检索问题
膝关节置换术，年龄75岁以上患者，安全性和效果的研究，近5年的研究
在过去五年内，有关膝关节置换术（TKA）在75岁以上患者中的安全性和效果的研究表明，虽然老年患者面临更高的术后并发症风险，但在适当选择和优化患者之后，手术往往是安全且有效的。
1. 手术安全性
没有显著的年龄影响
一项针对单侧和双侧膝关节置换术（SSBTKA）患者的研究表明，虽然年龄大于70岁的患者有更多的共病，但在术后并发症和再入院方面没有显著差异。这表明，年龄并不一定是影响术后安全的决定性因素。
水泥固定与无水泥固定
在75岁以上的女性中，进行无水泥膝关节置换术的研究显示，其风险相对较低。虽然一些外科医生对老年人的骨质量表示担忧，但有证据表明，在经验丰富的外科医生手中，无水泥手术是安全的，不论骨质量如何。
2. 手术效果
功能恢复
多项研究显示，TKA能显著改善患者的功能和生活质量。根据一项覆盖103,613名患者的系统综述，在75岁以上的患者中，术后健康相关生活质量（HRQoL）得到了显著改善，并且改善的幅度在年轻（65-74岁）和老年（≥75岁）群体之间没有显著差异。然而，虽然统计上显示出差异，但在患者主观感受方面（如痛苦和功能）并没有临床显著性。
特别老年群体的改善
一项关于膝关节置换术在年龄在75岁及以上患者中的效果的研究结果显示，尽管与较年轻患者相比，这些老年患者的弹性和恢复能力较差，但他们同样在术后经历了功能和生活质量的显著提升]. 例如，医院术后评分（HSS）在手术9个月后显示出显著提高，证明手术的有效性。
运动能力
一项关于高活跃度是否影响膝关节置换术后无菌修复风险的研究表明，实际参与运动的患者在5年内的预期植入存活率未受到影响，且参与运动的患者比不参与者的修复率更低。这表明，即使是老年患者，积极的生活方式也不会直接影响术后的效果。
3. 并发症与风险因素
合并症的作用
一项研究显示，慢性病如糖尿病和肾脏疾病未与PJI（假体关节感染）相关，而与PJI相关的因素主要包括肝炎C病毒感染、外周动脉疾病和自身免疫性炎症性关节炎等。这突显了在术前优化患者和谨慎选择手术时，考虑患者的健康状况和合并症的重要性。
血液损失与输血
在进行双侧同时置换的患者中，术后血液损失通常较高，增加了输血的需求。这表明在决定进行双侧膝关节置换术时需要谨慎，并考虑到较高的并发症风险。
4. 结论与建议
在75岁以上的患者中，膝关节置换术被证明是安全有效的，尽管患者的年龄和合并症可能影响术后恢复。尽管结果不如年轻患者理想，但显著改善的生活质量和功能使得这一手术成为值得考虑的选项。术前的评估与优化，以及采取个体化的手术策略，将帮助最大化老年患者的术后效果并降低风险。
在此基础上，对于老年患者的膝关节置换术，应鼓励积极参与手术前准备、功能训练及术后复健，以促进更好的术后恢复结果和生活质量。
上述研究显示，TKA在75岁以上患者中的安全性和效果虽然仍需持续观察和研究，但已有的证据支持这一手术在合适患者中的广泛应用。此外，未来研究应进一步集中于如何优化老年患者的手术方案，减少并发症，提高术后生活质量，充分评估老年人群体的个体需求和反应。
References
1Incidence, Microbiological Studies, and Factors Associated With Prosthetic Joint Infection After Total Knee Arthroplasty.PubMed
Erica J Weinstein, Alisa J Stephens-Shields, Craig W Newcomb, et al.
JAMA Netw Open. 2023 Oct 2;6(10):e2340457. doi: 10.1001/jamanetworkopen.2023.40457.
IMPORTANCE: Despite the frequency of total knee arthroplasty (TKA) and clinical implications of prosthetic joint infections (PJIs), knowledge gaps remain concerning the incidence, microbiological study results, and factors associated with these infections. OBJECTIVES: To identify the incidence rates, organisms isolated from microbiological studies, and patient and surgical factors of PJI occurring early, delayed, and late after primary TKA. DESIGN, SETTING, AND PARTICIPANTS: This cohort study obtained data from the US Department of Veterans Affairs (VA) Corporate Data Warehouse on patients who underwent elective primary TKA in the VA system between October 1, 1999, and September 30, 2019, and had at least 1 year of care in the VA prior to TKA. Patients who met these criteria were included in the overall cohort, and patients with linked Veterans Affairs Surgical Quality Improvement Program (VASQIP) data composed the VASQIP cohort. Data were analyzed between December 9, 2021, and September 18, 2023. EXPOSURES: Primary TKA as well as demographic, clinical, and perioperative factors. MAIN OUTCOMES AND MEASURES: Incident hospitalization with early, delayed, or late PJI. Incidence rate (events per 10 000 person-months) was measured in 3 postoperative periods: early (≤3 months), delayed (between >3 and ≤12 months), and late (>12 months). Unadjusted Poisson regression was used to estimate incidence rate ratios (IRRs) with 95% CIs of early and delayed PJI compared with late PJI. The frequency of organisms isolated from synovial or operative tissue culture results of PJIs during each postoperative period was identified. A piecewise exponential parametric survival model was used to estimate IRRs with 95% CIs associated with demographic and clinical factors in each postoperative period. RESULTS: The 79 367 patients (median (IQR) age of 65 (60-71) years) in the overall cohort who underwent primary TKA included 75 274 males (94.8%). A total of 1599 PJIs (2.0%) were identified. The incidence rate of PJI was higher in the early (26.8 [95% CI, 24.8-29.0] events per 10 000 person-months; IRR, 20.7 [95% CI, 18.5-23.1]) and delayed periods (5.4 [95% CI, 4.9-6.0] events per 10 000 person-months; IRR, 4.2 [95% CI, 3.7-4.8]) vs the late postoperative period (1.3 events per 10 000 person-months). Staphylococcus aureus was the most common organism isolated overall (489 [33.2%]); however, gram-negative infections were isolated in 15.4% (86) of early PJIs. In multivariable analyses, hepatitis C virus infection, peripheral artery disease, and autoimmune inflammatory arthritis were associated with PJI across all postoperative periods. Diabetes, chronic kidney disease, and obesity (body mass index of ≥30) were not associated factors. Other period-specific factors were identified. CONCLUSIONS AND RELEVANCE: This cohort study found that incidence rates of PJIs were higher in the early and delayed vs late post-TKA period; there were differences in microbiological cultures and factors associated with each postoperative period. These findings have implications for postoperative antibiotic use, stratification of PJI risk according to postoperative time, and PJI risk factor modification.
2Safety Considerations for Outpatient Arthroplasty.PubMed
Alberto E Ardon
Clin Sports Med. 2022 Apr;41(2):281-289. doi: 10.1016/j.csm.2021.11.005.
Since 2018, the number of total joint arthroplasties (TJAs) performed on an outpatient basis has dramatically increased. Both surgeon and anesthesiologist should be aware of the implications for the safety of outpatient TJAs and potential patient risk factors that could alter this safety profile. Although smaller studies suggest that the risk of negative outcomes is equivalent when comparing outpatient and inpatient arthroplasty, larger database analyses suggest that, even when matched for comorbidities, patients undergoing outpatient arthroplasty may be at increased risk of surgical or medical complications. Appropriate patient selection is critical for the success of any outpatient arthroplasty program. Potential exclusion criteria for outpatient TJA may include age greater than 75 years, bleeding disorder, history of deep vein thrombosis, uncontrolled diabetes mellitus, and hypoalbuminemia, among others. Patient optimization before surgery is also warranted. The potential risks of same-day versus next-day discharge have yet to be elicited in a large-scale manner.
3Factors affecting short-term functional gain following total knee arthroplasty in patients aged from 75 years at a postacute rehabilitation setting.PubMed
Kenichi Kawaguchi, So Kuwakado, Hiroshi Ohtsuka, et al.
Int J Rehabil Res. 2022 Sep 1;45(3):260-266. doi: 10.1097/MRR.0000000000000538. Epub 2022 Jul 1.
The intensive rehabilitation of older patients after total knee arthroplasty (TKA) is vital for short-term improvement in mobility and daily living activities. We aimed to investigate the effectiveness of multidisciplinary rehabilitation and assess the early postoperative predictors that are associated with functional gain in TKA patients aged from 75 years in a postacute care setting. This study included 190 patients following primary TKA who were admitted at the postacute rehabilitation hospital. The main outcome measures were the motor component of functional independence measure (M-FIM), M-FIM effectiveness, numerical rating scale, knee extension strength and range of motion, 10-m walk test, Berg balance scale (BBS), and mini-mental state examination (MMSE). The functional gain between patient age groups of ≥75 ( n = 105) and <75 ( n = 85) years were compared. Although patients aged ≥75 years showed lower improvement in BBS score compared with <75 years, the M-FIM gains and other physical functions were similar in both age groups. In multivariate analysis, the results for M-FIM at admission (β: -0.703; P = 0.001), BBS (β: 0.342; P = 0.032) and MMSE (β: 0.446; P = 0.021) were independently associated with functional gain in the patients following TKA aged ≥75 years. Multidisciplinary inpatient rehabilitation was beneficial for basic functional gain except for improvement in balance ability in patients after TKA aged ≥75 years. Functional level, balance ability and cognitive status in the early postoperative period can be useful predictors for short-term functional gain in the postacute care phase.
4Do Patient Outcomes Vary by Patient Age Following Primary Total Hip Arthroplasty?PubMed
David C Ayers, Mohamed Yousef, Hua Zheng, et al.
J Arthroplasty. 2022 Jul;37(7S):S510-S516. doi: 10.1016/j.arth.2022.03.032. Epub 2022 Mar 12.
BACKGROUND: Multiple authors have sought to determine what patient characteristics influence outcome after total hip arthroplasty (THA). Age has shown no effect on outcome in some evaluations, while others have reported higher functional improvement in younger patients. The aim of this study was to determine if outcome after THA varies based on patient age. METHODS: A prospective, multicenter cohort of 7,934 unilateral primary THA patients from the FORCE-TJR comparative effectiveness consortium was evaluated. Demographic data, comorbid conditions, and Patient-Reported Outcome Measures, including (HOOS), HOOS-12, HOOS JR, and SF-36 (PCS) and (MCS), were collected preop and at 1-year postop. Descriptive statistics were generated, stratified by age (<55 years [younger adult], 55-64 years [older adult], 65-74 years [early elder], and ≥75 years [late elder]), and differences in pain, function, and quality of life among the 4 age groups were evaluated. A multivariate regression model with 95% confidence interval (CI) was used to assess the role of patient age as a predictive factor for HOOS pain and function scores reported 1 year after primary THA. RESULTS: Prior to surgery, younger patients (<55 years) reported worse pain, function, and quality of life than the other 3 patient groups. At 1 year after THA, younger patients (<55 years) reported slightly worse pain and quality of life but better function scores than the 3 older patients' groups. Younger patients (<55 years) achieved higher baseline to 1-year pain, and function score changes when compared to the older patients' groups. The quality of life score changes was not different among the 4 age groups. The differences in 1-year postop scores (ranging from 2.74 to 8.46) and the magnitude of score changes from baseline to 1 year (ranging from 1.9 to 5.85), although statistically significant (P < .001), did not reach the minimal clinically important difference (MCID). The multivariate regression analysis shows that age is a significant predictor for pain at 1 year but not for function. Although HOOS pain score is predicted to be higher by 4.38 points (less pain) 1 year after THA in older patients (≥75), when compared to younger patients (<55 years), again the difference is well below the MCID and is clinically insignificant. CONCLUSION: Although there are statistically significant differences in pain relief, functional improvement, and quality of life between younger and older patients among different patients' age groups, there is no clinically significant difference. THA provides an improvement in quality of life by decreasing pain and increasing function in all 4 age groups, with large improvements in Patient-Reported Outcome Measures scores (>2 standard deviations) without clinically significant age-related differences in THA outcome at 1 year.
5Is Cementless Total Knee Arthroplasty Safe in Women Over 75 Y of Age?PubMed
John P Gibbons, Roslyn S Cassidy, Leeann Bryce, et al.
J Arthroplasty. 2023 Apr;38(4):691-699. doi: 10.1016/j.arth.2022.10.021. Epub 2022 Oct 19.
BACKGROUND: Cementless total knee arthroplasty (TKA) is the subject of renewed interest. Previous concerns about survivorship have been addressed and there is an appeal in terms of biological fixation and surgical efficiency. However, even surgeon advocates have concerns about the risk of marked subsidence when using this technology in older patients at risk for osteoporosis. METHODS: This was a retrospective analysis of 1,000 consecutive fully cementless mobile bearing TKAs performed at a single institution on women over 75 years of age who had postoperative and 1-year x-rays. The primary outcome was the incidence of subsidence. RESULTS: There were three asymptomatic cases with definite subsidence and change in alignment. In a fourth symptomatic case, the femoral component subsided into varus and the tibia into valgus, thus maintaining alignment which facilitated nonoperative treatment in a 92-year-old. Overall, at 1 year, there were two- liner revisions for infection without recurrence. Five patients had further surgery, of which three were washouts and two were for periprosthetic fractures sustained postoperatively within 1 year. Seven patients had further anesthesia, of which five were manipulations and two were nonrecurrent closed reductions for spinouts. CONCLUSION: Cementless TKA did not have a high risk of subsidence in this at-risk population. In the hands of experienced surgeons, these procedures can be used safely irrespective of bone quality.
6Consequences for preoperative pain and function when postponing elective knee and hip arthroplasty.PubMed
Lasse K Harris, Lina H Ingelsrud, Kirill Gromov, et al.
Dan Med J. 2022 May 19;69(6):A06210509.
INTRODUCTION: The coronavirus outbreak causes postponement of elective surgery. We evaluated how pain, function and general health were impacted by postponing elective knee and hip arthroplasty in patients with knee and hip osteoarthritis with no known surgery rescheduling date due to the coronavirus outbreak. METHODS: This study included 194 patients from a Danish public hospital with postponed elective primary knee or hip arthroplasty due to the lockdown. Patients responded to questionnaires when their surgery was cancelled and before surgery. Changes in pain and function were evaluated with the Oxford Knee and Hip Scores (OKS, OHS) and their general health with the EuroQol 5-dimension scale (EQ5D). Additionally, we asked about the patients' concerns and whether they felt improved, unchanged or deteriorated during the waiting period. RESULTS: Complete data were obtained for 110 (57%) patients, 59 and 51 awaiting knee or hip arthroplasty (median age 71 years, 62% were female), respectively. Arthroplasty was postponed for a median (range) 98 (63-161) days. A total of 34% were concerned that the postponement would lead to a poorer outcome. Mean OKS and OHS differences were 0 (95% confidence interval (CI): -1-1) and -1 (95% CI: -2-0) from surgery cancellation to re-scheduled surgery. The mean EQ5D index difference was 0.0 (95% CI: 0.0-0.1) for both groups. A total of 75 (68%) patients felt an important deterioration of their condition. CONCLUSIONS: Pre-operatively, patients worried about experiencing an altered treatment outcome due to postponed surgery and felt that their condition had deteriorated during the waiting period although this was not reflected in patient-reported outcome measures. FUNDING: Department of Orthopaedic Surgery. TRIAL REGISTRATION: not relevant.
7Health-Related Quality of Life after Hip and Knee Arthroplasty Operations.PubMed
Hannu J A Miettinen, Ninna Mäkirinne-Kallio, Heikki Kröger, et al.
Scand J Surg. 2021 Sep;110(3):427-433. doi: 10.1177/1457496920952232. Epub 2020 Aug 31.
BACKGROUND AND OBJECTIVE: The aim of this study was to investigate the health-related quality of life before and after a hip and a knee arthroplasty operation using a 15D instrument and to compare these scores to the Finnish control population 15D scores. METHODS: The pre- and post-operative data of 15D were prospective collected from the patients undergoing total hip arthroplasty or total knee arthroplasty at the Kuopio University Hospital. Post-operative data were collected at 6 and 12 months after the operation. RESULTS: The mean change of the 15D score after hip arthroplasty was +0.062 and after knee arthroplasty, it was +0.033 at the 12-month follow-up ( < 0.001). Total hip arthroplasty patients of all ages reached the control population 15D scores at the 12-month follow-up. Of the total knee arthroplasty patients, only patients aged >75 years and males aged 55-64 years did reach control population 15D scores at the 12-month follow-up. Patients experienced a statistically significant improvement in mobility, vision, sleeping, usual activities, discomfort and symptoms, distress, and vitality ( < 0.05). CONCLUSIONS: Successful hip and knee arthroplasty operations improve patients' health-related quality of life. According to this study, hip arthroplasty improves the health-related quality of life more than knee arthroplasty.
8Does high activity after total and unicompartmental knee arthroplasty increase the risk for aseptic revision?PubMed
Laura E Streck, Carola Hanreich, Agnes D Cororaton, et al.
Arch Orthop Trauma Surg. 2023 Sep;143(9):5843-5848. doi: 10.1007/s00402-023-04794-1. Epub 2023 Mar 7.
INTRODUCTION: It has been suggested that high activity might negatively impact implant survival following total and unicompartmental knee arthroplasty (TKA/UKA) and many surgeons advise their patients to only participate in moderate level sport activities. To date, it remains unclear whether such restraints are necessary to assure longevity of the implants. MATERIALS AND METHODS: We conducted a retrospective study on 1906 knees (1745 TKA, 161 UKA) in 1636 patients aged 45-75 years who underwent primary arthroplasty for primary osteoarthritis. Lower extremity activity scale (LEAS) at a two year follow-up was assessed to define the activity level. Cases were grouped in low (LEAS ≤ 6), moderate (LEAS 7-13) and high activity (LEAS ≥ 14). Cohorts were compared with Kruskal-Wallis- or Pearson-Chi-Test. Univariate logistic regression was conducted to test for association between activity level at two years and later revisions. Odds ratio was reported and converted to predicted probability. A Kaplan-Meier curve was plotted to predict implant survival. RESULTS: The predicted implant survival for UKA was 100.0% at two years and 98.1% at five years. The predicted implant survival for TKA was 99.8% at two years, 98.1% at five years. The difference was not significant (p = 0.410). 2.5% of the UKA underwent revision, one knee in the low and three knees in the moderate activity group, differences between the moderate and high activity group were not significant (p = 0.292). The revision rate in the high activity TKA group was lower than in the low and moderate activity groups (p = 0.008). A higher LEAS two years after surgery was associated with a lower risk for future revision (p = 0.001). A one-point increase in LEAS two years after surgery lowered the odds for undergoing revision surgery by 19%. CONCLUSIONS: The study suggests that participating in sports activity following both UKA and TKA is safe and not a risk factor for revision surgery at a mid-term follow-up. Patients should not be prevented from an active lifestyle following knee replacement.
9Primary total knee arthroplasty in patients with post-polio syndrome.PubMed
Daniel Karczewski, Matthew P Siljander, Dirk R Larson, et al.
Bone Joint J. 2023 Jun 1;105-B(6):635-640. doi: 10.1302/0301-620X.105B6.BJJ-2022-0988.R2.
AIMS: Knowledge on total knee arthroplasties (TKAs) in patients with a history of poliomyelitis is limited. This study compared implant survivorship and clinical outcomes among affected and unaffected limbs in patients with sequelae of poliomyelitis undergoing TKAs. METHODS: A retrospective review of our total joint registry identified 94 patients with post-polio syndrome undergoing 116 primary TKAs between January 2000 and December 2019. The mean age was 70 years (33 to 86) with 56% males (n = 65) and a mean BMI of 31 kg/m (18 to 49). Rotating hinge TKAs were used in 14 of 63 affected limbs (22%), but not in any of the 53 unaffected limbs. Kaplan-Meier survivorship analyses were completed. The mean follow-up was eight years (2 to 19). RESULTS: The ten-year survivorship free from revision was 91% (95% confidence interval (CI) 81 to 100) in affected and 84% (95% CI 68 to 100) in unaffected limbs. There were six revisions in affected limbs: three for periprosthetic femoral fractures and one each for periprosthetic joint infection (PJI), patellar clunk syndrome, and instability. Unaffected limbs were revised in four cases: two for instability and one each for PJI and tibial component loosening. The ten-year survivorship free from any reoperation was 86% (95% CI 75 to 97) and 80% (95% CI 64 to 99) in affected and unaffected limbs, respectively. There were three additional reoperations among affected and two in unaffected limbs. There were 12 nonoperative complications, including four periprosthetic fractures. Arthrofibrosis occurred in five affected (8%) and two unaffected limbs (4%). Postoperative range of motion decreased with 31% achieving less than 90° knee flexion by five years. CONCLUSION: TKAs in post-polio patients are complex cases associated with instability, and one in four require constraint on the affected side. Periprosthetic fracture was the main mode of failure. Arthrofibrosis rates were high and twice as frequent in affected limbs.
10Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty?PubMed
Megan Ishii, Krystin Wong, Brent Shimoda, et al.
Arch Orthop Trauma Surg. 2023 Aug;143(8):5283-5292. doi: 10.1007/s00402-022-04749-y. Epub 2023 Jan 5.
INTRODUCTION: The safety and benefits of single stage bilateral total knee arthroplasty (SSBTKA) among older patients as compared to unilateral TKA remains controversial. This study aimed to evaluate the influence of age and comorbidities on complications and early outcomes for unilateral and BTKA in patients over and under 70 years of age. MATERIALS AND METHODS: This prospective study compared postoperative complications and early patient-reported outcomes at 6 weeks of 142 unilateral TKA patients (N = 75, ≤ 70; N = 67, > 70) and 89 SSBTKA patients (N = 48, ≤ 70; N = 41, > 70). Patients completed the KOOS JR and PROMIS Global Mental (GMH) and Global Physical Health (GPH) surveys. Knee Society Scores for Knee (KSS-K) and Function (KSS-F) were completed in the clinic. Parametric tests were performed for comparisons of unilateral and BTKA outcomes and complications for patients over and under 70. RESULTS: While patient demographics were similar, patients > 70 had more comorbidities than patients ≤ 70 (p < 0.004). There were no significant differences in postoperative complications or readmissions between age groups or procedures. Unilateral TKA patients > 70 had significantly lower pre- (p < 0.001) and post-operative (p = 0.011) KSS-F scores compared to those ≤ 70. SSBTKA patients > 70 had significantly higher preoperative GMH (p = 0.029), postoperative KSS-K (p = 0.027), KOOS JR scores (p = 0.039) and satisfaction (p = 0.048) compared to those ≤ 70. CONCLUSION: Age did not influence the risk of early postoperative complications. Additionally, the greater improvements in KOOS JR and higher patient satisfaction for SSBTKA patients > 70 suggests that SSBTKA may meet elderly patient expectations and should not necessarily be discouraged due to safety concerns.
11Changes in health-related quality of life in young-old and old-old patients undergoing elective orthopedic surgery: A systematic review.PubMed
Yun Jin Chen, Justine Lau, Yasmin Alhamdah, et al.
PLoS One. 2024 Oct 1;19(10):e0308842. doi: 10.1371/journal.pone.0308842. eCollection 2024.
BACKGROUND: There is a significant gap in research exploring changes in postoperative health-related quality of life (HRQoL) among patients aged 65 years and older undergoing hip or knee arthroplasty. OBJECTIVES: To investigate the variations in HRQoL improvement, as evaluated by patient-reported outcome measures following total hip arthroplasty, total knee arthroplasty, and partial knee arthroplasty between the young-old and old-old adults. METHODS/DESIGN: We searched six online databases (including MEDLINE, Embase) from their inception dates to May 15, 2023. We included studies using a validated HRQoL assessment tool to evaluate changes in HRQoL in patients aged ≥65 years undergoing hip or knee arthroplasty. These include the EuroQol five-dimension (EQ-5D), Short Form 36 (SF-36) and Short Form 12 (SF-12). The primary outcomes were postoperative HRQoL changes between young-old (65-74 years) and old-old groups (≥75 years). The secondary outcomes included complications, length of stay, and mortality. RESULTS: The search yielded 12,229 articles; twelve studies (n = 103,613) were included. Studies using EQ-5D found no significant differences between young-old and old-old patients after hip and knee arthroplasty. Analyses of SF-36 and SF-12 scales showed no significant age-related differences in postoperative improvements in physical and mental health. Our review of four studies that included multivariable analyses revealed inconsistent associations between age and EQ-5D. Comparisons between the young-old and old-old age groups in postoperative complications, hospital length of stay, and mortality revealed no associated age-related changes in HRQoL. CONCLUSIONS: The young-old and old-old patients exhibited comparable improvement in HRQoL following hip or knee arthroplasty. The older patients did not have higher postoperative complications rates, longer hospital length of stay, and increased mortality. While chronological age should be considered when planning hip and knee arthroplasty, greater emphasis should be placed on assessing the comorbidities and functional status of patients.
12Age stratified, matched comparison of unicompartmental and total knee replacement.PubMed
J A Kennedy, H R Mohammad, S J Mellon, et al.
Knee. 2020 Oct;27(5):1332-1342. doi: 10.1016/j.knee.2020.06.004. Epub 2020 Jul 27.
BACKGROUND: Unicompartmental knee replacement (UKR) tends to provide better function but has a higher revision rate than total knee replacement (TKR). The aim was to determine if this occurred in all age groups. METHODS: Two large, non-registry, prospective cohorts with median 10-year follow-up (2252 TKR, 1000 medial UKR) were identified. All UKR met recommended indications. TKR with an inappropriate disease pattern for medial UKR were excluded. Knees were propensity score-matched within age-strata (<60 years at operation, 60 to <75, 75+) and compared using Oxford Knee Score (OKS), Kaplan-Meier revision rates and a composite failure, defined as any of revision, reoperation or no improvement in OKS. RESULTS: One thousand five hundred and eighty-two TKR and UKR were matched. Results are reported TKR vs UKR for ages <60, 60 to <75 and 75+. Median 10-year OKS were 33 vs 45 (p < 0.001), 36 vs 42 (p < 0.001) and 36 vs 38 (p = 0.25). Ten-year revision rates were 11% vs 7%, 5% vs 5%, and 5% vs 10%, (none significant). The composite failures occurred 8%, 5% and 5% more frequently with TKR than UKR (none significant). CONCLUSIONS: In this matched study UKR provided better functional outcomes in all age groups, particularly the young, and provided substantially more excellent outcomes. Although in older groups TKR tended to have a lower revision rate, in the young UKR had a lower revision rate. This was surprising and was perhaps because in this study UKR was, as recommended, only used for bone-on-bone arthritis, whereas in young patients it is widely used for early arthritis, which is associated with a high failure rate. This study supports the use of UKR with recommended indications, in all age groups.
13[Effect of unicompartmental knee arthroplasty in patients over 75 years old with knee osteoarthritis].PubMed
Xiao-Cong Ju, Bing Wang, Feng Wang, et al.
Zhongguo Gu Shang. 2022 Jul 25;35(7):637-43. doi: 10.12200/j.issn.1003-0034.2022.07.009.
OBJECTIVE: To investigate the clinical effect of unicompartmental knee arthroplasty in patients with knee osteoarthritis over 75 years old. METHODS: From April 2010 to May 2015, 42 patients with knee medial compartment osteoarthritis were treated with Oxford third-generation unicompartmental knee arthroplasty. According to the single and bilateral replacement, the patients were divided into bilateral simultaneous replacement group and unilateral replacement group:11 patients in the simultaneous replacement group, 3 males and 8 females, aged (79.18±3.06) years;There were 31 cases in the unilateral replacement group, 13 males and 18 females, aged (78.16±3.48) years. The survival status of patients with knee prosthesis, the changes of hematocrit before and after operation, and the total amount of blood loss during and after operation were observed and compared;The HSS (Hospital for Special Surgery knee rating) scores of patients before and after operation were compared. RESULTS: There was significant difference in perioperative complications between two groups(<0.05). All 42 patients were followed up for(5.7±2.3) years. One patient with a history of previous hypertension developed cerebral thrombosis in the 4th month after operation, one patient developed pad dislocation in the 4th month after operation, and two patients died of other medical diseases(1 myocardial infarction and 1 lung cancer) 3 years after operation. The total amount of postoperative blood loss in bilateral simultaneous replacement group was higher than that in unilateral replacement group(<0.05);Four patients with bilateral simultaneous replacement received 2U blood transfusion after operation. The HSS score and total score of the two groups at 9 months after operation were higher than those before operation(<0.05). CONCLUSION: Unicompartmental knee arthroplasty is a feasible surgical treatment for osteoarthritis patients over 75 years old with medial single compartment degeneration. For elderly patients over 75 years old with bilateral knee lesions, bilateral simultaneous unicompartmental knee arthroplasty is more traumatic than unilateral unicompartmental knee arthroplasty, which will increase the incidence of perioperative complications, affect the rapid postoperative recovery and increase the blood loss. Although the long-term effect is equivalent to that of unilateral unicompartmental knee arthroplasty, staged operation is still recommended to ensure the safety of operation.
14Minimum Five Years Follow-Up of Total Knee Arthroplasty Using Morphometric Implants in Patients With Osteoarthritis.PubMed
Florent Bernard de Villeneuve, Christophe Jacquet, Stephane Puech, et al.
J Arthroplasty. 2021 Jul;36(7):2502-2509. doi: 10.1016/j.arth.2021.02.052. Epub 2021 Feb 25.
BACKGROUND: The use of morphometric implants in total knee arthroplasty (TKA) has shown better early clinical outcomes compared to conventional implants. The primary objective of this study is to evaluate the functional outcome and the implant survivorship of a morphometric TKA at a minimum of 5 years of follow-up. METHODS: From May 2012 to June 2015, all patients undergoing primary TKA with a single design of morphometric posterior-stabilized prosthesis (Persona; Zimmer) in a prospective observational single-center study were evaluated. The Knee Society Scoring System (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were completed preoperatively, 1, 3, and 5 years postoperatively. Kaplan-Meier was used to calculate survivorship of the implants. The average follow-up was 75 months. RESULTS: In total, 237 TKAs were performed in 235 patients with a mean age of 73 years (49-90). The KSS Knee Score increased from 44.7 (13-64) preoperatively to 93.6 (71-100), the KSS Function Score from 45.8 (17-69) to 92.2 (51-98), and the KSS Satisfaction Score from 26.6 (16-51) to 41 (35-55) at 5 years of follow-up. Similarly, for the KOOS score, a significant improvement of all the subscales was observed at 5 years of follow-up. Implant survival without reoperation at 5 years of follow up was 98.72% (95% confidence interval 0.95-1.00). CONCLUSION: This is the first study demonstrating that significant improvements of the functional scores with good survivorship can be achieved at a minimum of 5 years of follow-up with TKA using morphometric implants.