Can Total Knee Arthroplasty Be Safely Performed Among Nonagenarians? An Evaluation of Morbidity and Mortality Within a Total Joint Replacement Registry

Miric, Alexander; Inacio, Maria C.S.; Kelly, Mike; Namba, Robert S.

doi:10.1016/j.arth.2014.03.014

Cited by 35 publications

(35 citation statements)

References 12 publications

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“…The volume of total joint arthroplasties performed on nonagenarians will likely increase rapidly as this age cohort grows in number. However, some orthopedic surgeons may be reluctant to perform total joint arthroplasty on a nonagenarian due to the significant number of medical comorbidities expected in this age demographic [3]. It is therefore important that orthopedic surgeons as well as primary care providers and other members of the care team have an understanding of the expected postoperative inpatient course of nonagenarians undergoing total joint arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Comparing Inpatient Complication Rates between Octogenarians and Nonagenarians Following Primary and Revision Total Hip Arthroplasty in a Nationally Representative Sample 2010–2014

et al. 2019

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We compared inpatient postoperative complication rates between octogenarians and nonagenarians undergoing primary and revision total hip arthroplasty (THA). We used inpatient admission data from 2010–2014 from the Nationwide Inpatient Sample (NIS). We compared the rates at which nonagenarians and octogenarians developed each complication in the inpatient setting following both primary THA (PTHA) and revision THA (RTHA). A total of 40,944 inpatient admissions were included in our study which extrapolates to a national estimate of 199,793 patients. A total of 185,799 (93%) were octogenarians and 13,994 (7%) were nonagenarians. PTHA was performed on 155,669 (78%) and RTHA was performed on 44,124 (22%) of the patients. Nonagenarians undergoing PTHA required transfusions significantly more frequently (33.13% v. 24.0%, p < 0.001) and developed urinary tract infection (5.14% v. 3.92%, p = 0.012) and acute kidney injury (5.50% v. 3.57%, p < 0.001) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA required transfusions significantly more frequently (51.43% v. 41.46%, p < 0.001) and developed urinary tract infection (19.66% v. 11.73%, p < 0.001), acute kidney injury (13.8% v. 9.66%, p < 0.001), pulmonary embolism (1.24% v. 0.67%, p = 0.031), postoperative infection (1.89% v. 1.11%, p = 0.023), sepsis (3.59% v. 2.43%, p = 0.021) and other postoperative shock (1.76% v. 1.06%, p = 0.036) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA also had a significantly higher inpatient mortality rate (3.28% v. 1.43%, p < 0.001) than octogenarians. Orthopedic surgeons and primary care providers can use these findings to help counsel both their octogenarian and nonagenarian patients preoperatively when considering THA. Our analysis can help these patients better understand expected inpatient complication rates and assist them in deciding whether to pursue surgical intervention when applicable.

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Section: Introductionmentioning

confidence: 99%

Comparing Inpatient Complication Rates between Octogenarians and Nonagenarians Following Primary and Revision Total Hip Arthroplasty in a Nationally Representative Sample 2010–2014

et al. 2019

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“…To date, there is no consensus on an age limit for the procedure. It is agreed that patients in their 80s or even 90s could still benefit from the surgery 18 provided the associated higher mortality is well explained and accepted.…”

Section: Mortality Risk Factorsmentioning

confidence: 99%

Mortality following primary total knee replacement in public hospitals in Hong Kong

Lee¹,

Mak²,

Wong³

2016

Hong Kong Med J

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“…Older age has been implicated in longer hospital stays, greater postoperative complications, and occasionally, poorer general outcomes following arthroplasty. 3,4 Also, negative correlations have been found between patient age and expectations for surgical success. 5 Conversely, other reports have shown that older patients may be more satisfied following surgery and may have comparable postoperative outcomes to their younger cohorts.…”

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confidence: 99%

Effect of Age on Postoperative Outcomes Following Total Knee Arthroplasty

et al. 2016

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The demand for total knee arthroplasty (TKA) continues to grow exponentially, and this has been attributed to a higher prevalence of osteoarthritis and excellent procedural success. In particular, with increasing life expectancies and obesity rates, surgeons are seeing patients with a wider age range. Therefore, we assessed the effects of patient age on: (1) range of motion (ROM); (2) pain and function; (3) physical and mental status; and (4) activity levels following TKA. We assessed 278 TKA patients (108 men, 170 women), with subdivision into three age-specific groups: < 55, 55 to 74, and 75 years or older. ROM was assessed and functional outcomes were evaluated using the Knee Society scoring (KSS) system, the short form-36 (SF-36), and the lower extremity activity scale (LEAS). The patients were assessed preoperatively and postoperatively at 6 weeks, 3 months, 12 months, and then yearly thereafter until 7 years. All cohorts demonstrated improvements in ROM, with no significant differences between the age groups. For KSS objective, there were no significant differences between groups after 6-week follow-up, though in pain and motion, the 75 years and older had the highest mean score at final follow-up (97 points). In KSS function, the < 55 years group had highest scores at 2 (90 vs. 87 vs. 75 points) and 5-year follow-up (96 vs. 88 vs. 72 points). For SF-36 and LEAS, the 75 year and older cohorts had the lowest mean scores at various time points. In the mental component, those < 55 years had the lowest scores postoperatively. It is important to understand the effect of age on post-TKA outcomes, particularly as the cohort of these patients continues to grow. Our results demonstrate that comprehensive preoperative discussions and management are needed, particularly in those patients at either end of the age spectrum (< 55 or ≥ 75 years).

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Can Total Knee Arthroplasty Be Safely Performed Among Nonagenarians? An Evaluation of Morbidity and Mortality Within a Total Joint Replacement Registry

Cited by 35 publications

References 12 publications

Comparing Inpatient Complication Rates between Octogenarians and Nonagenarians Following Primary and Revision Total Hip Arthroplasty in a Nationally Representative Sample 2010–2014

Comparing Inpatient Complication Rates between Octogenarians and Nonagenarians Following Primary and Revision Total Hip Arthroplasty in a Nationally Representative Sample 2010–2014

Mortality following primary total knee replacement in public hospitals in Hong Kong

Effect of Age on Postoperative Outcomes Following Total Knee Arthroplasty

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