Total Knee Arthroplasty in the Younger Patient

Abstract

The rate of total knee arthroplasty (TKA) utilization in younger patients (< 65 years old) is increasing. Little is known regarding demographics and in-hospital outcomes in this population. The National Hospital Discharge Survey (NHDS) database was searched using International Classification of Diseases, Ninth Revision (ICD-9) procedure codes for patients admitted to U.S. hospitals for unilateral primary TKA between 2001 and 2010. Patients were separated into young (< 65 years of age) and senior cohorts (≥ 65 years of age). ICD-9 diagnosis and procedure codes were used to identify demographics, hospital length of stay, in-hospital adverse events, mortality, and discharge disposition. Trends were evaluated by linear regression with Pearson correlation coefficient () and statistical comparisons were made using Student -test and chi-square analysis. The young cohort accounted for 38.4% of TKAs performed from 2001 to 2005, increasing to 42.7% of TKAs from 2006 to 2010. They had a higher percentage of males (36.4 vs. 34.2%, < 0.001). Rates of obesity (11.1 vs. 6.0%, < 0.001) and morbid obesity (5.8 vs. 1.9%, < 0.001) were significantly higher, yet they had less comorbidities (4.7 vs. 5.2, < 0.001), and lower rates of transfusion (12.2 vs. 19.8%, < 0.001), pulmonary embolism (PE) (0.31 vs. 0.49%, < 0.020), and mortality (0.03 vs. 0.18%, < 0.001). Patients < 65 years old undergoing TKA have almost double the rate of obesity of patients ≥ 65 years old. This could explain the higher rates of periprosthetic infection and aseptic mechanical failure seen in younger patients. However, the young cohort had a more favorable discharge disposition and lower mortality and risk of PE than elderly patients.

Weight affects survival of primary total knee arthroplasty: study based on the Danish Knee Arthroplasty Register with 67,810 patients and a median follow-up time of 5 years

“…Shah et al. (2017) found a significantly higher occurrence of obesity and morbid obesity among patients <65.We could not show that increased weight was associated with increased risk of revision in younger patients, but patients weighing 60–69 kg had a lower risk of revision. These results may be due to the lower number of patients aged 18–55 years.…”

Is there an optimal age for total knee arthroplasty?: A systematic review

“…In three studies, the mortality rate in patients ≥ 80 years of age was higher than that in the control groups [ 48 , 59 , 60 ]. In another study, the mortality rate in patients ≥ 65 years of age was higher than that in patients < 65 years of age [ 20 ].…”

“…However, the impact of age on patient satisfaction is still debated even though the incidence of TKA uptake among younger (< 55 years) and geriatric (> 80 years) patients is increasing [ 18 , 20 ]. Some studies have shown good treatment results for TKA even when performed at extreme ages.…”

Higher mid-term revision rates of posterior stabilized compared with cruciate retaining total knee arthroplasties: 133,841 cemented arthroplasties for osteoarthritis in the Netherlands in 2007–2016

“…2015, Shah et al. 2017). The number of patients currently living with a TKA suggests a large potential revision healthcare burden (Hamilton et al.…”