Background Revision total hip arthroplasty (RTHA) is increasingly performed in very elderly patients. Although chronological age is traditionally viewed as a limiting factor, clinical experience suggests that physiological status and frailty play a more decisive role. This study aimed to assess whether comorbidity burden, rather than age itself, predicts perioperative complications and functional recovery following RTHA in patients aged 80 years and older. Methods A retrospective review was conducted on 102 RTHA procedures performed between 2015 and 2020. Patients were stratified into two age groups: octogenarians (80–89 years, n=73) and nonagenarians (≥90 years, n=29). Demographic data, ASA classification, Charlson Comorbidity Index (CCI), surgical details, complications, and 1-year survival were analyzed. Logistic regression was used to identify predictors of postoperative complications, focusing on frailty-related variables (ASA and CCI). Functional outcomes were evaluated using the Harris Hip Score (HHS). Results No significant differences were found in ASA (p=0.10) or CCI distribution (p=0.45) between age groups. Nonagenarians had shorter surgical times (96 vs. 107 min, p=0.02) but longer hospital stays (8.6 vs. 6.1 days, p=0.01). Functional improvement (HHS) was comparable between cohorts (p=0.57). Medical complications were more frequent in nonagenarians (27.6% vs. 9.6%, p=0.03), while orthopedic complications, reoperations, and 1-year mortality did not differ significantly. Multivariate analysis showed that ASA III (OR 2.4, p=0.045) and severe CCI (OR 2.03, p=0.041) independently predicted postoperative complications, irrespective of chronological age. Conclusions Chronological age alone is not a reliable predictor of outcomes after RTHA in the extremely elderly. Instead, frailty markers such as ASA and comorbidity burden are stronger determinants of medical complications. These findings support an individualized approach to surgical decision-making, emphasizing comprehensive preoperative optimization over strict age-based selection criteria.
Lucero et al. (Thu,) studied this question.