title: Longer hospital stay, more complications, and increased mortality but substantially improved function after knee replacement in older patients.
abstract: OBJECTIVE
  Total knee replacement (TKR) is being increasingly performed in elderly patients, yet there is little information on specific requirements and complication rates encountered by this group. We assessed whether elderly patients undergoing TKR had different length of stay, requirements, complication rates, and functional outcomes compared to younger counterparts.
  
  
  METHODS
  We analyzed prospectively gathered data on 3,144 consecutive primary TKRs (in 2,092 patients aged less than 75 years, 694 patients aged between 75 and 80 years, and 358 patients aged over 80 years at the time of surgery).
  
  
  RESULTS
  Incidence of blood transfusion, urinary catheterization, postoperative confusion, cardiac arrhythmia, and 1-year mortality increased with age, even after adjusting for confounding factors, whereas the incidences of chest infection and mortality at 1 month were highest in those aged 75-80. Rates of thromboembolism, prosthetic infection, and revision were similar in the 3 age groups. All groups showed similar substantial improvements in American Knee Society (AKS) knee scores, which were maintained at 5 years. Older patients had smaller improvements in AKS function score, which deteriorated between 3 and 5 years postoperatively, in contrast to the younger group.
  
  
  CONCLUSIONS
  Elderly people stand to gain considerably from TKR, particularly in terms of pain relief, and they should not be denied surgery based solely on age. However, they should be warned that they can expect a longer length of stay, a higher requirement for blood transfusion and/or urinary catheterization, and more medical complications postoperatively. Mortality was also higher in the older age groups. The risks have been quantified to assist in perioperative counselling, informed consent, and healthcare planning.
authors.affiliation: Department of Trauma and Orthopaedics , Victoria Hospital, Kirkcaldy, Fife.
authors.forename: Julian F
authors.initials: JF
authors.lastname: Maempel
authors.forename: Fraser
authors.initials: F
authors.lastname: Riddoch
authors.forename: Neville
authors.initials: N
authors.lastname: Calleja
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Brenkel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000502:physiology*; D007720:Knee Prosthesis / Q000382:microbiology*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000401:mortality; D016059:Range of Motion, Articular / Q000502:physiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000401:mortality