Age younger than 65 years may be a risk factor for re-revision after aseptic revision TKA
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Key takeaways:
- Patients 65 years or older had a higher survivorship free of re-revision for all causes vs. patients younger than 65 years.
- Age younger than 65 years had one of the highest HRs for re-revision.
SAN FRANCISCO — Results showed age younger than 65 years may be a risk factor for all-cause re-revision after aseptic revision total knee arthroplasty.
“The clinical implication of this is that when seeing a patient who is under 65 [years], but even especially younger, let’s say in their 40s or 50s, who you are considering a revision total knee on, they can be counselled that the results may not be as good as someone who is older, specifically 65 years of age or older,” Nicholas M. Hernandez, MD, assistant professor in the department of orthopedic surgery and sports medicine at the University of Washington, told Healio.
Using the American Joint Replacement Registry, Hernandez, Jaewon “Freddy” Yang, MD, and colleagues retrospectively reviewed all aseptic revision TKAs performed between 2012 and 2020 to identify patients who underwent a subsequent re-revision. Researchers categorized patients into groups based on whether they were younger than 65 years or aged 65 years or older.
“The big take-home finding was that the survivorship free of re-revision for all causes was higher in the 65 [years] or older group,” Hernandez said. “Specifically, it was 94.4% in the older group and 89.9% in the younger group at 10 years following re-revision surgery.”
Cox proportional hazard regression model showed age younger than 65 years, male sex, higher BMI and revision initially performed for instability were associated with higher HRs for re-revision, with age associated with the highest increase in HR. Patients who were older more commonly underwent re-revision for infection, while patients who were younger more commonly underwent re-revision for aseptic loosening and mechanical failure. Infection was the most common reason for re-revision for both groups, however, according to Yang, who presented the results at the American Academy of Orthopaedic Surgeons Annual Meeting.
“When evaluating the younger cohort, a 5-year decrease in age was associated with a 10.5% increase in odds of re-revision and even a 1-year decrease in age was associated with a 2% increase in odds of re-revision,” Yang said in his presentation.
As the number of primary TKAs continues to increase, Hernandez said orthopedic surgeons “need to have pause before we offer a revision in a younger patient and make sure that we have a solid diagnosis.”
“Doing a revision in someone for mechanical loosening is going to be different than doing a revision in a young patient for pain or subtle instability,” Hernandez said. “We just need to make sure we have pause before we offer revision surgery, as the survivorship may not be quite as high in some situations.”
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Yang JF, et al. Paper 468. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Feb. 12-16, 2024; San Francisco.
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