The Effect of Comorbidities and Age on Functional Outcomes After Total Knee Arthroplasty in the Octogenarian: A Matched Cohort Study

Abstract

Introduction:According to the World Health Organization data repository, the average life expectancy at birth for Singapore in 2015 has risen to 83.4 years, and many octogenarians (OG) remain active socioeconomically. The aim of this study is to compare the improvement and the impact of comorbidities on functional recovery after total knee arthroplasty (TKA) between OG and their younger counterparts.Methods:This is a retrospective study of prospectively collected data from a single institution arthroplasty register. Between January 2006 and December 2011, 209 OG with primary knee osteoarthritis underwent TKA. Each OG (mean age 82 ± 2.1) was then carefully matched to a younger control group (YG, mean age 66 ± 4.5). Their postoperative outcomes measured include Oxford Knee Score (OKS), SF36-Physical Function (SF-PF), and knee society rating score comprising of Knee Score (KS) and Function Score (FS). Their respective degrees of improvement were compared and adjusted for their baseline comorbidities, measured using the Deyo-Charlson Comorbidity Index (D-CCI).Results:There were more comorbidities among the OG (P < .05). Both groups saw the largest improvement (P < .05) during the first 6 months. There was no statistical significance between their improvement for OKS, KS, and FS between baseline and 6 months and OKS, FS, and SF-PF between 6 and 24 months. Adjusted for D-CCI using linear regression, the above results remained largely unchanged.Discussion:In our study, both groups showed significant improvement across all functional outcomes, especially during the first 6 months. The improvement observed in OG at 6 and 24 months was comparable to that of YG, despite an overall higher baseline D-CCI.Conclusions:Total knee arthroplasty is a viable treatment option for the OG, offering good functional outcomes and results at 6 and 24 months when compared to their younger counterparts.

Assessment and identification of predictors of performance of early rehabilitation of patients in the general intensive care unit. Article

“…Результаты нашей работы не подтвердили зависимость функциональных исходов от возраста. Некоторые исследователи объясняют повышенную инвалидизацию у пожилых пациентов после госпитального лечения высокой частотой сопутствующей патологии, осложняющей течение основного заболевания и препятствующей проведению реабилитации [23]. Вероятно, возраст сам по себе не влияет на скорость функционального восстановления и прогнозирует результат в меньшей степени, чем другие клинические показатели [24].…”

Knee joint function, walking ability and quality of life within 6 weeks after total knee arthroplasty: A prospective cohort study

“…While the average number of inpatient days decreased from 9.4 to 4.2 days, the percentage of discharged patients transferring to rehabilitation wards increased from 10% to 38% (Vincent, Vincent, Lee, & Alfano, ). According to the literature, previous studies found that patients’ joint and body functions are able to sufficiently recover by 3–6 months after TKA, resulting in high patient satisfaction levels (Cher et al, ; Kennedy, Stratford, Hanna, Wessel, & Gollish, ; Lin, Chang, & Chuang, ; Maruyama et al, ; Naal et al, ). Cher et al () followed 209 TKA patients for 2 years and found that patients reached the largest improvement during the first 6 months.…”

“…According to the literature, previous studies found that patients’ joint and body functions are able to sufficiently recover by 3–6 months after TKA, resulting in high patient satisfaction levels (Cher et al, ; Kennedy, Stratford, Hanna, Wessel, & Gollish, ; Lin, Chang, & Chuang, ; Maruyama et al, ; Naal et al, ). Cher et al () followed 209 TKA patients for 2 years and found that patients reached the largest improvement during the first 6 months. Naal et al followed 233 TKA patients before surgery, and at 3, 6 and 12 months after surgery, and found that as assessed by patient‐reported outcomes over time, at 12 months more than 90% of the patients were satisfied with the surgical results.…”

“…The initial recovery after discharge from the hospital should be taken seriously. Most studies tracked the functional recovery of TKA patients 1 or 2 years after surgery (Cher et al, ; Konopka, Lee, Su., & McLawhorn, ; Minator et al, ; Thiam, Teh, Bin Abd Razak, & Tan, ), and few studies have examined the QOL in the early stages after the TKA procedure. Therefore, this study explored the physical recovery and QOL of patients discharged after the number of inpatient days was shortened, specifically focusing on the period immediately following patient discharge.…”

The Long-term Results of Total Knee Arthroplasty in Octogenarian

“…Cher et al studied the functional scoring between octogenarians and younger patients in TKA at 6 and 24 months[29]. Both groups showed statistical improvement in KSS and KFS post-operatively.…”