Higher rates of surgical and medical complications and mortality following TKA in patients aged ≥ 80 years: a systematic review of comparative studies

Abstract

The purpose of this systematic review was to synthesize studies published since the last systematic review in 2015 that compare outcomes of primary total knee arthroplasty (TKA) in older patients (≥ 80 years) and in younger patients (< 80 years), in terms of complication rates and mortality. An electronic literature search was conducted using PubMed, Embase®, and Cochrane Register. Studies were included if they compared outcomes of primary TKA for osteoarthritis in patients aged 80 years and over to patients aged under 80 years, in terms of complication rates, mortality, or patient-reported outcomes (PROs). Thirteen studies were eligible. Surgical complications in older patients ranged from 0.6–21.1%, while in younger patients they ranged from 0.3–14.6%. Wound complications in older patients ranged from 0.5–20%, while in younger patients they ranged from 0.8–22.0%. Medical complications (cardiac, respiratory, thromboembolic) in older patients ranged from 0.4–17.3%, while in younger patients they ranged from 0.2–11.5%. Mortality within 90 days in older patients ranged between 0–2%, while in younger patients it ranged between 0.0–0.03%. Compared to younger patients, older patients have higher rates of surgical and medical complications, as well as higher mortality following TKA. The literature also reports greater length of stay for older patients, but inconsistent findings regarding PROs. The present findings provide surgeons and older patients with clearer updated evidence, to make informed decisions regarding TKA, considering the risks and benefits within this age group. Patients aged over 80 years should therefore not be excluded from consideration for primary TKA based on age alone. Cite this article: EFORT Open Rev 2021;6:1052-1062. DOI: 10.1302/2058-5241.6.200150

Development and validation of a nomogram to predict complications in patients undergoing simultaneous bilateral total knee arthroplasty: A retrospective study from two centers

“…Previous studies focused on the analysis of postoperative efficacy and perioperative complications in patients of different ages after TKA ( 19 , 20 , 26 ). Regardless of age, the satisfaction rate of knee surgery is more than 85%, and advanced age does not affect the efficacy of TKA ( 19 ).…”

“…In addition, we found that preoperative lower hemoglobin was an independent risk factor for complications in patients with SBTKA within 30 days after surgery. Interestingly, a recent study found that lower preoperative hemoglobin levels were identified as an independent predictor of blood transfusion in patients after TKA ( 26 ). In this study, severe postoperative anemia was the most common complication, which well explained the influence of preoperative hemoglobin level on postoperative complications.…”

Similar survival rate but lower functional outcomes following TKA in the elderly people compared to younger patients: analysis of a posterior stabilised implant with minimum 5-year follow-up

“…Furthermore, due to the small sample size in patients under 80, it is difficult to reach conclusions on certain rare complications such as periprosthetic joint infection. Nonetheless, elderly patients undergoing TKA must be warned of the heightened risks of general medical complications, as several studies have shown an increased rate in the elderly [6, 13]. Rather than using age as a condition for surgery, we support an approach of basing the decision on comorbidities instead.…”

“…Of the published series, studies report aggregate data sometimes containing multiple implant designs [13, 16], or do not report the prosthesis used [2], or have relatively short follow‐up [4, 13, 19, 26, 34] or use outdated prostheses and perioperative protocols. In 2021, Courage et al published a systematic review comparing complications after TKA in patients under or over 80 years of age [6]. They reported higher rates of medical and surgical complications, higher early and late mortality, and longer length of hospital stay.…”

A Prospective Randomized Comparative Study Between Midvastus and Standard Medial Parapatellar Approaches for Total Knee Replacement Regarding the Peri-Operative Factors

“…TKR is a common and safe procedure that relieves the symptoms of arthritis and improves the quality of life [ 12 ]. Nevertheless, like any major surgical procedure, TKR is not without complications, with rates reaching up to 20% for older patients [ 21 ]. The most often referenced complications in the literature are cardiovascular, respiratory and thromboembolic episodes [ 12 , 13 ].…”