Abstract
Introduction
Total knee arthroplasty (TKA) is a successful treatment for degenerative end stage knee arthritis. Younger patients who undergo TKA may face multiple revisions during their lifetime due to aseptic loosening, infection, and instability. The purpose of this study was to compare the early complication rates and revision free survivorship between age groups undergoing TKA in a nationwide database.
Methods
The PearlDiver national insurance database was queried from 2007–2015 for all patients who underwent primary TKA. Kaplan-Meier Curve survival analysis and log rank test were performed to evaluate revision rates between age groups (<40, 40–49, 50–59, 60–69, 70–79, 80–89, and ≥90 years). Complication rates were compared to rates in the age 60–79 group using multiple logistic regressions controlling for baseline demographics and comorbidities.
Results
There were 114,698 patients included in the analysis. Patients under age 40 years had higher rates of diabetes mellitus, inflammatory arthritis, drug abuse, and smoking status compared to the rest of the cohort (p<0.001). After controlling for baseline comorbidities using multiple logistic regressions, patients under age 40 and those age 40–49 had an increased rate of early mechanical complications (OR 2.84, p=0.01 and 2.95, p<0.001 respectively). 90-day readmission rates were significantly higher in the under age 40 group (OR 1.63, p=0.03). Revision free survivorship at 5 years was significantly worse in patients less than 60 years of age (77.2% in age <40 group, 88.9% in age 40–49 group, and 91.7% in age 50–59 group, p<0.01).
Conclusions
Young patients under 40 years of age had a higher risk of early revision after TKA with 77% revision free survivorship at 5 years. Additionally, these patients have an increased risk of mechanical complications and readmission at 90 days. These outcomes may be used to shape preoperative counseling for the young patient.
