Patient-Reported Outcomes Following Total Knee Replacement in Patients <65 Years of Age—A Systematic Review and Meta-Analysis

Abstract

An increasing number of total knee replacements (TKRs) are being performed in response to the growing burden of osteoarthritis. Patients &lt;65 years of age represent the fastest growing group of TKR recipients and are expected to account for an increasing number of primary and revision procedures. Concerns have been raised about the outcomes that can be expected by this age demographic who are more active, physically demanding, and have longer life expectancies compared to older TKR recipients. This systematic review and meta-analysis evaluated the effectiveness of TKR for osteoarthritis in patients &lt;65 years of age, compared to older individuals. A systematic search of Embase and Medline was conducted to identify studies which examined patient-reported outcomes measured using disease-specific and generic health-related quality of life instruments. Ten studies met our inclusion criteria and were included in this review. These studies comprised 1747 TKRs performed between 1977 and 2014. In the meta-analysis of two prospective studies (288 TKRs), patients &lt;65 years of age were able to attain large and clinically meaningful improvements in pain, function, and quality of life. One of these studies (61 TKRs) suggested that patients &lt;55 years of age attained a larger degree of improvement compared to older individuals. Results into the second postoperative decade were less certain, with some data suggesting a high prevalence of pain and patterns of functional decline. Further research is required to investigate longer-term outcomes following TKR for osteoarthritis in younger patients.

Patient-Reported Outcomes following Total Knee Replacement in Patients Aged 65 Years and Over—A Systematic Review

“…All four studies (with serious risk of bias) examining satisfaction exhibited overall patient-reported satisfaction with TKR procedure [ 27 , 28 , 35 , 37 ]. These satisfaction results are consistent with the broader literature and studies analysing TKRs for younger patients [ 8 , 44 , 45 ]. Despite these findings, the measure of satisfaction is under the influence of a range of factors and thus remains a complex area.…”

“…A prior systematic review and meta-analysis examined the patient-reported outcomes following TKR in patients aged less than 65 years [ 8 ]. This report found significant and meaningful improvements in pain, knee function, quality of life, and overall satisfaction with the procedure in individuals within this age demographic [ 8 ].…”

“…A prior systematic review and meta-analysis examined the patient-reported outcomes following TKR in patients aged less than 65 years [ 8 ]. This report found significant and meaningful improvements in pain, knee function, quality of life, and overall satisfaction with the procedure in individuals within this age demographic [ 8 ]. The question remains as to whether these results are replicated for older adults aged over 65 years, a population with increased comorbidities and worse functional and psychosocial status but representing a significant proportion of those undergoing TKR [ 9 , 10 ].…”

Implementing evidence-based pre-operative education in hospitalized patients undergoing total knee replacement: a best practice implementation project

“…A substantial increase in the number of TKR surgeries has also been reported in other countries 3 . TKR surgery typically results in functional knee range of motion and improved performance in daily life 4 . However, a significant number of patients experiences suboptimal outcomes, including falls and functional limitations after surgery 5,6 …”

The German version of the High-Activity Arthroplasty Score is valid and reliable for patients after total knee arthroplasty

“…The number of TKAs in patients under the age of 65 years notably increased in recent years [13, 23]. They represent the fastest growing population of TKA recipients and are expected to account for more than 50% of knee replacement procedures by the year 2030 [24].…”