Total knee arthroplasty in carefully selected patients aged 80 years or older

BACKGROUND: The patients aged ≥ 80 years have been considered to have a higher risk of mortality, postoperative complications, and longer hospital stay following total knee arthroplasty (TKA) than younger patients. The purposes of this retrospective study were to review the results of TKA in patients aged ≥ 80 years after a preoperative consultation. METHODS: Seventy-five patients aged ≥ 80 years underwent TKA from January 2006 and June 2010. A control group of younger patients (65-74 years) was matched in a 1:1 ratio with the ≥ 80 years group for sex, diagnosis of the disease, body mass index, the American Society of Anesthesiologists' type of anesthesia, and comorbidities. Cardiologists and neurologists carefully evaluated the risk of patients for both groups before surgery. The groups were compared with regard to Knee Society Scores, Knee Society Function Score, Western Ontario and McMaster Universities Osteoarthritis Index scores, length of stay, postoperative complications, and 90-day mortality rate. RESULTS: The mean follow-up was 2.3 years (range 1-5 years). We found no difference in the functional outcomes and length of stay between the two groups. The ≥ 80 years group had a higher rate of blood transfusion (29.3% versus 10.7%, p = 0.006) after Bonferroni correction. There were no cardiovascular or cerebrovascular complications in the ≥ 80 years group. There were no mortalities within 90 days in either group. CONCLUSIONS: Despite similar functional results and pain relief of the TKA compared with the young patient group, the ≥ 80 years group had a higher complication rate of blood transfusion. With a preoperative consultation by cardiologists and neurologists, patients aged ≥ 80 years have a low cardiovascular or cerebrovascular complications and 90-day mortality after TKA.