Surgical Outcomes and Analysis of Quality of Life Following Knee Arthroplasty in Very Elderly Patients

Abstract

In an aging population, the incidence of severe knee osteoarthritis in very elderly patients increases, leading to functional impairment and loss of independence. Knee replacement could be an effective treatment but is often denied due to fear of increased complication rate with advanced age. The objective of this study was to investigate complication rate, mortality, clinical outcome, and quality-adjusted life years (QALYs) of primary knee replacement in very elderly patients, defined as 83 years or older. Medical records of 85 cases, receiving a primary total (total knee arthroplasty [TKA]) or unicompartmental (unicompartmental knee arthroplasty [UKA]) knee replacement, aged 83 years or older at the time of surgery, were retrospectively reviewed for surgical and medical complications as well as survivorship. Functional outcome was obtained by Oxford Knee Score (OKS) and QALY. At a mean follow-up of 21 months (TKA) and 24 months (UKA), surgical and medical complication rates were 9.7 and 8.1% for TKA and 4.3 and 4.3% for UKA, respectively. One-year survival rate was 98.4% in TKA and 98.8% in UKA, the 5-year survival rate was 83.1 and 86.6%, respectively. OKS improved from 19 to 41 points in TKA and 23 to 40 points in UKA. Mean QALYs were 4.1 years for TKA and 3.9 years for UKA. TKA and UKA are safe and reliable surgical procedures in treating end-stage osteoarthritis in very elderly patients. Patients might benefit from improved pain, function, and quality of life. The mortality rate and overall complication rate were low, although slightly higher than reported in cohorts with younger patients. If the patient is suitable, UKA might be preferred over TKA, as the complication rate was significantly lower. Patients should not be excluded from knee replacement based on their age alone, but careful patient selection, peri- and postoperative optimization, and awareness for complications are quintessential for successful treatment.

Keywords

total knee arthroplasty - unicompartmental knee arthroplasty - elderly - quality-adjusted life years - clinical outcome - complications

Ethical Approval

The study was approved by our institution's Internal Review Board and the National Ethics Committee.

Informed Consent

Each patient provides written informed consent before participation.

^* These authors contributed equally for this manuscript.

Publikationsverlauf

Eingereicht: 23. Oktober 2021

Angenommen: 25. Februar 2022

Artikel online veröffentlicht:
28. Juli 2022

• References

• 1 Murphy L, Schwartz TA, Helmick CG. et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum 2008; 59 (09) 1207-1213
• 2 Spahn G, Schiele R, Hofmann GO. et al. [The prevalence of radiological osteoarthritis in relation to age, gender, birth-year cohort, and ethnic origins]. Z Orthop Unfall 2011; 149 (02) 145-152
• 3 Guccione AA. Arthritis and the process of disablement. Phys Ther 1994; 74 (05) 408-414
• 4 Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster J-Y. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004; 86 (05) 963-974
• 5 Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. National Joint Registry for England and Wales, Data from the National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. J Bone Joint Surg Br 2007; 89 (07) 893-900
• 6 Nwachukwu BU, Schairer WW, O'Dea E, McCormick F, Lane JM. The quality of cost-utility analyses in orthopedic trauma. Orthopedics 2015; 38 (08) e673-e680
• 7 Ortman JM, Velkoff VA, Hogan H. An Aging Nation: The Older Population in the United States. Published by US Census Bureau, Economics and Statistics Administration, US Department of Commerce. 2014. 25. 1140
• 8 OECD. Health at a Glance 2017: OECD Indicators. Published by OECD Publishing; Paris: 2017
• 9 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
• 10 Clement ND, MacDonald D, Howie CR, Biant LC. The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more. J Bone Joint Surg Br 2011; 93 (09) 1265-1270
• 11 Rubin LE, Blood TD, Defillo-Draiby JC. Total hip and knee arthroplasty in patients older than age 80 years. J Am Acad Orthop Surg 2016; 24 (10) 683-690
• 12 Katz BP, Freund DA, Heck DA. et al. Demographic variation in the rate of knee replacement: a multi-year analysis. Health Serv Res 1996; 31 (02) 125-140
• 13 Federal Statistical Office, Switzerland. Life expectancy, 1999-2018. 2019
• 14 Muñoz M, Acheson AG, Bisbe E. et al. An international consensus statement on the management of postoperative anaemia after major surgical procedures. Anaesthesia 2018; 73 (11) 1418-1431
• 15 Vellas B, Villars H, Abellan G. et al. Overview of the MNA–its history and challenges. J Nutr Health Aging 2006; 10 (06) 456-463 , discussion 463–465
• 16 Murphy MF, Wallington TB, Kelsey P. et al; British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the clinical use of red cell transfusions. Br J Haematol 2001; 113 (01) 24-31
• 17 Parvizi J, Zmistowski B, Berbari EF. et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469 (11) 2992-2994
• 18 Murray DW, Fitzpatrick R, Rogers K. et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br 2007; 89 (08) 1010-1014
• 19 Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 1998; 80 (01) 63-69
• 20 Clement ND, MacDonald D, Simpson AHRW. The minimal clinically important difference in the Oxford Knee Score and Short Form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1933-1939
• 21 Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life. Med Care 1989; 27 (3, Suppl): S217-S232
• 22 Brooks R. EuroQol: the current state of play. Health Policy 1996; 37 (01) 53-72
• 23 Beard DJ, Davies LJ, Cook JA. et al; TOPKAT Study Group. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet 2019; 394 (10200): 746-756
• 24 Townsend LA, Roubion RC, Bourgeois DM. et al. Impact of age on patient-reported outcome measures in total knee arthroplasty. J Knee Surg 2018; 31 (06) 580-584
• 25 Burn E, Liddle AD, Hamilton TW. et al. Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales. BMJ Open 2018; 8 (04) e020977
• 26 Easterlin MC, Chang DG, Talamini M, Chang DC. Older age increases short-term surgical complications after primary knee arthroplasty. Clin Orthop Relat Res 2013; 471 (08) 2611-2620
• 27 Maempel JF, Riddoch F, Calleja N, Brenkel IJ. Longer hospital stay, more complications, and increased mortality but substantially improved function after knee replacement in older patients. Acta Orthop 2015; 86 (04) 451-456
• 28 Klasan A, Putnis SE, Yeo WW, Fritsch BA, Coolican MR, Parker DA. Advanced age is not a barrier to total knee arthroplasty: a detailed analysis of outcomes and complications in an elderly cohort compared with average age total knee arthroplasty patients. J Arthroplasty 2019; 34 (09) 1938-1945
• 29 Siman H, Kamath AF, Carrillo N, Harmsen WS, Pagnano MW, Sierra RJ. Unicompartmental knee arthroplasty vs total knee arthroplasty for medial compartment arthritis in patients older than 75 years: comparable reoperation, revision, and complication rates. J Arthroplasty 2017; 32 (06) 1792-1797
• 30 Fabre-Aubrespy M, Ollivier M, Pesenti S, Parratte S, Argenson J-N. Unicompartmental knee arthroplasty in patients older than 75 results in better clinical outcomes and similar survivorship compared to total knee arthroplasty. A matched controlled study. J Arthroplasty 2016; 31 (12) 2668-2671
• 31 Yang KY, Wang MC, Yeo SJ, Lo NN. Minimally invasive unicondylar versus total condylar knee arthroplasty–early results of a matched-pair comparison. Singapore Med J 2003; 44 (11) 559-562
• 32 Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br 2009; 91 (01) 52-57
• 33 Berstock JR, Beswick AD, López-López JA, Whitehouse MR, Blom AW. Mortality after total knee arthroplasty: a systematic review of incidence, temporal trends, and risk factors. J Bone Joint Surg Am 2018; 100 (12) 1064-1070