Short- to mid-term outcomes of total hip arthroplasty in high hip dislocations: does age matter?

Background: Total hip arthroplasty (THA) is a complex intervention for patients with Crowe 3–4 high hip dislocations (HHD). The impact of age on outcomes in this patient group remains unclear. Aim: The current study evaluates short- to mid-term outcomes of THA in patients younger and older than 60 years, focusing on complication rates, clinical outcomes, and implant survival. Methods: A retrospective cohort study was conducted on 77 patients with HHD (Crowe 3–4) who underwent cementless THA. Patients were stratified into 2 age groups: <60 years ( n = 43) and ⩾60 years ( n = 34). Outcomes assessed included Harris Hip Score (HHS), complications, and revision-free survival. Kaplan-Meier and Cox proportional hazards analyses were employed. Results: Older patients had significantly higher complication rates (20.6% vs. 4.7%, p = 0.045), primarily due to deep vein thrombosis (DVT) (11.8% vs. none, p = 0.045). However, complication rates were comparable between unilateral (14.9%) and staged bilateral THA (16.7%, p = 0.789). Cox regression identified ASA Class 3 as an independent predictor of complications (HR 1.89, p = 0.043), while age and procedure type were not significant. Functional outcomes, including HHS and SF-36 scores, improved significantly in both groups without age-related differences. Kaplan-Meier survival analysis showed similar revision-free survival rates between age groups at 2 years (95.3% vs. 91.2%) and 3 years (92.1% vs. 88.5%, p = 0.287). Conclusions: Age does not independently predict revision or inferior functional outcomes following THA in HHD. Higher complication rates in older patients are primarily attributed to comorbidities. Appropriate perioperative management ensures comparable long-term outcomes regardless of age, emphasing the importance of addressing comorbidities over chronological age in candidate selection for THA.