demographic is the over 85 years of age, but despite this, outcomes achieved in the octogenarian population with a Unicompartmental Knee Replacement (UKR) are underrepresented in the literature. The Elective Orthopaedic Centre, Epsom, has an established patient reported outcome measures (PROMs) programme into which all patients are routinely enrolled. We aim to investigate the outcome of medial UKR using the oxford phase 3 implant in octogenarians. Methods. We retrospectively reviewed our database for patients aged 60–89 years, who underwent a medial unicompartmental Knee Replacement (UKR) using the oxford phase 3 implant, between June 2007-December 2012 (N=395). The patients were stratified into 3 groups based on age, 60–69 (N=188), 70–79(N=149), and 80–89(N=58). Oxford Knee Scores (OKS), Euro-quol (EQ-5D) scores, revision rates, and mortality were compared. Results. We found that the octogenarian group achieved considerable improvement at 1 year with a mean OKS of 39.2 (+/−7.193) and EQ-5D score of 0.791(+/−0.241). And this improvement remained significant at 2 years. There was no difference in functional outcome when the 3 groups were compared. Revision rates for the 3 groups from youngest to oldest were, 8.5%, 4.5%, and 6.9% respectively. Odds ratio and survival analysis showed no significant difference between the groups. Conclusion. In conclusion, we found that octogenarians over a 2 year period achieved similar functional outcome as their younger counterparts. Level of Evidence. IV

Uncemented total hip arthroplasty (THA) implants have become the standard for younger patients on account of increased implant survivorship and multiple other advantages. Nevertheless, uncemented THA remains controversial in elderly patients. The evidence base for this is limited, as previous studies have compared octogenarians to a younger control group. The aim of this prospective cohort study is to evaluate the outcome of octogenarian patients undergoing uncemented THA with a control group of similarly aged patients undergoing hybrid THA with a minimum 5 years follow up. Clinical outcomes including intra and postoperative complications, blood transfusion, revision rate and mortality were recorded. Radiological analysis of pre and postoperative radiograph assessed bone quality, implant fixation and any subsequent loosening. 143 patients, (mean age 86.2 yrs.) were enrolled in the study. 76 patients underwent uncemented THA and 67 underwent hybrid THA. The uncemented cohort had fewer intraoperative and postoperative complications. The uncemented cohort also had a lower transfusion rate (p=0.002). Mean hospital stay (p=0.27) was comparable between the 2 groups. Two patients underwent revision surgery in either cohort. Our study demonstrates uncemented THA is safe for the octogenarian patient and we recommend that age should be not be a barrier of choice of implant. However intraoperative assessment of bone quality should guide surgeon to the optimum decision regarding uncemented and hybrid implant

Abstract. Background. Elderly patients with degenerative lumbar disease are increasingly undergoing posterior lumbar decompression without instrumented stabilisation. There is a paucity of studies examining clinical outcomes, morbidity & mortality associated with this procedure in this population. Methods. A retrospective analysis of aged 80–100 years who underwent posterior lumbar decompression without instrumented stabilisation at University Hospitals of Derby &Burton between 2016–2020. Results. Total 167 eligible patients, 163 octogenarians & 4 nonagenarians. Mean age was 82.78 ± 3.07 years. Mean length of hospital stay 4.79 ± 10.92 days. 76% were pain free at 3months following decompression. The average Charleston co-morbidity index (CCI) was 4.87. No association found with CCI in predicting mortality (ODD ratio 0.916, CI95%). 17patients suffered complications; dural tear (0.017%), post-op paralysis (0.017%), SSI(0.01%), and 0.001% of hospital acquired pneumonia, delirium, TIA, urinary retention, ileus, anaemia. High BMI (35+) was associated with increased incidence of complication (CI 95%, p<0.002). There was significant social drift following discharge as 147 patients went home and 4 patients to rehabilitation facility (p<0.001FE test). The mean operative time was 91.408±41.17 mins and mean anaesthetic time was 36.8±16.06 mins. Prolonged operative time was not associated with increased mortality.2year revision decompression rate was 0.011%. Conclusion. Posterior lumbar decompression without instrumented stablisation in elderly is safe & associated with low mortality with 99.5%survival at 1 year. It significantly improves PROMs & has extremely low revision rate. Incidence of post-op complication is <0.05% and 54% of patients get discharged within 72hours of surgery. Careful selection & optimising patients with high BMI would reduced perioperative morbidity and mortality

Introduction. Total knee arthroplasty (TKA) is an effective surgical intervention, which alleviates pain and improves function and health-related quality of life in patients with end-stage arthritis of the knee joint. With improvements in anesthesia, general health care, and surgical techniques, this procedure has become widely accepted for use in very elderly patients. However, many elderly patients tend to have compromised function and low reserve capabilities of organs and are therefore likely to develop various complications during the perioperative period. Thus, elderly patients often hesitate to undergo simultaneous bilateral TKA (SBTKA). Our purpose was to report the short-term results and clinical complications of octogenarians undergoing SBTKA. Materials and Methods. Between 2015 and 2016 all patients greater than 80years of age who underwent SBTKA by a single surgeon were retrospectively evaluated demographics, comorbidity, complications, and 30days mortality following SBTKA. Arthroplasty was performed sequentially under general anesthesia by one team led by primary surgeon. After the first knee, the patient's cardiopulmonary status was assessed by anesthesiology to determine whether or not to begin the second side. Cardiopulmonary decompensation, such as significant shifts in heart rate, oxygen saturation or blood pressure, was not showed. Then the second procedure was undertaken. Inclusion criteria of this study was underlying diseases were osteoarthritis. Exclusion criteria were (1) previous knee surgery; (2) underlying diseases were osteonecrosis, rheumatoid arthritis, fracture, and others. Fifty-seven patients with an average age of 82.7years were identified. The results of these procedures were retrospectively compared with those of patients greater than 80years of age of 89 patients unilateral TKA (UTKA) that had been performed by the same surgeon. Results. The study groups did not differ significantly with regard to age, gender, or body mass index. The mean age was 82.7years with a mean body mass index of 25.8 for the SBTKA group, compared with 84.0years with a mean body mass index of 24.9 for the UBTKA group. The length of hospital stay was longer in SBTKA groups. There was no serious complication. No deaths, no pulmonary embolisms and no nerve paralysis occurred within 30days in both groups. There was one wound problem in SBTKA group, compared 10 wound problem in UBTKA group; this difference was significant. Three deliriums occurred in SBTKA group, compared 13 deliriums in UBTKA group; this difference was significant. Minor complications included urinary tract infection, decubitus ulcer, transfusion reaction and ileus were noted seven in SBTKA group, compared in 11 UBTKA group; this difference was not significant. Conclusions. Complications and mortality are not higher for SBTKA compared to UTKA, SBTKA can be a safe and effective option for octogenarians

Aims. The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods. A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after. Results. A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested positive for COVID-19 with mean age of 73 years (28 to 98; SD 17.99) and 22 (56.4%) males. Common symptoms were dyspnoea, dry cough, and pyrexia. Of these patients, 27 (69.2%) were nosocomial infections and two (5.1%) of these patients required intensive care unit (ICU) admission with 8/39 mortality (20.5%). Of the patients who died, 50% were older and had underlying comorbidities (hypertension and cardiovascular disease, dementia, arthritis). Conclusion. Trauma admissions decreased in the lockdown phase with an increased incidence of RTAs. Nosocomial infection was common in 27 (69.2%) of those with COVID-19. Symptoms and comorbidities were consistent with previous reports with noted inclusion of dementia and arthritis. The mortality rate of trauma and COVID-19 was 20.5%, mainly in octogenarians, and COVID-19 surgical mortality was 15.4%. Cite this article: Bone Joint Open 2020;1-7:330–338

65 patients over the age of 80 years, who underwent a total knee arthroplasty between 1989 and 1994, were retrospectively reviewed, by means of questionnaire, phone call, clinical and radiological examination.Notes were reviewed for pre-existing medical conditions, pre-operative and post-operative Knee Society “Knee” and “Function” scores. They were then compared with 65 randomly selected patients in a different age group, 70 years and under.56 octogenarians were alive at 5 years and 50 available for full review. Elderly patients had more pre-existing medical conditions, with hypertension a ubiquitous diagnosis, required a longer in patient stay and more social services input before discharge, than the younger age groups. All patients in the elderly group suffered from osteoarthritis, unlike the younger age groups. Valgus deformity of the knees was only seen in the younger cohort. Previous surgery was more common in the octogenarians, with more octogenarians having undergone a tibial osteotomy and more youngsters undergoing arthroscopy. A reflection of changing surgical practice. “Knee” Scores were not significantly different between the age groups. However, the “function “ scores pre-operatively, were significantly lower in the over 80s and they made a more significant post-operative gain. Post-operatively, elderly male patients were more likely to go into retention post-operatively, than female patients and males in the younger age group. None of the prostheses had required revision in the elderly age group and only 5 patients had died since the surgery. None of the deaths were related to the surgery. We recommend pre-operative catheterisation of octogenarian patients, especially those with a history of prostatism. There would appear to be from this review no indication for denying elderly patients an arthroplasty on the basis of age

Background: Previous studies have reported mixed findings with regards to post operative complication rates and overall outcome in elderly patients undergoing total hip arthroplasty. The aim of this study was a prospective comparison of physical and functional outcome measurements following primary hip arthroplasty in patients aged 80–90 years to those aged 70–79. Methods: Data was prospectively recorded from 1998–2002. 144 patients aged 80–90 years underwent primary hip arthroplasty compared to 441 aged 70–79. A pre-operative Harris Hip Score was obtained on all patients and a standardized follow up regimen was used for assessment at 6, 18 and 36 months post surgery. Data collection included: intraoperative blood loss; post operative transfusion rate; incidence of wound infection, DVT and pulmonary embolus; dislocation and mortality rates. Statistical analysis involved two-sample t-test and chi-squared with Yates correction. Results: Pre-operative Harris Hip Scores were 41.6 (SD 11.2) in the younger cohort and 39.3 (SD 12.4) in the octogenarian (P = 0.04). This score had improved by 39.3 and 38.1 points respectively (P = 0.5) at 6 months; 42.3 and 37.7 at 18 months (P = 0.02); 43.4 and 39.8 at 36 months (P = 0.24). The mortality rate at 3 months following surgery was 4% in our octogenarian group compared to 1% (P=0.02). Mean length of hospital stay was significantly (P< 0.001) longer at 12.9 (SD 7.0) days compared to 10.1 (SD 4.7). The transfusion rate in our octogenarian group was 40% compared to 28% (P = 0.009). The incidence of deep infection was 1.4% in the older group compared to 0.5% (NS). Each group had a dislocation rate of 1%. and an incidence of DVT and pulmonary embolus that was comparable. Discussion: Total hip arthroplasty can be performed safely in octogenarians with excellent relief of pain and improved function

Due to demographic changes patients > 80yrs (octogenarians) are a rapidly growing group in total hip arthroplasty (THA). Stem design, choice, sizing and surgical insertion are more important in these patients as complications such as fractures are critical. Age and gender driven differences regarding canal shape (flare index, CFI), cortical wall thickness (WT) and bone mineral density (BMD) have been studied before only in isolation. Using CT, this study aims to investigate these parameters in combination and in 3D with a focus on the very elderly, identifying the regions critical for THA. High-resolution CT-scans (1mm slices) of 168 femora (M/F=100/68) were analyzed in 3D (Mimics V12). Flaring indices were based on the dimensions measured 20mm proximal to the lesser trochanter (LT) and 60mm distal to LT: intramedullary surface area (3D-CFI), frontal/lateral planes (2D-CFI) and flaring of the 4 sides medial (med), lateral (lat), anterior (ant), posterior (post) (1D-CFI). WT was calculated subtracting periosteal and endosteal dimensions and BMD was measured in Hounsfield Units (HU). An octogenarian group (80+: n=117, mean age 84yrs [80–105]) was compared to a typical THA age group (80−: n=51, mean age 68yrs [39–79]). Age and gender had significant effects on several parameters but at different levels, e.g. 2D frontal CFI was more influenced by the small age difference (80+ vs 80−=12%, p< 0.01) than gender (F vs M=2%). However, regarding lateral canal width, gender (F vs M=7%, p< 0.01), was more influential than age (80+ vs 80−=3%). The age-related changes on the shape occurred in 3D (3D-CFI 80+ vs 80−=23%, p< 0.01), but were asymmetrical between the 4 sides (e.g. 1D-CFI 80+ vs 80−: med=11%, p< 0.01) vs ant=27%, p< 0.01). Age and gender did not only effect shape, but also cortical WT, e.g. proximally octogenarian females had 35% less WT than the typical THA age group while males only had 14% lower WT (p< 0.01). Age, gender and shape asymmetry was also reflected in BMD distribution. on the medial side, the BMD gender difference in the octogenarians was small (=1%, p=0.61) but high on the anterior side (12%, p< 0.01). The most critical configurations for the octogenarians were found proximally on the posterior side with the lowest WT, lowest BMD and largest gender difference. The complex transition of the proximal femur affects shape, WT and BMD, continues in the very elderly and differs between genders. It produces femoral canals and bone stock different from the typical THA patient group. Conventional stems may not fit properly. Surgical implant choice, sizing and templating should consider this asymmetric age plus gender effect on shape, WT and BMD to avoid complications such as periprosthetic fracture, excessive migration or luxation in this vulnerable age group. A major risk zone is the posterior wall where age transition and gender differences are high and WT and BMD low

The February 2014 Trauma Roundup. 360 . looks at: predicting nonunion; compartment Syndrome; octogenarian RTCs; does HIV status affect decision making in open tibial fractures?; flap timing and related complications; proximal humeral fractures under the spotlight; restoration of hip architecture with bipolar hemiarthroplasty in the elderly; and short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients over 65 years

The June 2015 Spine Roundup360 looks at: Less is more in pyogenic vertebral osteomyelitis; Paracetamol out of favour in spinal pain but effective for osteoarthritis; Local wound irrigation to reduce infection?; Lumbar facet joint effusion: a reliable prognostic sign?; SPORT for the octogenarian; Neurological deterioration following traumatic spinal cord injury; PROMS in spinal surgery