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Are Younger Patients Undergoing TKAs Appropriately Characterized As Active?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The use of TKAs in young patients is increasing. Demographic characteristics and activity levels among this patient group may affect implant selection, performance, and survivorship. Patient age (≤ 55 years) and preoperative diagnosis have been used to define this patient group, with the presumption that these patients are more active than older patients with similar indications for TKA.

Questions/purposes

We questioned whether (1) demographic features of young patients support high activity expectations after TKA, and (2) preoperative or postoperative functional activity measures support projections that young patients are active after TKA.

Methods

We retrospectively compared demographic characteristics (gender, BMI, diagnosis) and functional activity profile (as determined by preoperative and postoperative UCLA activity score and functional subscores of The Knee Society and WOMAC instruments) for 150 patients 55 years old or younger (181 TKAs) and 262 patients who were between 65 to 75 years old (314 TKAs) at the time of surgery.

Results

Younger patients having TKAs were significantly more likely than older patients to be female (74% versus 60%, p < 0.001) and to have diagnoses other than osteoarthritis (18% versus 3%, p < 0.001). BMI was significantly greater among younger female patients than among other age and gender combinations (35 kg/m2 versus 31 kg/m2, p < 0.001). Male patients had higher mean postoperative UCLA activity scores (5.5 versus 4.4, p < 0.001), Knee Society function subscores (80.2 versus 66.4, p < 0.001), and WOMAC function subscores (82.8 versus 74.2, p < 0.01) compared with female patients, but these were not different in older versus younger patients.

Conclusions

Sustained high activity levels are not likely to be a principal cause of revision TKAs among younger patients when considering age and diagnosis alone. Determining the effect of activity on survivorship of prosthetic designs and techniques should be based on measured functional activity instead of using age and diagnosis as surrogates for activity.

Level of Evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid, CB 8233, St Louis, MO, 63110, USA

    James A. Keeney MD, Ryan M. Nunley MD, Rick W. Wright MD, Robert L. Barrack MD & John C. Clohisy MD

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  1. James A. Keeney MD
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  2. Ryan M. Nunley MD
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  3. Rick W. Wright MD
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  4. Robert L. Barrack MD
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  5. John C. Clohisy MD
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Correspondence to James A. Keeney MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Keeney, J.A., Nunley, R.M., Wright, R.W. et al. Are Younger Patients Undergoing TKAs Appropriately Characterized As Active?. Clin Orthop Relat Res 472, 1210–1216 (2014). https://doi.org/10.1007/s11999-013-3376-x

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