Total knee arthroplasty for elderly patients in the era of Fast-track Surgery

Abstract

Introduction: Total knee replacement (TKR) in the elderly population is becoming increasingly prevalent. This study aimed to compare perioperative and rehabilitation outcomes of patients aged ≥80 years with those aged <80 years at time of TKR. Methods: A total of 423 TKR surgeries were performed in those aged ≥80 years (≥80 group) between 2009 and 2018. A control group aged <80 years was established. Perioperative mortality, complications, 30-day all-cause readmissions to hospital, length of stay, and rehabilitation parameters were recorded. Results: Mean age at surgery was 82.7 (standard deviation 2.5; range 80-93) years for ≥80 group and 69.3 (standard deviation 7.6; range 37-79) years for the control group. Postoperative Knee Society Function Assessment scores were higher in the control group (49 vs 57, p=0.003). Mean length of stay was longer in the ≥80 group (17.2 vs 12.4 days, p<0.01). Mortality within 3 months of surgery was 0.014% in the ≥80 group and 0% for the control group. Incidence of complications was comparable between the two groups at 12.8% and 12.9% for the ≥80 and control groups, respectively (p=0.962). Conclusion: The length of stay was longer in the ≥80 group, likely related to higher levels of comorbidity. Complications were just as common among the two groups but were more severe in the elderly group. Mortality rate after TKR was very low even in those aged ≥80 years. Younger patients benefit more in terms of functional improvement after TKR. The TKR is a safe and efficacious procedure even in the elderly patients. More severe complications, longer length of stay, and smaller gains in functional improvement can be expected for patients aged ≥80 years, compared with those aged <80 years.