Mid-term lifetime survivals of octogenarians following primary and revision total knee arthroplasties were satisfactory: a retrospective single center study in contemporary period
2
조회
0
다운로드
1
인용
0
참고문헌
초록
As life expectancy increases, the number of octogenarians requiring primary and revision total knee arthroplasty (TKA) is increasing. Recently, primary TKA has become a common treatment option in octogenarians. However, surgeons may still be hesitant about performing revision TKA on octogenarians because of concern about risk and cost benefit. The purpose of this study was to investigate clinical outcomes, postoperative complications, and mid-term lifetime survival in octogenarians after primary and revision TKA. We retrospectively reviewed 231 primary TKAs and 41 revision TKAs performed on octogenarians between 2000 and 2016. The mean age of patients undergoing primary TKA was 81.9 years and that of patients undergoing revision TKA was 82.3 years ( p = 0.310). The age-adjusted Charlson comorbidity index was higher in revision TKA (4.4 vs. 4.8, p = 0.003). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. The incidence of postoperative complications (TKA-related, specific or systemic) and lifetime survival rate (endpoint death determined by telephone or mail communication with patient or family) were investigated. The WOMAC and ROM improved significantly after primary and revision TKA, although postoperative results were worse in the revision group (33.1 vs. 47.2; 128.9° vs. 113.6°; p < 0.001, respectively). There were no cases of aseptic or septic component failure in either group. One case of periprosthetic fracture was observed in the revision group (0% vs. 2.4%, p = 0.151), and three cases of deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE) (one case of DVT and two cases of PTE) were observed in the primary group (1.3% vs. 0%, p = 1.000). The most common systemic complication in both groups was delirium (7.4% vs. 14.6%, p = 0.131). There were no differences between the two groups in the other systemic complication rates. The 5-year and 10-year lifetime survival rates were 87.2% and 62.9%, respectively, in primary TKA and 82.1% and 42.2%, respectively, in revision TKA ( p = 0.017). Both primary and revision TKA are viable options for octogenarians, based on the satisfactory clinical outcomes, TKA-related complication rates, and mid-term lifetime survival. Delirium needs to be managed appropriately as the most common systemic complication in both primary and revision TKA in octogenarians.IV
Abstract
As life expectancy increases, the number of octogenarians requiring primary and revision total knee arthroplasty (TKA) is increasing. Recently, primary TKA has become a common treatment option in octogenarians. However, surgeons may still be hesitant about performing revision TKA on octogenarians because of concern about risk and cost benefit. The purpose of this study was to investigate clinical outcomes, postoperative complications, and mid-term lifetime survival in octogenarians after primary and revision TKA. We retrospectively reviewed 231 primary TKAs and 41 revision TKAs performed on octogenarians between 2000 and 2016. The mean age of patients undergoing primary TKA was 81.9 years and that of patients undergoing revision TKA was 82.3 years ( p = 0.310). The age-adjusted Charlson comorbidity index was higher in revision TKA (4.4 vs. 4.8, p = 0.003). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. The incidence of postoperative complications (TKA-related, specific or systemic) and lifetime survival rate (endpoint death determined by telephone or mail communication with patient or family) were investigated. The WOMAC and ROM improved significantly after primary and revision TKA, although postoperative results were worse in the revision group (33.1 vs. 47.2; 128.9° vs. 113.6°; p < 0.001, respectively). There were no cases of aseptic or septic component failure in either group. One case of periprosthetic fracture was observed in the revision group (0% vs. 2.4%, p = 0.151), and three cases of deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE) (one case of DVT and two cases of PTE) were observed in the primary group (1.3% vs. 0%, p = 1.000). The most common systemic complication in both groups was delirium (7.4% vs. 14.6%, p = 0.131). There were no differences between the two groups in the other systemic complication rates. The 5-year and 10-year lifetime survival rates were 87.2% and 62.9%, respectively, in primary TKA and 82.1% and 42.2%, respectively, in revision TKA ( p = 0.017). Both primary and revision TKA are viable options for octogenarians, based on the satisfactory clinical outcomes, TKA-related complication rates, and mid-term lifetime survival. Delirium needs to be managed appropriately as the most common systemic complication in both primary and revision TKA in octogenarians.IV
참고문헌 (21)
- Bovonratwet P, "Revision total knee arthroplasty in octogenarians : an analysis of 957 cases", J Arthroplast, 33(1), pp.178~184 (2018)
- Bozic KJ, "Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA", Clin Orthop Relat Res, 473(6), pp.2131~2138 (2015)
- Rubin LE, "Total hip and knee arthroplasty in patients older than age 80 years", J Am Acad Orthop Surg, 24(10), pp.683~690 (2016)
- Pagnano MW, "Total knee arthroplasty for patients 90 years of age and older", Clin Orthop Relat Res, 418, pp.179~183 (2004)
- Fehring TK, "Mortality following revision joint arthroplasty: is age a factor?", Orthopedics, 33(10), pp.715~ (2010)
- Scott WN, "Insall & Scott surgery of the knee", pp.1062~ (2018), Elsevier
- Park CH, "Factors affecting the choice of constrained prostheses when performing revision total knee arthroplasty", Int Orthop, 43(8), pp.1831~1840 (2019)
- Giesinger JM, "WOMAC, EQ-5D and Knee Society score thresholds for treatment success after total knee arthroplasty", J Arthroplast, 30(12), pp.2154~2158 (2015)
- Bae DK, "Mid-term survival analysis of closed wedge high tibial osteotomy : a comparative study of computerassisted and conventional techniques", Knee, 23(2), pp.283~288 (2016)
- 송상준, "Comparison of Clinical Results and Risk of Patellar Injury between Attune and PFC Sigma Knee Systems", Knee Surgery and Related Research, 30(4), pp.334~340 (2018), 대한슬관절학회
- Hocevar LA, "American Society of Anesthesiologists Staging" (2020), StatPearls
- Yang CC, "The age-adjusted Charlson comorbidity index is a better predictor of survival in operated lung cancer patients than the Charlson and Elixhauser comorbidity indices", Eur J Cardiothorac Surg, 53(1), pp.235~240 (2018)
- Folpe AL, "Bone and soft tissue pathology", pp.239~254 (2010), Elsevier Health Sciences
- Yao JJ, "Long-term mortality trends after revision total knee arthroplasty", J Arthroplast, 34(3), pp.542~548 (2018)
- Takemura K, "Age-adjusted Charlson Comorbidity Index predicts prognosis of laryngopharyngeal cancer treated with radiation therapy", Acta Otolaryngol, 137(12), pp.1307~1312 (2017)
- Lizaur-Utrilla A, "Ten-year mortality risk predictors after primary total knee arthroplasty for osteoarthritis", Knee Surg Sports Traumatol Arthrosc, 23(6), pp.1848~1855 (2015)
- Hamilton DF, "Dealing with the predicted increase in demand for revision total knee arthroplasty:challenges, risks and opportunities", Bone Joint J, 97-B(6), pp.723~728 (2015)
- Oh ES, "Delirium in older persons : advances in diagnosis and treatment", JAMA, 318(12), pp.1161~1174 (2017)
- Bin Abd Razak HR, "Postoperative delirium in patients undergoing total joint arthroplasty : a systematic review", J Arthroplast, 30(8), pp.1414~1417 (2015)
- 송상준, "What to Know for Selecting Cruciate-Retaining or Posterior-Stabilized Total Knee Arthroplasty", Clinics in Orthopedic Surgery, 11(2), pp.142~150 (2019), 대한정형외과학회
- Song SJ, "A current prosthesis with a 1-mm thickness increment for polyethylene insert could result in fewer adjustments of posterior tibial slope in cruciate-retaining total knee arthroplasty", J Arthroplast (2020)[DOI]