Effect of Age on Postoperative Outcomes Following Total Knee Arthroplasty

Abstract

The demand for total knee arthroplasty (TKA) continues to grow exponentially, and this has been attributed to a higher prevalence of osteoarthritis and excellent procedural success. In particular, with increasing life expectancies and obesity rates, surgeons are seeing patients with a wider age range. Therefore, we assessed the effects of patient age on: (1) range of motion (ROM); (2) pain and function; (3) physical and mental status; and (4) activity levels following TKA. We assessed 278 TKA patients (108 men, 170 women), with subdivision into three age-specific groups: < 55, 55 to 74, and 75 years or older. ROM was assessed and functional outcomes were evaluated using the Knee Society scoring (KSS) system, the short form-36 (SF-36), and the lower extremity activity scale (LEAS). The patients were assessed preoperatively and postoperatively at 6 weeks, 3 months, 12 months, and then yearly thereafter until 7 years. All cohorts demonstrated improvements in ROM, with no significant differences between the age groups. For KSS objective, there were no significant differences between groups after 6-week follow-up, though in pain and motion, the 75 years and older had the highest mean score at final follow-up (97 points). In KSS function, the < 55 years group had highest scores at 2 (90 vs. 87 vs. 75 points) and 5-year follow-up (96 vs. 88 vs. 72 points). For SF-36 and LEAS, the 75 year and older cohorts had the lowest mean scores at various time points. In the mental component, those < 55 years had the lowest scores postoperatively. It is important to understand the effect of age on post-TKA outcomes, particularly as the cohort of these patients continues to grow. Our results demonstrate that comprehensive preoperative discussions and management are needed, particularly in those patients at either end of the age spectrum (< 55 or ≥ 75 years).

Keywords

total knee arthroplasty - outcomes - TKA - age - postoperative

• References

• 1 Gelber AC, Hochberg MC, Mead LA, Wang NY, Wigley FM, Klag MJ. Body mass index in young men and the risk of subsequent knee and hip osteoarthritis. Am J Med 1999; 107 (6) 542-548
• 2 Apold H, Meyer HE, Nordsletten L, Furnes O, Baste V, Flugsrud GB. Weight gain and the risk of knee replacement due to primary osteoarthritis: a population based, prospective cohort study of 225,908 individuals. Osteoarthritis Cartilage 2014; 22 (5) 652-658
• 3 Miric A, Inacio MC, Kelly MP, Namba RS. Can total knee arthroplasty be safely performed among nonagenarians? An evaluation of morbidity and mortality within a total joint replacement registry. J Arthroplasty 2014; 29 (8) 1635-1638
• 4 Singh JA, O'Byrne M, Harmsen S, Lewallen D. Predictors of moderate-severe functional limitation after primary Total Knee Arthroplasty (TKA): 4701 TKAs at 2-years and 2935 TKAs at 5-years. Osteoarthritis Cartilage 2010; 18 (4) 515-521
• 5 Hepinstall MS, Rutledge JR, Bornstein LJ, Mazumdar M, Westrich GH. Factors that impact expectations before total knee arthroplasty. J Arthroplasty 2011; 26 (6) 870-876
• 6 Williams DP, Price AJ, Beard DJ , et al. The effects of age on patient-reported outcome measures in total knee replacements. Bone Joint J 2013; 95-B (1) 38-44
• 7 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
• 8 Patel AA, Donegan D, Albert T. The 36-item short form. J Am Acad Orthop Surg 2007; 15 (2) 126-134
• 9 Saleh KJ, Mulhall KJ, Bershadsky B , et al. Development and validation of a lower-extremity activity scale. Use for patients treated with revision total knee arthroplasty. J Bone Joint Surg Am 2005; 87 (9) 1985-1994
• 10 Von Keudell A, Sodha S, Collins J, Minas T, Fitz W, Gomoll AH. Patient satisfaction after primary total and unicompartmental knee arthroplasty: an age-dependent analysis. Knee 2014; 21 (1) 180-184
• 11 McCalden RW, Robert CE, Howard JL, Naudie DD, McAuley JP, MacDonald SJ. Comparison of outcomes and survivorship between patients of different age groups following TKA. J Arthroplasty 2013; 28 (8, Suppl): 83-86
• 12 Kennedy JW, Johnston L, Cochrane L, Boscainos PJ. Total knee arthroplasty in the elderly: does age affect pain, function or complications?. Clin Orthop Relat Res 2013; 471 (6) 1964-1969
• 13 Pivec R, Issa K, Given K , et al. A Prospective, Longitudinal Study of Patient Satisfaction Following Total Knee Arthroplasty Using the Short-Form 36 (SF-36) Survey Stratified by Various Demographic and Comorbid Factors. J Arthroplasty 2015; 30 (3) 374-378
• 14 Sloan FA, Ruiz Jr D, Platt A. Changes in functional status among persons over age sixty-five undergoing total knee arthroplasty. Med Care 2009; 47 (7) 742-748
• 15 Felts E, Parratte S, Pauly V, Aubaniac JM, Argenson JN. Function and quality of life following medial unicompartmental knee arthroplasty in patients 60 years of age or younger. Orthop Traumatol Surg Res 2010; 96 (8) 861-867
• 16 Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty 1998; 13 (8) 890-895
• 17 Dahm DL, Barnes SA, Harrington JR, Sayeed SA, Berry DJ. Patient-reported activity level after total knee arthroplasty. J Arthroplasty 2008; 23 (3) 401-407
• 18 Stuck AE, Walthert JM, Nikolaus T, Büla CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med 1999; 48 (4) 445-469