Younger Patients Are More Likely than Older Patients to Require Reoperation after TKA
Total knee arthroplasty (TKA) is increasing among patients age 65 and younger, with 1 study projecting a potential increase of 183% in the number of TKA and revision TKA surgeries in that age group by the year 2030. Concerns have been raised about poorer clinical outcomes, lower patient satisfaction, and diminished joint survival in a younger compared with an older patient population.
Unfortunately, the concerns may be warranted: In a paper published online ahead of print in the Journal of Arthroplasty, researchers from the University of Missouri School of Medicine and MU Health Care report that their younger patients underwent early reoperation and component revision surgery nearly twice as often as their older patients.
“Advances in the field of joint replacement, along with newer implant designs, have encouraged surgeons to expand TKA to a younger age group,” said senior author James A. Keeney, MD, associate professor of orthopaedic surgery.
“Most of our younger patients who have had knee replacement surgery are doing very well, but this patient group has a higher likelihood of needing an additional surgery during their lifetime. A small percentage of these patients may undergo a revision surgery during the first 5 years after their knee replacement. We wanted to know more about the potential causes of poor outcomes.”
Dr. Keeney and colleagues reviewed the medical records of 147 patients (158 knees) age 55 and younger and compared them with 276 patients (300 knees) who were between ages 60 and 75 at the time of surgery. They documented:
- Reoperation rates
- Timing of reoperation
- Patient demographics
They found that their younger patients were more likely than their older patients to undergo aseptic revision surgery within 2 years of the primary procedure: 52.5% vs 29.0%, respectively. After the revision procedure, younger patients were also more likely to require early reoperation (17.7% vs 9.7%) and component re-revision (11.4% vs 6.0%). In addition, younger patients had a higher incidence of infection, extensor mechanism complications, and 5-year failure of the joint.
“A combination of factors may contribute to the risk of failure, but the general observation of higher tobacco use among the younger patients suggests a possible primary culprit,” Dr. Keeney said. “Smokers have been noted in previous studies to experience increased joint infection risk after primary hip and knee replacement surgery and higher rates of wound complications.”
Although younger age is thought to be associated with better physical health, previous studies have suggested that younger TKA patients potentially have poorer health characteristics, including increased obesity, higher body mass index, and lower activity levels. However, Dr. Keeney and colleagues found no significant differences in comorbidities between the younger and older patient groups, with the exception of a history of tobacco use.
“Based on our findings, smoking cessation efforts should be part of the treatment plan following initial surgery and may be even more important for patients undergoing revision surgery,” Dr.. Keeney said. “Efforts should also be made to decrease the risk of infection, mechanism failure, stiffness and instability, which are the common reasons for reoperation.”
Walker-Santiago R, Tegethoff JD, Ralston WM, Keeney JA. Revision total knee arthroplasty in young patients: higher early reoperation and rerevision. J Arthroplasty. 2020 August 31. Published online ahead of print. DOI: https://doi.org/10.1016/j.arth.2020.08.052