Summary
By narrowing down the indication for TKA in the elderly OA patients aged 85 years and older, it is less likely to suffer severe complications post-surgery. It is also possible for them to obtain the same surgical outcome as regular elderly people, and so it is meaningfulness that the elderly knee OA patient aged 85 years and older undergo TKA.
Abstract
Background
Between 2005 and 2014 the percentage of total knee replacement surgery (TKA) for the elderly aged 75 to 79 increased to 32.2% compared with 8.8% for the same population between 1985 and 1994. TKA for the elderly patient aged 85 and older has also been increasing.
Purpose
Our purpose is to compare the surgical results and complications of TKA against an osteoarthritis (OA) knee in patients aged 85 years or older with patients in the young age groups. Our hypothesis is that the surgical results of TKA in elderly OA patients (85+ years) will not be as good when compared with TKA results in the young age groups, and that they will suffer more complications at post-surgery.
Methods
Between 2005 – 2014, TKA surgery was performed on 247 cases (291 knees with OA). Cases were TKA was performed on both sides were excluded from the study. Follow-up was performed for more than 12 months after surgery. The cases were divided into three groups depending on the age at the time of operation, Group A; 14 knees aged 85 and older (3 male, 11 female, average age was 87.3 years), Group B; 85 knees aged 75-79 (17 male, 68 female, average age 77.2 years), Group C; 14 knees aged from 65 to 69 (3 men, 11 females, average age 66.6 years). We compared the survey results for these three groups. The survey items were: the patient background (gender, left / right, Kellgren-Laurence classification, preoperative general condition, comorbid condition), surgical outcome (walking ability, knee joint range, the japanese orthopaedic association (JOA) score), postoperative course (complications, days of stay).
Results
All groups had 90% or more of the possible complications at the time of admission. But in the preoperative whole-body condition evaluation, no significant difference was observed between three groups. Combination of locomotorium degenerative disease under treatment was dominantly biased to Group A 4/14 knee (28.6%), Group B 56/85 knee (63.6%), Group C 5/14 (33.3%) (p= 0.011). Serious complications did not occur in Group A during the perioperative period and for 1 year after the surgery. There were no differences between the groups in the number of hospital days, discharge destination, knee joint motion range before surgery and 1 year after operation, improvement rate of JOA score.
Conclusions
By narrowing down the indication for TKA in the elderly OA patients (85+ years), it is less likely to suffer severe complications post-surgery. It is also possible for them to obtain the same surgical outcome as regular elderly people, and so it is meaningfulness that the elderly knee OA patient (85+ years) undergo TKA.