How well do elderly patients do after total knee arthroplasty in the era of fast-track surgery?

IntroductionTotal knee arthroplasty (TKA) in the elderly population is becoming increasingly prevalent. This study aimed to compare outcomes of patients aged >= 80years with those aged <80years at time of TKA and to assess the effect of fast track peri-operative care on outcomes in the elderly.Materials and methods422 TKAs were performed in aged <greater than or equal to>80 at the time of surgery between 2009 and 2018. A control group aged <80years (37-79 +/-7.6) was established. Peri-operative mortality, complications, 30-day re-admission, length of stay (LOS) and rehabilitation parameters were recorded.ResultsMean age at operation for the <greater than or equal to>80's group and control group was 82.7 (80-93+/-2.5) and 69.3 (37-79+/-7.6) years respectively. Post-operative Knee Society Functional Assessment (KSFA) scores were higher in the control group (49 vs. 57, p=0.003). Average LOS was longer in the >= 80's group (17.2 vs. 12.4days respectively, p<0.01). Mortality within 3months of operation was 0.7% in the <greater than or equal to>80 group and 0% in the control group. Incidence of complications was comparable between the two groups at 12.8 and 12.9% for the group >= 80's and control groups respectively (p=0.962). Patients >= 80years, receiving fast track peri-operative care had significantly shorter LOS and higher post-operative KSFA scores at all time points post-operation and shorter LOS (p<0.01) compared to those who received conventional rehabilitation. LOS was longer in the <greater than or equal to>80's group, which was likely related to higher levels of comorbidities. Complications were comparable in the two groups but were more severe in the elderly. Mortality rate after TKA was very low even in those over the age of 80. Younger patients benefited more in terms of functional improvement after TKA.ConclusionTKA is a safe and efficacious procedure for the elderly. More severe complications, longer length of stay and smaller gains in functional improvement can be expected in the elderly compared to younger patients. Fast track peri-operative care is useful in improving outcomes after TKA for elderly patients.