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Similar survival rate but lower functional outcomes following TKA in the elderly people compared to younger patients: analysis of a posterior stabilised implant with minimum 5-year follow-up

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Background

Literature regarding outcomes in patients over 80 years old after total knee arthroplasty (TKA) is inconsistent. We aimed to compare implant survivorship and functional outcomes between elderly patients (≥ 80 years) and younger patients (< 80 years) following TKA, using a single modern posterior-stabilized (PS) prosthetic design.

Methods

This is a retrospective cohort study of 80 patients over 80 years old who underwent TKA between January 2015 and December 2016, who were compared with younger patients (60–75 years old) operated during the same period. Patients were matched with a ratio of 1:3 based on logistic regression analysis of gender and body mass index. All patients received the same cemented PS prosthesis with a fixed bearing polyethylene insert, with or without patellar resurfacing. Implant survival and patient-reported outcome measurements were compared between the two groups. At last follow-up, data were available for 41 knees in the elderly group (including 17 patients who died before 5-year follow-up) and 123 knees in the younger group.

Results

Functional results were better at final follow-up in the group < 80 years with a significantly higher Knee Society Function Subscore (88.6 ± 16.9 vs 79.4 ± 22.1, p < 0.01), but no significant differences in Knee Subscore and global Knee Society Score (p > 0.05), nor regarding maximum flexion (121° ± 12 and 117° ± 13, p = 0.08). The implant survivorship was 100.0% after a mean 64.4-month follow-up (range 60–78), without revision requiring removal of the implant in any group. The survival rate without any reoperation was 97.6% (95% CI 93.0–100.0) in the elderly group and 95.9% (95% CI 92.5–99.5) in the younger group (p = 0.64).

Conclusion

At a minimum of 5-year follow-up, there was no revision surgery and a very low rate of complications requiring reoperations both in the group over 80 years of age and in the younger population, with the use of a PS prosthesis. The functional results were slightly lower for elderly patients and correlate with the lower functional demands of this population. The indication for TKA, especially with a PS implant, may be encouraged in appropriately selected elderly patients.

Level of evidence

III (retrospective cohort study).

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Data availability

The data that support the findings of this study are available from the corresponding author (ED) upon reasonable request.

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Authors and Affiliations

  1. Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France

    Etienne Deroche, Cécile Batailler, Stanislas Gunst, Elvire Servien & Sébastien Lustig

  2. Sydney Orthopaedic Research Institute (SORI) at Landmark Orthopaedics, 500 Pacific Hwy, St. Leonards, NSW, Australia

    Jobe Shatrov

  3. LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France

    Elvire Servien

  4. Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France

    Sébastien Lustig

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  1. Etienne Deroche
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  2. Cécile Batailler
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Corresponding author

Correspondence to Etienne Deroche.

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Conflict of interest

ED, CB, JS, SG: no conflict of interest. ES: Institutional research support for Corin. SL: Royalties from Stryker; Consultant for Stryker, Smith & Nephew, Hereaus, Depuy Synthes; Institutional research support for Groupe Lépine, Amplitude; Editorial Board of Journal of Bone and Joint Surgery (Am).

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Ethics approval was obtained from our institutional ethics committee (ICP-D08.16).

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Deroche, E., Batailler, C., Shatrov, J. et al. Similar survival rate but lower functional outcomes following TKA in the elderly people compared to younger patients: analysis of a posterior stabilised implant with minimum 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 31, 1470–1476 (2023). https://doi.org/10.1007/s00167-022-07287-7

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