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

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.

JM and FR were responsible for conversion of raw data into a format appropriate for statistical analysis, and for literature review and initial drafting of the manuscript. Statistical analysis was performed by JM and NC. IB was responsible for design of the database and setting up of review clinics for data collection, and also for the initial idea for this study. He provided guidance on drafting of the manuscript and subsequent improvements.

We thank Anne Simpson for her work in maintaining the database for this project and Lorraine McComiskie, Shona McKean, and Sherral Wilson for help with data collection.

No competing interest declared.