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Longer hospital stay, more complications, and increased mortality but substantially improved function after knee replacement in older patients.

Maempel JF, Riddoch F, Calleja N, Brenkel IJ - Acta Orthop (2015)

Bottom Line: We assessed whether elderly patients undergoing TKR had different length of stay, requirements, complication rates, and functional outcomes compared to younger counterparts.Mortality was also higher in the older age groups.The risks have been quantified to assist in perioperative counselling, informed consent, and healthcare planning.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopaedics , Victoria Hospital, Kirkcaldy, Fife.

ABSTRACT

Background and purpose: Total knee replacement (TKR) is being increasingly performed in elderly patients, yet there is little information on specific requirements and complication rates encountered by this group. We assessed whether elderly patients undergoing TKR had different length of stay, requirements, complication rates, and functional outcomes compared to younger counterparts.

Patients and methods: We analyzed prospectively gathered data on 3,144 consecutive primary TKRs (in 2,092 patients aged less than 75 years, 694 patients aged between 75 and 80 years, and 358 patients aged over 80 years at the time of surgery).

Results: Incidence of blood transfusion, urinary catheterization, postoperative confusion, cardiac arrhythmia, and 1-year mortality increased with age, even after adjusting for confounding factors, whereas the incidences of chest infection and mortality at 1 month were highest in those aged 75-80. Rates of thromboembolism, prosthetic infection, and revision were similar in the 3 age groups. All groups showed similar substantial improvements in American Knee Society (AKS) knee scores, which were maintained at 5 years. Older patients had smaller improvements in AKS function score, which deteriorated between 3 and 5 years postoperatively, in contrast to the younger group.

Interpretation: Elderly people stand to gain considerably from TKR, particularly in terms of pain relief, and they should not be denied surgery based solely on age. However, they should be warned that they can expect a longer length of stay, a higher requirement for blood transfusion and/or urinary catheterization, and more medical complications postoperatively. Mortality was also higher in the older age groups. The risks have been quantified to assist in perioperative counselling, informed consent, and healthcare planning.

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Related in: MedlinePlus

Median length of stay throughout the study period. This was higher in the elderly (p < 0.001) but all 3 groups showed a reduction in median length of stay over the study period.
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Figure 2: Median length of stay throughout the study period. This was higher in the elderly (p < 0.001) but all 3 groups showed a reduction in median length of stay over the study period.

Mentions: Median length of stay was longer in the older age groups (p < 0.001, independent-samples Kruskal-Wallis test) and all 3 groups showed a significant reduction (of almost 50%) in median length of stay over the period under study (Figure 2).


Longer hospital stay, more complications, and increased mortality but substantially improved function after knee replacement in older patients.

Maempel JF, Riddoch F, Calleja N, Brenkel IJ - Acta Orthop (2015)

Median length of stay throughout the study period. This was higher in the elderly (p < 0.001) but all 3 groups showed a reduction in median length of stay over the study period.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4513600&req=5

Figure 2: Median length of stay throughout the study period. This was higher in the elderly (p < 0.001) but all 3 groups showed a reduction in median length of stay over the study period.
Mentions: Median length of stay was longer in the older age groups (p < 0.001, independent-samples Kruskal-Wallis test) and all 3 groups showed a significant reduction (of almost 50%) in median length of stay over the period under study (Figure 2).

Bottom Line: We assessed whether elderly patients undergoing TKR had different length of stay, requirements, complication rates, and functional outcomes compared to younger counterparts.Mortality was also higher in the older age groups.The risks have been quantified to assist in perioperative counselling, informed consent, and healthcare planning.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopaedics , Victoria Hospital, Kirkcaldy, Fife.

ABSTRACT

Background and purpose: Total knee replacement (TKR) is being increasingly performed in elderly patients, yet there is little information on specific requirements and complication rates encountered by this group. We assessed whether elderly patients undergoing TKR had different length of stay, requirements, complication rates, and functional outcomes compared to younger counterparts.

Patients and methods: We analyzed prospectively gathered data on 3,144 consecutive primary TKRs (in 2,092 patients aged less than 75 years, 694 patients aged between 75 and 80 years, and 358 patients aged over 80 years at the time of surgery).

Results: Incidence of blood transfusion, urinary catheterization, postoperative confusion, cardiac arrhythmia, and 1-year mortality increased with age, even after adjusting for confounding factors, whereas the incidences of chest infection and mortality at 1 month were highest in those aged 75-80. Rates of thromboembolism, prosthetic infection, and revision were similar in the 3 age groups. All groups showed similar substantial improvements in American Knee Society (AKS) knee scores, which were maintained at 5 years. Older patients had smaller improvements in AKS function score, which deteriorated between 3 and 5 years postoperatively, in contrast to the younger group.

Interpretation: Elderly people stand to gain considerably from TKR, particularly in terms of pain relief, and they should not be denied surgery based solely on age. However, they should be warned that they can expect a longer length of stay, a higher requirement for blood transfusion and/or urinary catheterization, and more medical complications postoperatively. Mortality was also higher in the older age groups. The risks have been quantified to assist in perioperative counselling, informed consent, and healthcare planning.

Show MeSH
Related in: MedlinePlus