Effect of Age on Postoperative Outcomes Following Total Knee Arthroplasty

Abstract

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).

Effectiveness of lidocaine patches for pain treatment after total knee arthroplasty

“…This finding corroborates the literature in that, in the majority of studies, the relative frequency of women was higher than that of men. In the study by van Egmond, C et al 27 the relative frequency of women was 60%, a percentage similar to that of the Elmallah R et al study, 28 in which 61.1% of the patients were female, and of the study by Jauregui J et al, 29 which showed that 61.5% of the sample were female. Age is another factor that is actively related to the period after surgery, 28 being an important predictor of functional outcome.…”

“…In the study by van Egmond, C et al 27 the relative frequency of women was 60%, a percentage similar to that of the Elmallah R et al study, 28 in which 61.1% of the patients were female, and of the study by Jauregui J et al, 29 which showed that 61.5% of the sample were female. Age is another factor that is actively related to the period after surgery, 28 being an important predictor of functional outcome. 30 In the study, patients older than 70 years presented a relative frequency of 45.45% in the intervention group and 43.47% in the control group.…”

Total Knee Arthroplasty in Severe Valgus Osteoarthritis Excellent Early Results in a 90-Year-Old Patient with a Valgus Deformity of 47°

“…Geriatric patients have been shown to have a higher rate of intra- and postoperative complications and longer hospitalization [5, 6]. An age of 70 years or older is a predisposing factor for postoperative delirium [7], the incidence of which is up to 50% after orthopedic operations [8].…”

“…Up to 38% of quadriceps strength deficit has been reported in end stage osteoarthritis of the knee [9], while in geriatric patients with severe osteoarthritis this deficit is expected to be even larger. Altogether, patients above 80 years have been shown to have poorer general outcomes following arthroplasty [6]. Currently only 5% of all TKAs are performed in patients aged 85 years or older [5].…”

Impact of Age on Patient-Reported Outcome Measures in Total Knee Arthroplasty

“…2 Outcome measures analyses have demonstrated worse outcomes on mental components, and are equivalent on pain and function for younger patients. 19 Understanding this relationship is important to create realistic postoperative expectations, a process which has been demonstrated to improve post-TKA outcomes. 20,21 Not meeting patient expectations prior to surgery has been shown to be a strong predictor of patient dissatisfaction after TKA.…”