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. 2008 Jun;32(3):339-43.
doi: 10.1007/s00264-007-0324-y. Epub 2007 Feb 28.

The mortality, morbidity and cost benefits of elective total knee arthroplasty in the nonagenarian population

S V Karuppiah  1 , P A Banaszkiewicz, W M Ledingham
Affiliations

The mortality, morbidity and cost benefits of elective total knee arthroplasty in the nonagenarian population

S V Karuppiah et al. Int Orthop. 2008 Jun.

Abstract
in English, French

With the increasing life expectancy, a greater number of elderly patients are being referred to an orthopaedic department to have elective total knee arthroplasty (TKA). Total knee arthroplasty should be considered in the very elderly only after carefully balancing the benefits of surgery against the risks of surgery. The aim of this study was to analyse the mortality, morbidity and cost benefits of elective TKA in a cohort group of the nonagenarian population. Between 1990 and 2006, 42 patients >or=90 years of age had TKA surgery. Patient's notes were retrospectively analysed. A cost-benefit analysis was carried out by comparing the surgical costs against nursing home placement. The mean age at surgery was 90.4 years (range: 90-90.6). There was one major and 11 minor postoperative complications with no immediate or late postoperative deaths. The Knee Society Scores improved from 25 points (range: 8-44) to 81 points (range: 60-95), and the WOMAC Scores improved from 62 points (range: 54-73) to 41 points (range: 34-46) (p<0.002). The calculated cost-benefit savings for 42 patients at 5 years after TKA was estimated to be pound 2,746,839. Total knee arthroplasty in the nonagenarian population is safe, beneficial and cost-effective.

L’augmentation de la durée de vie fait qu’une population de plus en plus âgée présente les conditions pour bénéficier d’une prothèse totale du genou. La prothèse totale du genou doit être considérée dans cette population en comparant les bénéfices de la chirurgie et les risques de celle-ci. Le but de cette étude est d’analyser la mortalité, la morbidité, le rapport coût/bénéfice après prothèse totale du genou dans une cohorte de patients nonagénaires. Entre 1990 et 2006, 42 patients d’âge supérieur ou égal à 90 ans ont bénéficié d’une chirurgie par arthroplastie totale du genou. L’analyse de ces patients a été rétrospective. Le rapport coût/bénéfice a été réalisé en comparant le coût chirurgical versus, le coût du nursing à domicile. La moyenne d’âge a été de 90,4 ans (de 90 à 90,6). Ces patients ont présenté une seule complication majeure et 11 complications mineures sans décès post-opératoire. Le score de la Knee Society a été amélioré en passant de 25 points (8 à 44) à 81 points (60 à 95) et le score Womac a été amélioré de 62 points (54 à 73) à 41 points (34 à 46) (p < 0.002). Le rapport coût/bénéfice de ces 42 patients à 5 ans de l’utilisation de la prothèse a été estimé à 2.746.839£. La prothèse totale du genou dans une population de nonagénaire est une intervention sûre et qui permet un rapport coût/bénéfice positif pour la société.

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