Top

International Orthopaedics

Published in:

Open Access 01-03-2021 | Osteoarthrosis | Original Paper

Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

Authors: Michele Palazzuolo, Alexander Antoniadis, Jaad Mahlouly, Julien Wegrzyn

Published in: International Orthopaedics | Issue 3/2021

Abstract

Purpose

Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis though its risk-benefit ratio in elderly patients remains debated. This study aimed to evaluate the functional outcome, rates of complication and mortality, and quality-adjusted life years (QALY) in patients who exceeded their estimated life expectancy.

Methods

Ninety-seven TKA implanted in 86 patients who exceeded their estimated life expectancy at the time of TKA were prospectively included in our institutional joint registry and retrospectively analyzed. At latest follow-up, the functional outcome with the Knee Society Score (KSS), rates of complication and mortality, and QALY with utility value of EuroQol-5D score were evaluated.

Results

At a mean follow-up of three ± one years, the pre- to post-operative KSS improved significantly (p < 0.01). The rates of surgical and major medical complications related to TKA were 3% and 10%, respectively. The re-operation rate with readmission was 3% while no TKA was revised. The 30-day and one year mortality was 1% and 3%, respectively. The pre- to one year post-operative QALY improved significantly (p < 0.01). The cumulative QALY five years after TKA was four years. Assuming that these patients did not undergo TKA, their cumulative QALY at five years would have been only two years.

Conclusion

TKA is an effective procedure for the treatment of end-stage osteoarthritis in patients who exceeded their estimated life expectancy. TKA provided significant improvement in function and quality of life without adversely affecting overall morbidity and mortality. Therefore, TKA should not be contra-indicated in elderly patients based on their advanced age alone.

Guccione AA, Felson DT, Anderson JJ et al (1994) The effects of specific medical conditions on the functional limitations of elders in the Framingham study. Am J Public Health 84:351–358. https://doi.org/10.2105/AJPH.84.3.351CrossRefPubMedPubMedCentral

Tarakji BA, Wynkoop AT, Srivastava AK et al (2018) Improvement in depression and physical health following total joint arthroplasty. J Arthroplast 33:2423–2427. https://doi.org/10.1016/j.arth.2018.03.051CrossRef

Inacio MCS, Paxton EW, Graves SE et al (2017) Projected increase in total knee arthroplasty in the United States – an alternative projection model. Osteoarthr Cartil 25:1797–1803. https://doi.org/10.1016/j.joca.2017.07.022CrossRef

Finlayson E (2000) Operative mortality with elective surgery in older adults. Eff Clin Pract 4(4):172–177

Murphy BP d S, Dowsey MM, Choong PFM (2018) The impact of advanced age on the outcomes of primary total hip and knee arthroplasty for osteoarthritis: a systematic review. JBJS Rev 6:e6. https://doi.org/10.2106/JBJS.RVW.17.00077CrossRefPubMed

Baker JF, Stoyanov V, Shafqat A et al (2012) Total joint arthroplasty in nonagenarians-a retrospective review of complications and resource use. Acta Orthop Belg 78:745–750PubMed

Higuera CA, Elsharkawy K, Klika AK et al (2011) 2010 Mid-America Orthopaedic Association physician in training award: predictors of early adverse outcomes after knee and hip arthroplasty in geriatric patients. Clin Orthop Relat Res 469:1391–1400. https://doi.org/10.1007/s11999-011-1804-3CrossRefPubMedPubMedCentral

Jauregui JJ, Boylan MR, Kapadia BH et al (2015) Total joint arthroplasty in nonagenarians: what are the risks? J Arthroplast 30:2102–2105.e1. https://doi.org/10.1016/j.arth.2015.06.028CrossRef

Miric A, Inacio MCS, Kelly MP, Namba RS (2014) Can total knee arthroplasty be safely performed among nonagenarians? An evaluation of morbidity and mortality within a total joint replacement registry. J Arthroplast 29:1635–1638. https://doi.org/10.1016/j.arth.2014.03.014CrossRef

10.

Klausing A, Martini M, Wimmer MD et al (2019) Postoperative medical complications and intermediate care unit/intensive care unit admission in joint replacement surgery: a prospective risk model. J Arthroplast 34:717–722. https://doi.org/10.1016/j.arth.2018.12.034CrossRef

11.

Bureau UC The nation’s older population is still growing, Census Bureau Reports https://www.census.gov/newsroom/press-releases/2017/cb17-100.html. Accessed 13 Apr 2020

12.

Sloan M, Premkumar A, Sheth NP (2018) Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Jt Surg Am 100:1455–1460. https://doi.org/10.2106/JBJS.17.01617CrossRef

13.

World Population Prospects - Population Division - United Nations. https://population.un.org/wpp/. Accessed 13 Apr 2020

14.

Dimitriou D, Antoniadis A, Flury A et al (2018) Total hip arthroplasty improves the quality-adjusted life years in patients who exceeded the estimated life expectancy. J Arthroplast 33:3484–3489. https://doi.org/10.1016/j.arth.2018.07.005CrossRef

15.

Konopka JF, Lee Y, Su EP, McLawhorn AS (2018) Quality-adjusted life years after hip and knee arthroplasty. JBJS Open Access 3:e0007. https://doi.org/10.2106/jbjs.oa.18.00007CrossRefPubMedPubMedCentral

16.

Liebs TR, Herzberg W, Rüther W et al (2016) Quality-adjusted life years gained by hip and knee replacement surgery and its aftercare. Arch Phys Med Rehabil 97:691–700. https://doi.org/10.1016/j.apmr.2015.12.021CrossRefPubMed

17.

Whitehead SJ, Ali S (2010) Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull 96:5–21. https://doi.org/10.1093/bmb/ldq033CrossRefPubMed

18.

Bozic KJ, Katz P, Cisternas M et al (2005) Hospital resource utilization for primary and revision total hip arthroplasty. J Bone Jt Surg Ser A 87:570–576. https://doi.org/10.2106/JBJS.D.02121CrossRef

19.

Bunn KJ, Isaacson MJ, Ismaily SK et al (2016) Quantifying and predicting surgeon work effort for primary and revision total knee arthroplasty. J Arthroplast 31:59–62. https://doi.org/10.1016/j.arth.2016.05.003CrossRef

20.

Lebenserwartung, 1999–2018 - 1999-2018 | Tabelle. https://www.bfs.admin.ch/bfs/de/home/statistiken/bevoelkerung/geburten-todesfaelle/lebenserwartung.assetdetail.9466621.html. Accessed 13 Apr 2020

21.

Muñoz M, Acheson AG, Auerbach M et al (2017) International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia 72:233–247. https://doi.org/10.1111/anae.13773CrossRefPubMed

22.

Murphy MF, Wallington TB, Kelsey P et al (2001) Guidelines for the clinical use of red cell transfusions. Br J Haematol 113:24–31. https://doi.org/10.1046/j.1365-2141.2001.02701.xCrossRefPubMed

23.

Lizaur-Utrilla A, Gonzalez-Parreño S, Martinez-Mendez D et al (2020) Minimal clinically important differences and substantial clinical benefits for Knee Society Scores. Knee Surgery, Sport Traumatol Arthrosc 28:1473–1478. https://doi.org/10.1007/s00167-019-05543-xCrossRef

24.

EQ-5D. https://euroqol.org/. Accessed 13 Apr 2020

25.

Sassi F (2006) Calculating QALYs, comparing QALY and DALY calculations. Health Policy Plan 21:402–408. https://doi.org/10.1093/heapol/czl018CrossRefPubMed

26.

Jenkins PJ, Clement ND, Hamilton DF et al (2013) Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. J Bone Jt Surg Ser B 95(B):115–121. https://doi.org/10.1302/0301-620X.95B1.29835CrossRef

27.

Evolution de la population en 2019: résultats provisoires. https://www.bfs.admin.ch/bfs/fr/home/statistiques/population.gnpdetail.2020-0162.html. Accessed 6 May 2020

28.

Alfonso DT, Howell RD, Strauss EJ, Di Cesare PE (2007) Total hip and knee arthroplasty in nonagenarians. J Arthroplast 22:807–811. https://doi.org/10.1016/j.arth.2006.10.016CrossRef

29.

Schairer WW, Vail TP, Bozic KJ (2014) What are the rates and causes of hospital readmission after total knee arthroplasty? Clin Orthop Relat Res 472(1):181–187. https://doi.org/10.1007/s11999-013-3030-7CrossRefPubMed

30.

Noticewala MS, Nyce JD, Wang W et al (2012) Predicting need for allogeneic transfusion after total knee arthroplasty. J Arthroplast 27:961–967. https://doi.org/10.1016/j.arth.2011.10.008CrossRef

31.

Berstock JR, Beswick AD, López-López JA et al (2018) Mortality after total knee arthroplasty: a systematic review of incidence, temporal trends, and risk factors. J Bone Jt Surg Am 100:1064–1070. https://doi.org/10.2106/JBJS.17.00249CrossRef

32.

Courtney PM, Melnic CM, Gutsche J et al (2015) Which patients need critical care intervention after total joint arthroplasty? Bone Joint J 97-B:1512–1518. https://doi.org/10.1302/0301-620X.97B11.35813CrossRefPubMed

33.

Pagnano MW, McLamb LA, Trousdale RT (2004) Total knee arthroplasty for patients 90 years of age and older. Clin Orthop Relat Res (418):179–183. https://doi.org/10.1097/00003086-200401000-00029

34.

Petruccelli D, Rahman WA, de Beer J, Winemaker M (2012) Clinical outcomes of primary total joint arthroplasty among nonagenarian patients. J Arthroplast 27:1599–1603. https://doi.org/10.1016/j.arth.2012.03.007CrossRef

35.

Berend ME, Thong AE, Faris GW et al (2003) Total joint arthroplasty in the extremely elderly: hip and knee arthroplasty after entering the 89th year of life. J Arthroplast 18:817–821. https://doi.org/10.1016/S0883-5403(03)00338-3CrossRef

36.

Karuppiah SV, Banaszkiewicz PA, Ledingham WM (2008) The mortality, morbidity and cost benefits of elective total knee arthroplasty in the nonagenarian population. Int Orthop 32:339–343. https://doi.org/10.1007/s00264-007-0324-yCrossRefPubMed

37.

Song X, Xia C, Li Q et al (2020) Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China. BMC Musculoskelet Disord 21(1):62. https://doi.org/10.1186/s12891-020-3042-xCrossRefPubMedPubMedCentral

38.

Bozic KJ, Wagie A, Naessens JM et al (2006) Predictors of discharge to an inpatient extended care facility after total hip or knee arthroplasty. J Arthroplast 21:151–156. https://doi.org/10.1016/j.arth.2006.04.015CrossRef

39.

Klasan A, Putnis SE, Yeo WW et al (2019) 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 Arthroplast 34:1938–1945. https://doi.org/10.1016/j.arth.2019.05.007CrossRef

Title: Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy
Authors: Michele Palazzuolo
Alexander Antoniadis
Jaad Mahlouly
Julien Wegrzyn
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Keywords: Osteoarthrosis
Osteoarthrosis
Published in: International Orthopaedics / Issue 3/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04917-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Total knee arthroplasty improves the quality-adjusted life years in patients who exceeded their estimated life expectancy

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2021

Letter to the editor regarding “Bone marrow lesion on magnetic resonance imaging indicates the last chance for hip osteonecrosis treated with vascularized fibular grafting before collapse”

Free gracilis muscle transfer with ulnar nerve neurotization for elbow flexion restoration

Poor outcomes of primary total knee arthroplasty in patients with Parkinson’s disease

Serum cartilage oligomeric matrix protein as a biomarker for predicting development and progression of knee osteoarthritis

Managing patients’ expectations in orthopaedics

Orthopaedic approach to the congenital Zika syndrome