Chapter 36 Complications of Joint Replacement in the Elderly

Despite numerous long-term studies of total joint replacement showing successful relief of pain and improvement in function in more than 90% of patients, the life span of an artificial joint is limited. In addition, results of revising a failed arthroplasty are inferior to the primary procedure. Therefore, prosthetic joint replacement is reserved for the aging population except in circumstances wherein severe joint destruction is compromising activities of daily living and there is no better treatment alternative. Improved implant designs, patient selection, preoperative investigation, and surgical technique have all played a major role in the current success of total joint replacement. Nevertheless, complications continue to occur both early and late following surgery. Age-related systemic disease and specific musculoskeletal disease add to the perioperative surgical risk and technical demands of surgery as well as the postoperative rehabilitation. Long-term, well-designed clinical studies are necessary to determine the success rates, risk factors, complications, and adjunctive treatments that will optimize the management of joint disease in the aged. Unfortunately, joint replacement technology is evolving prior to long-term testing of new designs and techniques, making it difficult to draw conclusions about the status of some joint replacements being performed today.