Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain; Traumatology and Orthopaedia, Miguel Hernandez University, San Juan, Alicante, Spain.
Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain.
J Arthroplasty. 2017 Aug;32(8):2417-2420. doi: 10.1016/j.arth.2017.03.006. Epub 2017 Mar 16.
Clinical outcomes of total knee arthroplasty (TKA) in very older patients have been widely studied, but the available evidence on quality of life (QOL) is limited. The objective was to evaluate the impact of TKA on the QOL in octogenarian patients and assess whether the risk-benefit justified surgery.
Prospective study comparing 143 octogenarian and 149 septuagenarian patients. QOL was assessed with the Short Form-12 (SF-12) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaires and functional outcomes with the Knee Society score (KSS). Comorbidity, complications, pain, and satisfaction were also assessed.
Mean postoperative follow-up was 3.2 years (range, 2-5 years). Comorbidities, medical complications, transfusion rate, and length stay were not different between groups (P < .05). Comorbidities and complications had no influence on the outcomes. There were no significant differences in preoperative knee KSS, WOMAC, or SF-12 mental scores, but octogenarians had significantly lower functional KSS (P = .003) and SF-12 physical scores (P = .005). At the last follow-up, there were no significant differences in KSS, WOMAC, and SF-12 physical scores (P < .05), but octogenarians had higher SF-12 mental (P = .030) and satisfaction (P = .031) scores.
TKA provided pain relief, satisfaction, and improvement in QOL for octogenarian patients to the level of the septuagenarian patients. TKA was a suitable option for octogenarian patients with appropriate surgical indications and manageable risk.
全膝关节置换术（TKA）在非常高龄患者中的临床结果已得到广泛研究，但关于生活质量（QOL）的证据有限。目的是评估 TKA 对 80 岁以上患者 QOL 的影响，并评估手术的风险-获益是否合理。
前瞻性研究比较了 143 名 80 岁以上和 149 名 70 岁以下的患者。使用简明健康状况调查问卷 12 项（SF-12）和西部安大略省和麦克马斯特大学关节炎指数（WOMAC）问卷评估 QOL，使用膝关节学会评分（KSS）评估功能结果。还评估了合并症、并发症、疼痛和满意度。
平均术后随访 3.2 年（范围 2-5 年）。两组之间的合并症、医疗并发症、输血率和住院时间无差异（P<.05）。合并症和并发症对结果没有影响。术前膝关节 KSS、WOMAC 或 SF-12 心理评分无显著差异，但 80 岁以上患者的功能 KSS 显著较低（P=.003）和 SF-12 生理评分较低（P=.005）。末次随访时，KSS、WOMAC 和 SF-12 生理评分无显著差异（P<.05），但 80 岁以上患者的 SF-12 心理评分和满意度评分较高（P=.030、P=.031）。
TKA 为 80 岁以上患者提供了疼痛缓解、满意度和 QOL 改善，达到了 70 岁以下患者的水平。对于有适当手术适应证和可管理风险的 80 岁以上患者，TKA 是一种合适的选择。
