Total Knee Arthroplasty in the Elderly: Does Age Affect Pain, Function or Complications?

Kennedy, J. Ward; Johnston, Linda; Cochrane, Lindy; Boscainos, Petros J.

doi:10.1007/s11999-013-2803-3

Cited by 85 publications

(96 citation statements)

References 22 publications

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“…Consistent with the results of other studies, the older group of patients (> 65 years) was likely to stay in the hospital longer than the younger group (≤65 years) [7,[18][19][20]. Older patients tend to be in worse physical condition and more likely to have postoperative complications [21,22], which increases the LOS. Furthermore, older patients are more likely to live alone and need caregiver support than are younger patients, and these factors have been shown to be important predictive factors for an extended LOS [6].…”

Section: Discussionsupporting

confidence: 85%

Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China

Song

Xia

et al. 2020

BMC Musculoskelet Disord

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Background: Decreasing the length of hospital stay is an ideal course of action to appropriately allocate medical resources. The aim of this retrospective study was to identify perioperative factors that may decrease the length of hospital stay (LOS). Methods: In this study, we collected the data on 1112 patients who underwent primary total knee arthroplasty surgery (TKAs) at our institution from Jan 1, 2011 to Nov 31, 2017. Based on the published literature, 16 potential factors (12 preoperative variables, 1 intraoperative variable, and 3 postoperative variables) were investigated. The patients requiring a hospital stay longer than the mean LOS (8 days) were defined as patients with a prolonged LOS. The factors with a P value less than 0.1 in the univariate analysis were further analysed in a multivariate model. An ordinal regression was used to determine independent risk factors for a prolonged LOS. Results: The mean LOS was 8.3 days (±4.3), with a range of 2 to 30 days. Sixteen variables were analysed by univariate analysis, and 11 of them had p < 0.1 and were included in the multivariable model. Finally, 9 factors were found to be associated with a prolonged LOS. Among the 9 variables, 2 were surgery-related factors (operative time and intraoperative blood loss), and 3 were patient-related factors (age, ASA classification and neurological comorbidities). Conclusion: In this study, we found that the clinical protocol, complications, the patient's age, the ASA classification, neurological comorbidities, the operative time, the ward, intraoperative blood loss and the surgeon were all factors contributing to a prolonged LOS. In clinical practice, these factors provide important information for the surgeon and are useful for identifying patients with a high risk of a prolonged LOS.

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Section: Discussionsupporting

confidence: 85%

Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China

Song

Xia

et al. 2020

BMC Musculoskelet Disord

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“…Meehan et al [20] showed that patients younger than 50 years are more likely to undergo revision as a result of PJI or aseptic mechanical failure at 1 year after TKA. Similarly, the higher rates of AKA in older populations could be the result of differences in comorbidities and/or patient preferences [13]. The higher rates in older patients could also be the result of the methodology used in this study.…”

Section: Discussionmentioning

confidence: 93%

Racial Disparities in Above-knee Amputations After TKA: A National Database Study

George

Navale

Schiltz

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Above-knee amputation (AKA) is a rare but devastating complication of TKA. Although racial disparities have been previously reported in the utilization of TKA, it is unclear whether disparities exist in the rates of AKA after TKA. Questions/purposes (1) Which gender-racial group has the highest rate of AKA from septic and aseptic complications of TKA? (2) Which age groups have higher rates of AKA from septic and aseptic complications of TKA? Methods Using National Inpatient Sample data from 2000 to 2011, AKAs resulting from complications of TKA were identified using a combination of International Classification of Diseases, 9th Revision procedure and diagnosis codes. Of the 341,954 AKAs identified, 9733 AKAs were the result of complications of TKA (septic complications = 8104, aseptic complications = 1629). Standardized AKA rates were calculated for different age and gender-racial groups by dividing the number of AKAs in each group with the corresponding number of TKAs. Standardized rate ratios were calculated after adjusting for demographics and comorbidities. Results After adjusting for age and comorbidities, black men had the highest rate of AKA after TKA (adjusted rate in black men = 578 AKAs per 100,000 TKAs, standardized rate ratio [SRR] = 4.32 [confidence interval {CI},.82], p \ 0.001). Black men also had the highest rate of AKA after septic complications of TKA (p \ 0.001). The adjusted rates of AKA were higher in patients younger than 50 years (adjusted rate = 473, SRR = 3.14 [CI, 2.94-3.36], p \ 0.001) and older than 80 years (adjusted rate = 297, SRR = 1.85 [CI, 1.76-1.95], p \ 0.001). Conclusions The rising demand for TKA has led to an increase in the number of AKAs performed for complications of TKA in the United States. Although we did not find an increase in the rate of AKA during the study period, certain populations, including black men and patients older than 80 years and younger than 50 years, had higher rates of AKA. Further studies are required to understand the reasons for these disparities and measures should be undertaken to eliminate these disparities. Level of Evidence Level III, therapeutic study.

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“…First, our finding that Medicare payments were higher for several patient populations (women, older patients, and patients with greater comorbid illness) is not unexpected; our findings are likely a reflection of both higher complication rates for TKA in these subgroups and less social support necessitating greater reliance on home health services. [23][24][25][26] The implications of higher complication rates (and costs) for certain populations could have profound implications under a switch to bundled payments. To the extent that patients with similar sociodemographics (and risk for complications) cluster within hospitals, [27][28][29] certain hospitals could benefit by having a relatively low-risk TKA population and see profits from TKA soar; alternatively, other hospitals with a predominantly higher risk TKA population could see TKA as financially detrimental based upon geographic location and catchment area alone.…”

Section: Discussionmentioning

confidence: 99%

Bundled Payments for Elective Primary Total Knee Arthroplasty

Cram

Lü

2014

Geriatr Orthop Surg Rehabil

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Bundled payments have been proposed as a mechanism for restraining health care spending for total knee arthroplasty (TKA), but empirical data are limited. We used Medicare data to examine variation in payments for TKA during a window extending 30 days before to 90 days after TKA for 167 186 patients who underwent elective primary TKA in 2009. Mean Medicare payment was US$23 656. We found that 2.5% of patients incurred payments of >US$50 000 (0.2% >US$100 000). Payments were lower for men and for non-Hispanic whites but higher for patients with greater comorbidity. Episode-of-care payment for primary TKA varies substantially depending upon patient demographics and comorbidity. To the extent that similar patients tend to be clustered within hospitals, bundled payments could inadvertently cause financial harm to certain health systems while rewarding others.

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Total Knee Arthroplasty in the Elderly: Does Age Affect Pain, Function or Complications?

Cited by 85 publications

References 22 publications

Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China

Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China

Racial Disparities in Above-knee Amputations After TKA: A National Database Study

Bundled Payments for Elective Primary Total Knee Arthroplasty

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