Unicompartmental Knee Arthroplasty in Octogenarians: A National Database Analysis Including Over 700 Octogenarians

The Relationship Between Age and 30-Day Outcomes Following Unicompartmental Versus Total Knee Arthroplasty

BACKGROUND

Understanding the short-term complication profile following unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA) can improve surgical decision-making and patient outcomes. This study aimed to determine if the difference in risk of 30-day morbidity and mortality between UKA and TKA varied based on patient age.

METHODS

This retrospective study of a national quality improvement database using data from 2014 to 2020 included 403,342 patients undergoing UKA (n = 12,324) or TKA (n = 391,018). A generalized additive model evaluated nonlinear relationships between primary outcome and predictors (age, procedure, and procedure × age interaction) using a 1:5 UKA to TKA matched sample. Probabilities and odds ratios (95% confidence interval [CI]) estimated the relative risk of complications by age.

RESULTS

In the generalized additive model, TKA patients relative to UKA had 1.30 odds (95% CI 1.19 to 1.43, P < 0.001) of 30-day morbidity and mortality. There was a significant nonlinear relationship between age and primary outcome (P = 0.02), such that the odds were lowest at younger ages. They increased slowly until the age of 65 years, when the slope became steeper. The interaction terms for age and procedure were not significant (P = 0.30). The 30-day probability for short-term complications of a 65-, 75-, and 85-year-olds undergoing UKA was 2.1% (95% CI 1.8 to 2.3), 2.4% (95% CI 2.0 to 2.8), and 3.2% (95% CI 2.3 to 4.1), respectively. The probability of a 65-, 75-, and 85-year-old undergoing TKA was 2.9% (95% CI 2.7 to 3.0), 3.6% (95% CI 3.3 to 3.8), and 5.5% (95% CI 4.7 to 6.3), respectively.

CONCLUSIONS

Patients undergoing UKA had a quantifiable lower likelihood of morbidity or mortality than TKA at all ages. These data can provide individualized risk for UKA and TKA across the age spectrum and could be helpful in counseling patients regarding their perioperative risk.

LEVEL OF EVIDENCE

III (retrospective comparative study).

Unicompartmental knee arthroplasty in octogenarians: An analysis of 1,466 patients with 2-year follow-up

INTRODUCTION

Unicompartmental knee arthroplasty (UKA) has been shown to improve pain and function in appropriately selected patients. Limited data exists regarding outcomes and complication rates following UKA among octogenarians.

METHODS

The PearlDiver Mariner database was queried for patients undergoing primary UKA between 2010-2022. Patients < 80 years old were matched 4:1 to the octogenarian cohort (≥80 years old) by sex, year, Elixhauser Comorbidity Index (ECI), tobacco use, obesity, and diabetes. A total of 1,334 octogenarians and 5,313 controls were included in our analysis. Multivariate logistic regression was utilized to compare medical complications at 90-days post-operatively and surgical complications at 1- and 2-years post-operatively. Our regression analysis controlled for sex, ECI, tobacco use, obesity, and diabetes.

RESULTS

Octogenarians had an increased risk of acute kidney injury (OR: 2.306, 95% CI: 1.393-3.749; p < 0.001), pneumonia (OR: 2.367, 95% CI: 1.301-4.189; p = 0.003), UTI (OR: 1.846, 95% CI: 1.304-2.583; p < 0.001), ED visits (OR: 2.229, 95% CI: 1.586-3.105; p < 0.001), and any complication (OR: 1.575, 95% CI: 1.304-1.895; p < 0.001) at 90-days post-operatively. Octogenarians had lower odds of all-cause revision at 2-years (OR: 0.607, 95% CI: 0.382-0.923; p = 0.026). No differences were demonstrated between cohorts in rates of PJI (OR: 0.832, 95% CI: 0.334-1.796; p = 0.664), periprosthetic fracture (OR: 0.516, 95% CI: 0.120-1.520; p = 0.289), or aseptic loosening (OR: 0.285, 95% CI: 0.045-1.203; p = 0.088) at 2-years.

DISCUSSION

These findings suggest that despite an increased risk of certain medical complications within the acute post-operative period, octogenarians undergoing UKA experienced similar rates of surgical complications to younger matched controls at 2-year follow-up.

Revision total elbow arthroplasty is associated with a high rate of 30-day complications: A descriptive analysis of a national database

Introduction

Revision total elbow arthroplasty (TEA) is indicated for component loosening, periprosthetic joint infection, and fractures. Previous investigations into revision TEA complications have small sample sizes and limited exploration of acute complications. This study aims to characterize the 30-day complications and associated demographics of patients undergoing revision TEA using a large national database.

Methods

The 2015-2020 American College of Surgeons National Surgical Quality Improvement Program database was used to identify all revision TEA patients.

Results

The analysis included 158 patients (average age 62.6 years). The overall complication rate was 13.9% (n = 22). The most common 30-day complications were organ/space surgical site infection (3.8%, n = 6), unplanned readmission (3.2%, n = 5), intraoperative or postoperative transfusion (3.2%, n = 5), and unplanned reoperation (1.9%, n = 3). Patients with a history of dyspnea or steroid/immunosuppressant use for a chronic condition had significantly higher rates of bleeding requiring transfusion (p = .029 and p = .021, respectively). Additionally, patients aged 80 years or older had a significantly higher rate of unplanned readmission (p = .032).

Conclusion

Revision TEA has a 13.9% rate of complications within 30-days of surgery, with most involving surgical site infection, unplanned readmission, and blood transfusion.

Level of Evidence

IV.

A comprehensive analysis of age and 30-day complications following total shoulder arthroplasty: nonagenarians, octogenarians, and septuagenarians

Background

Increased age is a well-known risk factor for development of osteoarthritis. Total shoulder arthroplasty (TSA) is a common treatment option for patients with severe glenohumeral osteoarthritis. The purpose of this study was to investigate the association between the septuagenarian, octogenarian, and nonagenarian populations and postoperative outcomes following TSA.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2020. Patients were divided into cohorts based on age: sexagenarians (60-69), septuagenarians (70-79), octogenarians (80-89), and nonagenarians (90+). Multivariate logistic regression was used to identify associations between age and postoperative complications.

Results

On bivariate analysis, compared to sexagenarians, septuagenarians were significantly associated with higher rates of myocardial infarction (P = .038), blood transfusion (P < .001), organ/space surgical site infection (P = .048), readmission (P = .005), and nonhome discharge (P < .001. Compared to septuagenarians, octogenarians were significantly associated with higher rates of urinary tract infection (P < .001), blood transfusion (P < .001), readmission (P = .002), non-home discharge (P < .001), and mortality (P = .027). Compared to octogenarians, nonagenarians were significantly associated with higher rates of sepsis (P = .013), pneumonia (P = .003), reintubation (P = .009), myocardial infarction (P < .001), blood transfusion (P < .001), readmission (P = .026), nonhome discharge (P < .001), and mortality (P < .001).

Conclusion

From age 60, each decade of age was identified to be an increasingly significant predictor for blood transfusion, readmission, and nonhome discharge following TSA. From age 70, each decade of age was additionally identified to be an increasingly significant predictor for mortality.

Clinical outcomes, complications, and survivorship for unicompartmental knee arthroplasty versus total knee arthroplasty in patients aged 80 years and older with isolated medial knee osteoarthritis: a matched cohort analysis

PURPOSE

The primary goal of this study is to compare clinical outcomes, complication rate, and survivorship in octogenarians who underwent total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) by performing a matched cohort analysis.

METHODS

We analyzed 75 medial UKAs performed by a single experienced surgeon. The included cases were matched with 75 TKAs performed during the same study period. Potential TKA matches used identical exclusion criteria. UKAs were age-, gender-, and body mass index (BMI)-matched at the rate of 1 UKA to 1 TKA from our departmental database. Clinical evaluation included the visual analog scale for pain, range of motion (ROM-flexion and extension), Knee Society Score (KSS), and Oxford Knee Score (OKS). Each patient was clinically evaluated on the day before the surgery (T0) and at two follow-ups at least 12 months (T1) and 24 months (T2) after the surgery. For the survivorship, revision was defined as failure of the implant (periprosthetic joint infection, periprosthetic fracture, or aseptic loosening), and survival was based on implant revision or patient death. Undesirable clinical developments that were not present at baseline or that increased in severity after treatment were classified as adverse events.

RESULTS

The mean age at the time of the surgery was 82.1 ± 1.9 years for UKA and 81.5 ± 1.8 years for TKA (p = 0.06). The two groups differed in regard to surgical time (UKA 44.9 ± 7.2 min; TKA 54.4 ± 11.3 min; p < 0.001); furthermore, the UKA group showed better function (ROM; flexion and extension) than the TKA group at each follow-up time point (p < 0.05). Both groups reported a significant improvement in all clinical scores (KSS and OKS) when compared with their preoperative status (p < 0.05), while no differences were found between the groups at each follow-up (p > 0.05). The UKA group reported 7 (9.3%) failures, while TKA reported 6 failures. There were no survival differences between the groups (T1: p = 0.2; T2: p = 0.5). Overall complication rate was 6% in the UKA group versus 9.75% in TKA (p = 0.2).

CONCLUSION

The UKA and TKA patients had similar clinical outcomes, post-operative range of motion, and survivorship in octogenarians with medial knee osteoarthritis, with comparable complication rate. Both the surgical procedures may be considered in this patient population, but further long-term follow-up is needed.

LEVEL OF EVIDENCE

Level III.

Readmission and Reoperation Following Carpometacarpal Arthroplasty

Purpose

Carpometacarpal (CMC) arthroplasty is an effective surgical treatment for osteoarthritis of the CMC joint. Risk factors for readmission and reoperation have been studied for other joint arthroplasty procedures but have not yet been studied for CMC arthroplasty. The purpose of this study was to identify patient demographics and comorbidities associated with 30-day readmission and 30-day reoperation after CMC arthroplasty.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was queried for all records of patients who underwent CMC arthroplasty between 2015 and 2020. Variables collected in this study included patient demographics, comorbidities, surgical characteristics, and 30-day postsurgical complication data. Multivariate logistic regression was used to identify independent associations between patient characteristics and readmission and reoperation after CMC arthroplasty.

Results

In total, 6,432 records were included in this study: 34 (0.5%) were readmitted within 30 days, and 27 (0.4%) underwent reoperation within 30 days. Compared with the non-readmission cohort, the readmission cohort was significantly associated with higher rates of age ≥ 75 years (P = .003), body mass index (BMI) ≥ 40 kg/m2 (P = .005), American Society of Anesthesiologists classification (ASA) ≥ 3; P < .001), insulin-dependent diabetes (P = .016), and chronic obstructive pulmonary disease (COPD; P = .009). Compared with the non-reoperation cohort, the reoperation cohort was significantly associated with higher rates of age ≥ 75 years (P = .003), BMI ≥ 40 kg/m2 (P = .005), ASA ≥ 3 (P < .001), insulin-dependent diabetes (p = .016), and COPD (P = .009).

Conclusion

The clinically significant predictors for 30-day readmission and 30-reoperation after CMC arthroplasty were age ≥ 75 years, BMI ≥ 40 kg/m2, ASA ≥ 3, insulin-dependent diabetes, and COPD. Of these risk factors, age and BMI were identified as independent predictors for 30-day readmission. A better understanding of presurgical risk factors for postsurgical complications may help surgeons with risk stratification and optimization of outcomes.

Type of study/level of evidence

Prognostic III.