Department of Orthopedic Surgery, Lausanne University Hospital - CHUV, Lausanne, Switzerland.
Hôpital Orthopédique, Centre Hospitalier Universitaire Vaudois - CHUV, Avenue Pierre Decker, 4, CH-1011, Lausanne, Switzerland.
Int Orthop. 2021 Mar;45(3):635-641. doi: 10.1007/s00264-020-04917-y. Epub 2021 Jan 15.
Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis though its risk-benefit ratio in elderly patients remains debated. This study aimed to evaluate the functional outcome, rates of complication and mortality, and quality-adjusted life years (QALY) in patients who exceeded their estimated life expectancy.
Ninety-seven TKA implanted in 86 patients who exceeded their estimated life expectancy at the time of TKA were prospectively included in our institutional joint registry and retrospectively analyzed. At latest follow-up, the functional outcome with the Knee Society Score (KSS), rates of complication and mortality, and QALY with utility value of EuroQol-5D score were evaluated.
At a mean follow-up of three ± one years, the pre- to post-operative KSS improved significantly (p < 0.01). The rates of surgical and major medical complications related to TKA were 3% and 10%, respectively. The re-operation rate with readmission was 3% while no TKA was revised. The 30-day and one year mortality was 1% and 3%, respectively. The pre- to one year post-operative QALY improved significantly (p < 0.01). The cumulative QALY five years after TKA was four years. Assuming that these patients did not undergo TKA, their cumulative QALY at five years would have been only two years.
TKA is an effective procedure for the treatment of end-stage osteoarthritis in patients who exceeded their estimated life expectancy. TKA provided significant improvement in function and quality of life without adversely affecting overall morbidity and mortality. Therefore, TKA should not be contra-indicated in elderly patients based on their advanced age alone.
全膝关节置换术（TKA）是治疗终末期骨关节炎的首选方法，但在老年患者中的风险效益比仍存在争议。本研究旨在评估超过预期寿命的患者的功能结果、并发症和死亡率以及质量调整生命年（QALY）。
前瞻性纳入我院关节登记处 86 例超过 TKA 时预期寿命的 97 例 TKA 患者，并进行回顾性分析。在最近的随访中，采用膝关节协会评分（KSS）评估功能结果、并发症和死亡率的发生率以及欧洲五维健康量表（EQ-5D）效用值的 QALY。
平均随访 3±1 年，KSS 从术前到术后显著改善（p<0.01）。与 TKA 相关的手术和主要医疗并发症发生率分别为 3%和 10%。再次手术率（带再入院）为 3%，而无 TKA 翻修。30 天和 1 年死亡率分别为 1%和 3%。从术前到术后 1 年 QALY 显著改善（p<0.01）。TKA 后 5 年的累积 QALY 为 4 年。假设这些患者未行 TKA，其 5 年的累积 QALY 仅为 2 年。
TKA 是治疗超过预期寿命的终末期骨关节炎患者的有效方法。TKA 显著改善了功能和生活质量，而不会对总体发病率和死亡率产生不利影响。因此，不应仅基于患者年龄较大而对老年患者禁忌 TKA。
