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Younger patients may require different TKA outcome measures, study finds

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Although total knee arthroplasty can yield good outcomes regardless of patient age, researchers from the United Kingdom cautioned that patients younger than 55 years demonstrate lower satisfaction scores and thus outcomes may not be fully encapsulated by Oxford Knee Score and EQ-5D measures.

“We have seen changing indications [for knee arthroplasty],” Derfel Williams said during his presentation at the 13th EFORT Congress 2012, in Berlin. “Knee arthroplasty is now being performed more widely in young, active patients as well as the older and frailer patients. This brings us to the question of how these outcomes differ according to age.”

“We know our younger patients tend to have higher revision and higher activity levels following knee arthroplasty, whereas in the older population we tend to have higher mortality, higher morbidity and lower function,” he added. “However, the published data on the effects of age are a bit lacking.”

Williams and his team performed an analysis of outcome data — including Oxford Knee Score (OKS), EQ-5D, satisfaction and revision — from 2,456 primary total knee arthroplasty (TKA) patients. The patients were divided into several age groups (younger than 55 years, 55 years to 64 years, 65 years to 74 years, 75 years to 84 years, and 85 years or older). Their OKS and EQ5D were analyzed preoperatively and at the 6-month and 2-year postoperative marks.

According to the study abstract, patients between 65 years and 85 years of age demonstrated better preoperative status than patients younger than 65 years and older than 85 years. There were no reported significant differences in OKS or EQ5D between the different age groups.

The authors noted a trend of greater postoperative 6-month and 2-year improvements for younger patients, although patients younger than 55 years demonstrated a significantly lower satisfaction score (78.1) than patients in all other age groups (84.9 overall).

“We found good early postoperative outcomes regardless of age following knee arthroplasty, and therefore we say age should not be a barrier to surgery,” Price said. “However, although the younger patients demonstrate the greatest improvements in PROMs, those under 55 are less satisfied and caution should therefore be exercised. You may need to consider the need for alternative outcome measures to fully assess the success of a surgery.”

Reference:

• Price A, Beard D, Arden N, et al. The effects of age on knee arthroplasty patient reported outcomes. Paper #2596. Presented at the 13th EFORT Congress 2012. May 23-25. Berlin.
• Disclosure: Williams has no relevant financial disclosures.