Total knee replacement surgery in patients over 80 has lower levels of implant-related complications, but higher readmission rates, medical complications, and length of stay

CHICAGO, March 22, 2022 /PRNewswire/ — When patients over the age of 80 (octogenarians) are candidates for total knee replacement (TKR) surgery, there are concerns about the medical and implant-related complications of the procedure in because of their age. However, a study presented at the 2022 annual meeting of the American Academy of Orthopedic Surgeons (AAOS) found that octogenarians undergoing primary TKA had lower rates of implant-related complications and an equal incidence of developing a medical complication compared to younger patients.

The study, “Complications, Readmission Rates, and In-Hospital Lengths of Stay Rates in Octogenarian vs. Non-Octogenarians: An Analysis of Over 1.7 Million Patients,” found that octogenarians had lower rates of developing implant-related complications and an equal incidence and odds of developing medical complications. However, octogenarians had higher rates of certain medical complications, such as stroke, significantly higher readmission rates, and significantly longer length of hospital stay (HOS) than people aged 65 to 79 years old.

“The literature views older adults as one giant population,” said Priscilla P. Varghese, MBA, MS, MD candidate at State University of New York (SUNY) Downstate, College of Medicine. “By stratifying patients into these two cohorts, we are better able to explore differences and strengthen a personalized approach for patients undergoing TKA. Those who are 65 navigate very different issues than those who are 85 or 90. We can remove specific shades to promote quality of life.”

Total knee arthroplasty and the aging population
TKA is one of the most effective procedures for knee pain caused by common conditions such as osteoarthritis (OA). As the number of patients with osteoarthritis increases, the demand for growth is expected to increase to around 935,000 procedures by 2030.I

Previous studies have shown that distinct complications can occur in patients over the age of 80 during TKA, requiring orthopedic surgeons and patients to carefully consider the procedure. Complications include higher risk of mortality, increased risk of medical complications, and higher rates of prosthetic-related complications. Many of these studies grouped older adults into a single cohort of 65 and older.

TKA results in octogenarians compared to non-octogenarians
The research team set out to specifically study outcomes in octogenarians after undergoing TKA. Using the PearlDiver database and International Classification of Diseases, Ninth Revision (ICD-9) codes, a retrospective query from January 1, 2005 to March 31, 2014 was performed, extracting data from patients who underwent a primary TKA. Patients were divided into two cohorts – the octogenarian study group included patients aged 80 and over, and patients aged 65 to 79 were part of the control cohort. The query yielded 1,775,460 patients – 295,908 octogenarians and 1,479,552 non-octogenarians.

The study’s primary endpoints included medical complications at 90 days, readmission rates at 90 days, length of hospital stay, and implant-related complications at two years after TKA. The study found:

  • Compared to the control group, octogenarians had an equal incidence and probability of developing a medical complication (1.26 versus 1.26%); however, octogenarians were at higher risk for certain medical complications, including stroke, pneumonia, and acute kidney failure.
  • Patients 80 years and older had a significantly higher incidence and likelihood of 90-day readmission rates (10.59 versus 9.35%).
  • Octogenarians had a significantly longer length of hospital stay than the control cohort (3.69 days versus 3.23 days).
  • The study group had a lower incidence and likelihood of implant-related complications than the control group (1.67 versus 1.93%).

“Generally, you would expect older patients to have more significant medical complications after TKA, so the 90-day medical complication results were very interesting,” said researcher and orthopedic surgeon Martin William Roche, MD, FAAOS. “These data will be useful as surgeons advise patients on whether or not to undergo TKA. For older patients, it can be reassuring to know that they can have results similar to those of a 65-year-old. and improve their quality of life. The results reflect advances in healthcare and post-surgical interventions to alleviate complications.”

The results demonstrate the benefits of further stratification of patient populations. The research team plans to conduct further research to determine the consistency between different types of orthopedic procedures in octogenarians compared to non-octogenarians.

2022 AAOS Annual Meeting Disclosure Statement

About AAOS

With over 39,000 members, the American Academy of Orthopedic Surgeons is the world’s largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality and most comprehensive training to help orthopedic surgeons and allied health professionals at all career levels to best treat patients in their daily practices. The AAOS is the source for information about bone and joint conditions, treatments, and related musculoskeletal health issues, and it leads the discussion about healthcare to advance quality.

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I Sloan M, Premkumar A, Sheth NP. Predicted volume of primary total joint replacement in the United States, 2014 to 2030. JBJS. 2018; 100 (17):1455-1460. Accessed March 10, 2022.

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SOURCE American Academy of Orthopedic Surgeons

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