Many older patients worry that their age makes them ineligible for joint replacement surgery. The reassuring truth is that there is no upper age limit for hip or knee replacement. Age alone should not prevent you from having surgery. What matters is your general health, medical fitness, and ability to tolerate anaesthesia. I have successfully performed hip and knee replacements on patients in their 90s who went on to have excellent functional outcomes.
The Evidence
I have a patient who was 96 years old when she had her second joint replacement. She had her first replacement at 94, and she did remarkably well after both surgeries. She remains active and functional well into her 90s. Age is clearly not the determining factor for surgical success.
There are no established upper age limits in orthopaedic surgery guidelines for joint replacement. The decision is individualised based on overall health, cardiopulmonary fitness, cognitive function, and ability to engage with post-operative rehabilitation.
"Age is just a number. What matters is your health, strength, and willingness to commit to recovery."
— Dr Chien-Wen LiewBeyond Chronological Age
In older patients, I focus on several specific health factors rather than age itself. First is anaesthetic fitness — can you safely tolerate general or regional anaesthesia? This is assessed through physical examination, blood tests, and often cardiopulmonary evaluation. Second is overall health — do you have significant uncontrolled medical conditions that would make surgery risky? Third is cognition and function — are you mentally able to understand the procedure and participate in rehabilitation?
Some 70-year-olds are medically complex and high-risk. Some 90-year-olds are remarkably fit and healthy. The assessment depends on the individual, not the birth certificate.
Dr Chien-Wen Liew discusses why age is rarely the determining factor — and what actually matters when assessing a patient for hip or knee replacement.
Can You Recover Well?
Recovery from hip and knee replacement in older patients is variable, but many do exceptionally well. Modern techniques, improved anaesthesia, and early mobilisation protocols have made recovery safer and faster than ever before. Most older patients are mobilising within hours of surgery and walking within days.
Rehabilitation may take longer in older patients, and progress may be slower, but improvement is achievable. Pain relief is often dramatic, and the ability to walk and function without pain is transformative at any age.
When Suitability Is Questioned
I have not refused surgery based on age alone. However, I have declined surgery in patients of all ages — including older patients — when significant medical issues made anaesthesia unsafe. Examples include uncontrolled cardiac arrhythmias, severe heart failure, or conditions that preclude safe anaesthesia.
The decision is always about medical safety and whether the patient is likely to benefit from surgery. If your health status puts you at unacceptable anaesthetic risk, then surgery may not be advisable — regardless of whether you're 60 or 90. But age itself is not the barrier.
Assess Your Medical Fitness
A guide to understanding anaesthetic assessment and health evaluation for older patients.