Department of Orthopaedic Surgery, Bange Kosei General Hospital, Fukushima, Japan.
Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan,
Clin Interv Aging. 2019 Apr 15;14:681-688. doi: 10.2147/CIA.S193694. eCollection 2019.
The population of Japan is aging rapidly, and, since the aging of patients who undergo total knee arthroplasty (TKA) is also expected, it is necessary to determine the efficacy and safety of TKA among old adult patients.
This study retrospectively analyzed the cases of patients who underwent a primary TKA for osteoarthritis at Bange Kosei General Hospital between January 2009 and June 2014 and were postoperatively followed-up for ≥1 year. Among the 2,945 knees of the 1,968 patients, 1,003 knees of 679 patients aged ≥80 years at the time of surgery were designated as the older group, and we compared their cases with those of the younger group of 1,044 knees of 673 patients aged <75 years.
The rates of improvement of the Japanese Orthopaedic Association (JOA) score were not significantly different between the older and younger groups. Postoperative ranges of motion were significantly improved in both groups. The number of postoperative days of hospital stay in the older group was 2 days longer than that of the younger group. Concerning postoperative complications, confusion, delayed wound healing, and acute heart failure were significantly more frequent in the older group. The frequencies of pneumonia, cerebral infarction, peroneal nerve palsy, and bedsore did not differ significantly. Loosening of implants was observed: older group, n=0 joints; younger group, n=5 joints. The number of prosthetic joint infections: older group, n=5; younger group, n=2 (non-significant).
The rate of improvement in the JOA score did not differ significantly between the groups. TKA is an effective and safe treatment for osteoarthritis, even in old adult patients, when the surgical indication is based on careful preoperative screening and attention to specific postoperative complications.
日本人口老龄化迅速，预计接受全膝关节置换术（TKA）的患者也会老龄化，因此有必要确定老年患者接受 TKA 的疗效和安全性。
本研究回顾性分析了 2009 年 1 月至 2014 年 6 月期间在万代光生综合医院接受原发性膝关节骨关节炎 TKA 且术后随访时间≥1 年的患者的病例。在 1968 例患者的 2945 个膝关节中，将手术时年龄≥80 岁的 679 例患者的 1003 个膝关节指定为老年组，并与手术时年龄<75 岁的 673 例患者的 1044 个膝关节的年轻组进行比较。
老年组和年轻组的日本矫形协会（JOA）评分改善率无显著差异。两组术后活动范围均明显改善。老年组术后住院天数比年轻组长 2 天。关于术后并发症，老年组的意识障碍、伤口愈合延迟和急性心力衰竭明显更常见。肺炎、脑梗死、腓总神经麻痹和褥疮的频率无显著差异。松动的植入物：老年组，0 个关节；年轻组，5 个关节。假体关节感染的数量：老年组，5 例；年轻组，2 例（无显著性差异）。
两组 JOA 评分的改善率无显著差异。当手术指征基于术前仔细筛选和对特定术后并发症的关注时，TKA 是治疗骨关节炎的一种有效且安全的方法，即使是老年患者也是如此。
