Is Total Knee Arthroplasty a Viable Treatment Option in Octogenarians with Advanced Osteoarthritis?
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Purpose: This study directly compared clinical assessment scores and short-term systemic complications after total knee arthroplasty (TKA) between a group of patients aged 80 or older (141 patients) and another group of patients aged between 65 and 70 years (616 patients) with advanced osteoarthritis. Materials and Methods: We retrospectively investigated 757 osteoarthritic patients who underwent primary TKA from January 2007 to January 2011 with a follow-up of 1 year. The surgery was performed using an extramedullary alignment guide instrument without invasion of the intramedullary canal to decrease embolic load and blood loss.Results: At 1 year after surgery, the mean Knee Society knee score was improved in both groups (from 63.6 to 83.2 in octogenarians and from 68.3 to 89.0 in the younger group) and the level of satisfaction was excellent in both groups (8 in octogenarians and 8.3 in the younger group), even though there was no notable change in function score in the octogenarians (from 61.0 to 61.9 in the octogenarians and from 62.3 to 73.6 in the younger group). The total incidence of systemic complications (3.4% vs. 1.2%, p=0.400) and surgical complications (2.1% vs. 0.5%, p=0.229) showed no significant difference between groups.Conclusions: TKA yielded favorable clinical outcomes with a comparatively low postoperative complication rate in octogenarians despite the negligible functional improvement.
Abstract
Purpose: This study directly compared clinical assessment scores and short-term systemic complications after total knee arthroplasty (TKA) between a group of patients aged 80 or older (141 patients) and another group of patients aged between 65 and 70 years (616 patients) with advanced osteoarthritis. Materials and Methods: We retrospectively investigated 757 osteoarthritic patients who underwent primary TKA from January 2007 to January 2011 with a follow-up of 1 year. The surgery was performed using an extramedullary alignment guide instrument without invasion of the intramedullary canal to decrease embolic load and blood loss.Results: At 1 year after surgery, the mean Knee Society knee score was improved in both groups (from 63.6 to 83.2 in octogenarians and from 68.3 to 89.0 in the younger group) and the level of satisfaction was excellent in both groups (8 in octogenarians and 8.3 in the younger group), even though there was no notable change in function score in the octogenarians (from 61.0 to 61.9 in the octogenarians and from 62.3 to 73.6 in the younger group). The total incidence of systemic complications (3.4% vs. 1.2%, p=0.400) and surgical complications (2.1% vs. 0.5%, p=0.229) showed no significant difference between groups.Conclusions: TKA yielded favorable clinical outcomes with a comparatively low postoperative complication rate in octogenarians despite the negligible functional improvement.
참고문헌 (30)
- Callahan CM, "Patient outcomes following tricompartmental total knee replacement. A meta-analysis", JAMA, 271, pp.1349~1357 (1994)
- Parry MC, "Early death following primary total knee arthroplasty", J Bone Joint Surg Am, 93, pp.948~953 (2011)
- Raut VV, "Revision hip arthroplasty: can the octogenarian take it?", J Arthroplasty, 8, pp.401~403 (1993)
- Pavone V, "Total condylar knee arthroplasty: a long-term followup", Clin Orthop Relat Res, (388), pp.18~25 (2001)
- Kennedy JW, "Total knee arthroplasty in the elderly: does age affect pain, function or complications?", Clin Orthop Relat Res, 471, pp.1964~1969 (2013)
- Clement ND, "The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more", J Bone Joint Surg Br, 93, pp.1265~1270 (2011)
- Petersson IF, "Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35-54 years with chronic knee pain", Ann Rheum Dis, 56, pp.493~496 (1997)
- Insall J, "A midline approach to the knee", J Bone Joint Surg Am, 53, pp.1584~1586 (1971)
- Seo JG, "Mechanical axis-derived femoral component rotation in extramedullary total knee arthroplasty : a comparison between femoral transverse axis and transepicondylar axis", Knee Surg Sports Traumatol Arthrosc, 20, pp.538~545 (2012)
- Lee DH, "Synchronisation of tibial rotational alignment with femoral component in total knee arthroplasty", Int Orthop, 32, pp.223~227 (2008)
- Fakhry SM, "How low is too low? Cardiac risks with anemia", Crit Care, 8(Suppl 2), pp.S11~S14 (2004)
- Hebert PC, "A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care : Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group", N Engl J Med, 340, pp.409~417 (1999)
- Pierson JL, "A blood-conservation algorithm to reduce blood transfusions after total hip and knee arthroplasty", J Bone Joint Surg Am, 86, pp.1512~1518 (2004)
- Insall JN, "Rationale of the Knee Society clinical rating system", Clin Orthop Relat Res, (248), pp.13~14 (1989)
- McGrory JE, "Preoperative hip to ankle radiographs in total knee arthroplasty", Clin Orthop Relat Res, (404), pp.196~202 (2002)
- Belmar CJ, "Total knee arthroplasty in patients 90 years of age and older", J Arthroplasty, 14, pp.911~914 (1999)
- Pagnano MW, "Total knee arthroplasty for patients 90 years of age and older", Clin Orthop Relat Res, 418, pp.179~183 (2004)
- Anderson JG, "Functional outcome and patient satisfaction in total knee patients over the age of 75", J Arthroplasty, 11, pp.831~840 (1996)
- Hosick WB, "Total knee arthroplasty in patients 80 years of age and older", Clin Orthop Relat Res, (299), pp.77~80 (1994)
- Joshi AB, "Knee arthroplasty in octogenarians : results at 10 years", J Arthroplasty, 18, pp.295~298 (2003)
- Bullens PH, "Patient satisfaction after total knee arthroplasty : a comparison between subjective and objective outcome assessments", J Arthroplasty, 16, pp.740~747 (2001)
- Gandhi R, "Relationship between self-reported and performance-based tests in a hip and knee joint replacement population", Clin Rheumatol, 28, pp.253~257 (2009)
- Janse AJ, "Quality of life: patients and doctors don’t always agree: a meta-analysis", J Clin Epidemiol, 57, pp.653~661 (2004)
- Mantyselka P, "Patients’ versus general practitioners’ assessments of pain intensity in primary care patients with non-cancer pain", Br J Gen Pract, 51, pp.995~997 (2001)
- Chauhan SK, "Computer-assisted knee arthroplasty versus a conventional jig-based technique : a randomised, prospective trial", J Bone Joint Surg Br, 86, pp.372~377 (2004)
- Kandel L, "Extramedullary femoral alignment instrumentation reduces blood loss after uncemented total knee arthroplasty", J Knee Surg, 19, pp.256~258 (2006)
- Kalairajah Y, "Are systemic emboli reduced in computer-assisted knee surgery? : a prospective, randomised, clinical trial", J Bone Joint Surg Br, 88, pp.198~202 (2006)
- Fahmy NR, "Blood-gas and circulatory changes during total knee replacement. Role of the intramedullary alignment rod", J Bone Joint Surg Am, 72, pp.19~26 (1990)
- Ishii Y, "Extramedullary versus intramedullary alignment guides in total knee arthroplasty", Clin Orthop Relat Res, (318), pp.167~175 (1995)
- Easterlin MC, "Older age increases short-term surgical complications after primary knee arthroplasty", Clin Orthop Relat Res, 471, pp.2611~2620 (2013)