Hip Replacement in Older Adults with Advanced Hip Arthritis

Evidenzbasierte Empfehlung für die Prothesenauswahl

The American Academy of Orthopaedic Surgeons recommends a total hip replacement (THR) over a hemiprosthesis for patients with unstable hip fractures, as it provides a functional advantage, although with an increased risk of complications (moderate recommendation) 1
Important selection criteria for THR include patients with higher activity levels and longer life expectancy 1
Pre-existing hip arthritis is a key factor in the selection of THR 2
Patients seeking better functional recovery should be considered for THR 1

The European League Against Rheumatism reports that 43.2% to 84.1% of patients are pain-free after THR at a mean follow-up of 9.4 years 2
Revision rates for THR range from 0.18 to 2.04 per 100 person-years (adjusted for age, sex, and type of hip arthritis) 2, 3, 4
The Harris Hip Score improves by an average of 36% to 46% from baseline 2

The use of cemented femoral stems is strongly recommended for patients undergoing arthroplasty for hip fractures (strong recommendation) 1, 4
Both spinal and general anesthesia are suitable for patients with hip fractures (strong recommendation) 1
Multimodal analgesia with preoperative nerve blockade is recommended for pain management (strong recommendation) 1, 4
Tranexamic acid is recommended to reduce blood loss and transfusions (strong recommendation) 1

The American College of Rheumatology states that hip arthritis is not reversible, and current treatments focus on symptom control, pain management, and functional improvement, not structural restoration of damaged cartilage 3
Pharmacological interventions lack structural benefits, including glucosamine and chondroitin, which lack hip-specific evidence 3
Diacerhein may slow joint space narrowing but does not reverse existing damage (RR for diarrhea 3.73) 2, 3
Hyaluronic acid lacks RCT evidence for hip arthritis 2, 3