Advanced Age Is Not a Barrier to Total Knee Arthroplasty: A Detailed Analysis of Outcomes and Complications in an Elderly Cohort Compared With Average Age Total Knee Arthroplasty Patients

Klasan, Antonio; Putnis, Sven; Yeo, Wai Weng; Fritsch, Brett; Coolican, Myles; Parker, David

doi:10.1016/j.arth.2019.05.007

Cited by 33 publications

(35 citation statements)

References 33 publications

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“…Importantly, no patient required a transient or definitive skilled nursing facility after TKA. This finding contrasts with other studies that reported a transfer rate to skilled nursing facility as high as 14% [ 8 , 38 , 39 ]. This could indicate that the functional independence improved after TKA and that this procedure did not affect the overall morbidity of the patients evaluated in our cohort.…”

Section: Discussioncontrasting

confidence: 97%

Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

Palazzuolo

Antoniadis

Mahlouly

et al. 2021

International Orthopaedics (SICOT)

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Purpose Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis though its risk-benefit ratio in elderly patients remains debated. This study aimed to evaluate the functional outcome, rates of complication and mortality, and quality-adjusted life years (QALY) in patients who exceeded their estimated life expectancy. Methods Ninety-seven TKA implanted in 86 patients who exceeded their estimated life expectancy at the time of TKA were prospectively included in our institutional joint registry and retrospectively analyzed. At latest follow-up, the functional outcome with the Knee Society Score (KSS), rates of complication and mortality, and QALY with utility value of EuroQol-5D score were evaluated. Results At a mean follow-up of three ± one years, the pre- to post-operative KSS improved significantly (p < 0.01). The rates of surgical and major medical complications related to TKA were 3% and 10%, respectively. The re-operation rate with readmission was 3% while no TKA was revised. The 30-day and one year mortality was 1% and 3%, respectively. The pre- to one year post-operative QALY improved significantly (p < 0.01). The cumulative QALY five years after TKA was four years. Assuming that these patients did not undergo TKA, their cumulative QALY at five years would have been only two years. Conclusion TKA is an effective procedure for the treatment of end-stage osteoarthritis in patients who exceeded their estimated life expectancy. TKA provided significant improvement in function and quality of life without adversely affecting overall morbidity and mortality. Therefore, TKA should not be contra-indicated in elderly patients based on their advanced age alone.

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Section: Discussioncontrasting

confidence: 97%

Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

Palazzuolo

Antoniadis

Mahlouly

et al. 2021

International Orthopaedics (SICOT)

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“…In terms of implant survival, our study correlates with Klasan et al, who looked at the medium-term outcomes of TKAs in octogenarians in Australia [23]. Implant survivorship at 10 years was reported at 99.5%, and patient survivorship was 26% at 10 years; mean follow-up was 7.76 years.…”

Section: Discussionsupporting

confidence: 83%

“…Tay et al [25] found the 2-year revision rate was higher in octogenarians (2.9% vs 1.4%), but this was not statistically signi cant (p = 0.31). Klasan [23] reported a revision rate of 0.46% (versus 1.55% in younger patients, p = 0.51) with mean follow-up of 7.76 years. The lower rate of revision is likely due to lower functional demand and higher threshold for performing revision arthroplasty in the elderly.…”

Section: Discussionmentioning

confidence: 97%

The Long-term Results of Total Knee Arthroplasty in Octogenarian

Mak¹,

Chau²,

Chung³

et al. 2021

Preprint

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Background: With increasing life expectancy and aging population, more octogenarians would benefit from total knee arthroplasty (TKA). The aim of this study is to evaluate the survivorship of TKA in octogenarian and their long-term outcomes. Methods: This was a retrospective review of 67 patients aged above 80 years who had primary TKA performed between 2005-2013 at a single centre. A sex-matched younger cohort of 67 primary TKAs during the same time-period was recruited for control. 5- and 10-year survival was calculated. Pre- and peri-operative factors were collected and compared. Post-operative range of motion, Knee Society Score (KSS) and Function Score (KFS) were collected and compared. Rate of revision, infection, aseptic loosening and mortality was collected.Results: The mean follow-up period was 10.39±2.29 years. The 5- and 10- year survival of octogenarian group was 85.1% and 54.6% respectively. Pre- and peri-operative factors between the octogenarian and control groups were comparable (p>0.05). Both groups showed improvement in range of motion, KSS and KFS post-operatively. Rate of revision, aseptic loosening and deep infection was 0% in octogenarian and 1.5% in control group. Conclusions: TKA can be performed in patients with age above 80 years old with comparable post-op knee range, complication rate and long-term functional score. Advanced age should not be a limiting factor for TKA.

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“…Notably, the latter group of complications has been reported to be higher among smokers undergoing total hip and knee arthroplasty, as well as shoulder arthroscopy. 22,31 This difference may be attributable to a younger demographic undergoing hip arthroscopy (35.1 years at surgery in the current study) as compared with patients receiving total hip or knee arthroplasty (67.7 and 69.9 years at surgery, respectively) 9,18 or a rotator cuff repair (56.5 years at surgery). 6 Such age discrepancy is critical given the cumulative detrimental effects of smoking and the greater burden of comorbidities with increasing age among smokers.…”

Section: Discussionmentioning

confidence: 81%

Hip Arthroscopy in Smokers: A Systematic Review of Patient-Reported Outcomes and Complications in 18,585 Cases

et al. 2020

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Background: Although the negative effects of smoking have been documented for other types of arthroscopic procedures, there is limited information regarding its influence on hip arthroscopy outcomes. Purpose: To examine the effect of smoking on the following outcomes after hip arthroscopy: patient-reported outcomes (PROs), the degree of improvement in PROs relative to baseline, complication rates, and rates of revision arthroscopy and/or conversion to total hip arthroplasty (THA). Study Design: Systematic review. Methods: The PubMed, Embase, and Cochrane Library databases were queried for studies published between January 1, 1985, and January 14, 2020, comparing the outcomes of hip arthroscopy between smokers and nonsmokers. Case reports, basic science studies, and studies investigating pediatric patients or lacking a description of outcomes were excluded. Included outcome tools were the modified Harris Hip Score, the visual analog scale (VAS) for pain and satisfaction, and the Hip Outcome Score (HOS)–Sports Specific and HOS–Activities of Daily Living. Preoperative characteristics and operative indications were also recorded. Results: Postoperative combined means (± SD) were better in nonsmokers versus smokers for the modified Harris Hip Score (75.67 ± 20.88 vs 82.32 ± 15.5; P = .001), the VAS pain (3.13 ± 2.79 vs 2.13 ± 2.21; P < .001), and the HOS–Sports Specific (62.54 ± 25.38 vs 71.7 ± 23.3; P < .001). There was no difference between groups in VAS satisfaction ( P = .23) or HOS–Activities of Daily Living ( P = .13). The extent of PRO score improvement relative to baseline values was similar in smokers and nonsmokers in all PRO measures ( P > .05 for all). Smokers demonstrated higher rates of postoperative thromboembolic ( P = .0177) and infectious ( P = .006) complications. There was no difference between rates of revision arthroscopy ( P = .47) and THA conversion ( P = .31). Conclusion: Smoking adversely affects certain postoperative PROs and is associated with higher postoperative complication rates. Further studies are required investigating the degree of PRO improvement and long-term arthroscopy revision and THA conversion rates.

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Advanced Age Is Not a Barrier to Total Knee Arthroplasty: A Detailed Analysis of Outcomes and Complications in an Elderly Cohort Compared With Average Age Total Knee Arthroplasty Patients

Cited by 33 publications

References 33 publications

Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

The Long-term Results of Total Knee Arthroplasty in Octogenarian

Hip Arthroscopy in Smokers: A Systematic Review of Patient-Reported Outcomes and Complications in 18,585 Cases

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