Abstract
BACKGROUND: As the number of total hip arthroplasties (THA) performed in elderly patients continues to rise, the optimal fixation strategy for individuals over 75 years remains debated. Hybrid constructs, combining a cemented femoral stem with an uncemented acetabular component, may offer a balance between immediate mechanical stability and durable biological fixation. This study aimed to evaluate clinical outcomes, complications, implant survivorship, and patient-reported satisfaction following hybrid THA in patients aged >75 years. METHODS: A retrospective multicenter study was conducted including patients ≥75 years who underwent primary hybrid THA between 2017 and 2023, with a minimum follow-up of 12 months. All procedures were performed using a mini-posterolateral approach within a standardized fast-track perioperative protocol. Patients were further stratified into two subgroups based on acetabular articulation: Group A, treated with a dual-mobility construct, and Group B, treated with a fixed-bearing liner. Outcomes included the Oxford Hip Score (OHS), patient satisfaction, complications, and Kaplan-Meier survivorship analyses using best- and worst-case scenarios. RESULTS: A total of 642 patients were included (mean age 80.0 ± 4.0 years; 72.6 % female), with a mean follow-up of 39.9 ± 19.4 months. The OHS improved from 22.4 ± 3.3 preoperatively to 42.1 ± 2.8 at final follow-up. Overall satisfaction was high, with 93.5 % of patients reporting a score of 3 or 4 on a 5-point scale. Complication rates were low, including dislocation (1.2 %), periprosthetic fracture (0.5 %), infection (0.2 %), aseptic loosening (0.2 %), and reoperation (1.2 %). Thirty-day readmission was 0.8 %. Overall mortality during follow-up was 6.4 %, with no procedure-related deaths. Implant survivorship was 98.6 % in the best-case and 84.1 % in the worst-case scenario. CONCLUSION: Hybrid THA in patients over 75 years provides excellent functional recovery, high satisfaction, and low complication rates, supporting its safety and effectiveness in the elderly population. Further long-term prospective studies are warranted.