Published in:
20-12-2022 | Knee
Similar survival rate but lower functional outcomes following TKA in the elderly people compared to younger patients: analysis of a posterior stabilised implant with minimum 5-year follow-up
Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2023
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Background
Literature regarding outcomes in patients over 80 years old after total knee arthroplasty (TKA) is inconsistent. We aimed to compare implant survivorship and functional outcomes between elderly patients (≥ 80 years) and younger patients (< 80 years) following TKA, using a single modern posterior-stabilized (PS) prosthetic design.
Methods
This is a retrospective cohort study of 80 patients over 80 years old who underwent TKA between January 2015 and December 2016, who were compared with younger patients (60–75 years old) operated during the same period. Patients were matched with a ratio of 1:3 based on logistic regression analysis of gender and body mass index. All patients received the same cemented PS prosthesis with a fixed bearing polyethylene insert, with or without patellar resurfacing. Implant survival and patient-reported outcome measurements were compared between the two groups. At last follow-up, data were available for 41 knees in the elderly group (including 17 patients who died before 5-year follow-up) and 123 knees in the younger group.
Results
Functional results were better at final follow-up in the group < 80 years with a significantly higher Knee Society Function Subscore (88.6 ± 16.9 vs 79.4 ± 22.1, p < 0.01), but no significant differences in Knee Subscore and global Knee Society Score (p > 0.05), nor regarding maximum flexion (121° ± 12 and 117° ± 13, p = 0.08). The implant survivorship was 100.0% after a mean 64.4-month follow-up (range 60–78), without revision requiring removal of the implant in any group. The survival rate without any reoperation was 97.6% (95% CI 93.0–100.0) in the elderly group and 95.9% (95% CI 92.5–99.5) in the younger group (p = 0.64).
Conclusion
At a minimum of 5-year follow-up, there was no revision surgery and a very low rate of complications requiring reoperations both in the group over 80 years of age and in the younger population, with the use of a PS prosthesis. The functional results were slightly lower for elderly patients and correlate with the lower functional demands of this population. The indication for TKA, especially with a PS implant, may be encouraged in appropriately selected elderly patients.
Level of evidence
III (retrospective cohort study).