Not Too Old for Joint Replacement

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Knee replacement surgery can improve the quality of life even for very elderly patients, according to a study presented today at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The study found that patients in their 80s can benefit both physically and socially from knee replacement surgery, also called total knee arthroplasty (TKA), once thought too risky for the very elderly.

“As patients are living longer, there is an upward trend in the demand for quality of life among the elderly population,” said Edsel Arandia, M.D., lead author of the study and an orthopaedic surgeon at Philippine Orthopaedic Center and a Fellow at Singapore General Hospital. “As patients age, debilitating diseases like arthritis of the knee begin to develop. We conducted this study to determine the viability of TKA in octogenarians and to learn whether their quality of life improves after TKA.”

Dr. Arandia and his team reviewed data from 128 patients older than 80 years of age who underwent knee replacement surgeries at Singapore General Hospital between October 1998 and December 2006.

The results were measured using two quality-of-life scales, the SF-36 and the Oxford Knee Score, which assign scores to elements of physical and emotional health, such as:
• physical pain
• social functioning
• vitality
• physical functioning

When researchers compared the patients’ preoperative scores to their postoperative scores up to 2 years following surgery, they found the patients’ quality of life scores had risen significantly during the postoperative period.

“The improvement in pain and function of elderly patients was remarkable as early as 6 months and showed long-lasting improvement at the 2-year follow-up,” Dr. Arandia noted. “Overall, total knee arthroplasty in elderly patients resulted in significant gains in their quality of life, which was reflected in both health- and social-related quality of life score dimensions.”

“In our institution, many surgeons are still skeptical to perform TKA in the very elderly since few data or studies pertaining to the gains of TKA versus the complications and risks that can occur with surgery in elderly patients exist,” Dr. Arandia said. “This study shows that with the advent of new technology and techniques in both orthopaedics and geriatric medicine, total knee arthroplasty in the very elderly population is very safe and offers significant gains in their quality of life.”

Disclosure: Available upon request

Source: American Academy of Orthopaedic Surgeons (AAOS)

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