Abstract
Background
As life expectancy increases, the number of octogenarians requiring primary and revision total knee arthroplasty (TKA) is increasing. Recently, primary TKA has become a common treatment option in octogenarians. However, surgeons are still hesitant about performing revision TKA on octogenarians because of concerning about risk- and cost-benefit. The purpose of this study was to investigate postoperative complications and mid-term survival in octogenarians following primary and revision total knee arthroplasty (TKA).
Methods
We retrospectively reviewed 231 primary TKAs and 41 revision TKAs performed on octogenarians between 2000 and 2016. The mean age was 81.9 for primary TKA and 82.3 for revision TKA (p=0.310). The American Society of Anesthesiologists (ASA) score was not different, but the age-adjusted Charlson comorbidity index was higher in revision TKA (4.4 vs. 4.8, p=0.003). The mean follow-up period did not differ (3.8 vs. 3.5 years, p=0.451). The WOMAC scores and range of motion (ROM) were evaluated. The incidence of postoperative complication and survival rate (end point; death determined by telephone or mail communication with patient or family) were investigated.
Results
The postoperative WOMAC and ROM were better in primary TKA (33.1 vs. 47.2, p<0.001; 128.9° vs. 113.6°, p<0.001). The most common postoperative complication was delirium in both groups (7.4% vs. 14.6%, p=0.131). There were no differences in the specific complication rates between the two groups. The 5- and 10-year survival rates were 87.2% and 62.9%, respectively, in primary TKA and 82.1% and 42.2%, respectively, in revision TKA (p=0.017).
Conclusions
Both primary and revision TKAs are viable options for octogenarians when considering the clinical results and mid-term survival. Delirium needs to be managed appropriately as the most common complication in both primary and revision TKAs for octogenarians.
