Total Knee Arthroplasty in Octogenarians: Should We Still Be so Restrictive?

Abstract

Demand for total knee arthroplasty (TKA) in octogenarians will increase in subsequent years as society ages. We conducted a retrospective observational study in octogenarians operated on with TKA between 2015 and 2019, comparing preoperative and postoperative Knee Society Score (KSS), Knee Society Function Score (KSFS), extension and flexion balance, and radiologic alignment using a paired Student t-test. A chi-squared test was used to correlate mortality with Charlson comorbidities index score and with ASA scale. Kaplan–Meier analysis was performed to calculate patient survival. In this period 36 patients ≥80 years underwent TKA, with a mean age of 81.6 years. Of these, 24 patients (66.7%) were classified as ASA II and 12 (33.3%) as ASA III. Sixteen patients (44.4%) were Charlson 0, 14 (38.9%) Charlson 1, two (5.6%) Charlson 2, and four (11.1%) Charlson 3. KSS, KSFS, flexion and extension range, and radiologic alignment were statistically significant (p < 0.001) when comparing preoperatory and post-operatory data. No correlation (p > 0.05) was found between mortality and ASA or Charlson score. Seven patients (19.4%) suffered a medical complication and two patients experienced surgical complications. Four patient died (11.1%) during follow-up. The mean patient survival was 67.4 months. Patients ≥80 years achieve clinical improvement after TKA. Comorbidities, not age, are the burden for surgery in older patients.

The Effect of Age on Peri-Operative Outcomes after FEVAR

“…The need for finding solutions for an aging population is not limited to but certainly of high interest in healthcare. Age as a limitation for operative procedures has been of growing interest in clinical medicine, for example, in orthopedics for total joint replacement surgery [23][24][25]. There has been a plethora of studies suggesting an increased risk for peri-operative complications for elderly patients in several fields, ranging from cerebral aneurysms [26,27] to common abdominal procedures [28].…”

Periprosthetic hip infection in octogenarians

“…[1][2][3] While total hip arthroplasty (tHa) for degenerative joint disease remains among the most successful procedures of the 20th century, 4 knowledge on outcomes and characteristics in elderly patients is limited to a few studies. [5][6][7] Moreover, studies on tHas in octogenarians and older patients rarely describe complications, and almost nothing is known on periprosthetic joint infections (pJis) in this uniquely challenging cohort. 8,9 the purpose of this investigation is to explore the baseline demographic details, infection characteristics, surgical outcomes, as well as perioperative complications in octogenarians revised for pJi of a tHa in a single university-based institution.…”

Perioperative Complications after Hip and Knee Revision Arthroplasty in the over 80 Years Old Population: A Retrospective Observational Case–Control Study

“…Although a few studies have already investigated perioperative complications after total hip and knee revision arthroplasty in the elderly [ 15 , 16 ], to the best of our knowledge, only one compared the rate of perioperative complications following aseptic revision of THA in patients aged ≥ 80 with that of those <80 [ 17 ]. Because it was based on a national database in the United States, some bias affected the study, such as different perioperative management, application of drug protocols, types of implants, and number of procedures per surgeon.…”