Hybrid Total Hip Arthroplasty in Patients Aged Over 75: Patient-Reported Outcomes and Complication Rates

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.