Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
J Knee Surg. 2023 Jul;36(9):1001-1011. doi: 10.1055/s-0042-1748821. Epub 2022 Jun 10.
Total knee arthroplasty (TKA) is increasing in the elderly population; however, some patients, family members, and surgeons raise age-related concerns over expected improvement and risks. This study aimed to (1) evaluate the relationship between age and change in patient-reported outcome measures (PROMs); (2) model how many patients would be denied improvements in PROMs if hypothetical age cutoffs were implemented; and (3) assess length of stay (LOS), readmission, reoperation, and mortality per age group. A prospective cohort of 4,396 primary TKAs (August 2015-August 2018) was analyzed. One-year PROMs were evaluated via Knee injury and Osteoarthritis Outcome Score (KOOS)-pain, -physical function short form (-PS), and -quality of life (-QOL), as well as Veterans Rand-12 (VR-12) physical (-PCS) and mental component (-MCS) scores. Positive predictive values (PPVs) of the number of postoperative "failures" (i.e., unattained minimal clinically important difference in PROMs) relative to number of hypothetically denied "successes" from a theoretical age-group restriction was estimated. KOOS-PS and QOL median score improvements were equivalent among all age groups ( = 0.946 and = 0.467, respectively). KOOS-pain improvement was equivalent for ≥80 and 60-69-year groups (44.4 [27.8-55.6]). Median VR-12 PCS improvements diminished as age increased (15.9, 14.8, and 13.4 for the 60-69, 70-79, and ≥80 groups, respectively; = 0.002) while improvement in VR-12 MCS was similar among age groups ( = 0.440). PPV for failure was highest in the ≥80 group, yet remained <34% for all KOOS measures. Overall mortality was highest in the ≥80 group (2.14%, = 9). LOS >2, non-home discharge, and 90-day readmission were highest in the ≥80 group (8.11% [ = 24], < 0.001; 33.7% [ = 109], < 0.001; and 34.4% [ = 111], = 0.001, respectively). Elderly patients exhibited similar improvement in PROMs to younger counterparts despite higher LOS, non-home discharge, and 90-day readmission. Therefore, special care pathways should be implemented for those age groups.
全膝关节置换术（TKA）在老年人群中越来越常见；然而，一些患者、家属和外科医生对与年龄相关的预期改善和风险表示担忧。本研究旨在：（1）评估年龄与患者报告的结果测量（PROM）变化之间的关系；（2）如果实施假设的年龄截止值，模拟有多少患者会被拒绝改善 PROM；（3）评估每个年龄组的住院时间（LOS）、再入院、再次手术和死亡率。对 4396 例原发性 TKA（2015 年 8 月至 2018 年 8 月）进行前瞻性队列研究。通过膝关节损伤和骨关节炎结果评分（KOOS）-疼痛、-物理功能简短形式（-PS）和-生活质量（-QOL），以及退伍军人 Rand-12（VR-12）的身体（-PCS）和精神成分（-MCS）评分评估 1 年的 PROM。估计相对于从理论上的年龄组限制中拒绝的“成功”数量，术后“失败”（即 PROM 未达到最小临床重要差异）的数量的阳性预测值（PPV）。所有年龄组的 KOOS-PS 和 QOL 中位数评分改善均相当（ = 0.946 和 = 0.467）。≥80 岁和 60-69 岁组的 KOOS-疼痛改善相当（分别为 44.4 [27.8-55.6]）。随着年龄的增长，VR-12 PCS 改善的中位数逐渐减少（60-69、70-79 和≥80 组分别为 15.9、14.8 和 13.4； = 0.002），而 VR-12 MCS 的改善在各年龄组相似（ = 0.440）。失败的 PPV 在≥80 岁组最高，但所有 KOOS 指标的比例仍<34%。≥80 岁组的总体死亡率最高（2.14%， = 9）。LOS>2、非家庭出院和 90 天再入院在≥80 岁组中最高（8.11% [ = 24]，< 0.001；33.7% [ = 109]，< 0.001；和 34.4% [ = 111]， = 0.001）。尽管 LOS、非家庭出院和 90 天再入院较高，但老年患者的 PROM 改善与年轻患者相似。因此，应针对这些年龄组实施特殊的护理途径。
