Nonagenarians qualify for total knee arthroplasty: a report on 329 patients from the Swedish Knee Arthroplasty Register 2000–2016

Abstract

Background and purpose — The nonagenarian (those aged 90 years and older) population is expected to double in the next 20 years. This demographic age quake may have a significant impact on the incidence of total knee arthroplasty (TKA), although current literature provides limited data. We examined death and revision rates, patient-reported outcomes (PROs) and bias on patient selection of nonagenarian patients operated on with TKA for osteoarthritis (OA) between 2000 and 2016.Patients and methods — The Swedish national knee arthroplasty register was used to identify 329 nonagenarians (mean age, 92 years). Each patient was followed-up until death or the end of 2017. PRO data of 22 of these patients were compared with 65- to 74-year-old patients operated in 2015, from the same register.Results — 5 patients (1.5%) died within 90 days and 23 (7%) patients died within 365 days after TKA. 8 patients (2.4%) developed knee complications that needed revision. For patients followed for 5 and 10 years, more than 50% and 10%, respectively, lived without being revised. The patients had statistically significant improvements in PROs, not significantly different from the younger SKAR cohort. However, the material is small and this statistical finding does not preclude that there may be clinically relevant differences. TKA incidence was different amongst the 21 counties in the country (range, 0–5.1/10,000).Interpretation — Our study suggests that nonagenarians with knee OA qualify for TKA, having similar outcomes to younger patients. The data presented may help surgeons and patients assessing the risks and outcome associated with the procedure.

Preoperative characteristics and intraoperative factors do not correlate with accomplishments of active straight-leg raising, standing up, and walking after primary total knee arthroplasty

“…Whether there is a correlation between clinical outcomes and unmodifiable patient factors such as age and sex in TKA patients remains inconclusive. Some studies reported that older people have worse clinical outcomes [ 15 , 21 ] whereas others reported older people can expect outcomes equivalent to those in younger people (over 80 vs less than 80 years [ 22 ], over 90 vs less than 90 years [ 23 ]). Regarding sex differences, some [ 24 , 25 ] studies reported that men had better outcomes, whereas other studies [ 21 , 26 ] reported better outcomes in women.…”

Pushing the Surgical Limits: Primary Total Knee Arthroplasty Using Rotational Prosthesis in a 96-Year-Old Lady with End-Stage Osteoarthritis

“…Degenerative conditions such as osteoarthritis are, therefore, becoming increasingly prevalent. A recent study investigating TKA for nonagenarians in Sweden found good outcomes for death and revision rates, as well as patient-reported outcomes compared with other age groups undergoing TKA [ 1 ]. Complications after TKA have been reported at between five out of 20 and 11 out of 15 TKAs [ 2 , 3 ].…”

“…Longer-term follow-up including mortality rate is less easily interpreted among this elderly group because these patients have a short life expectancy. Some authors suggest that death rates up to and including one year postoperatively are better indicators of safety among this age group [ 1 ].…”

“…Cost-benefit considerations must also be made when undertaking elective surgery for the elderly population. Length of hospital stay for acute postoperative care has been reported as higher among the nonagenarian population at around 10-15 days, with associated increase in the cost of TKA [ 1 ]. Offsetting this amount with the public health cost of keeping a healthy and active patient population from needing TKA could be deliberated.…”

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

“…The success of TKA for patients aged over 80 years is a matter of controversy, as prior studies have reported inconsistent associations between advanced age and outcomes. Whereas some studies found patient-reported outcomes (PROs) following TKA in older patients to be comparable to those in their younger counterparts, 5 – 7 others reported them to be significantly inferior in elderly patients. 8 , 9 Furthermore, some studies reported higher complication rates, length of stay (LoS) in hospital, and mortality following TKA in older patients, 6 , 10 – 12 whilst other studies argued that these outcomes depend more on morbidities and health status, rather than age per se.…”