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. 2023 Sep;14(3):305-311.
doi: 10.1177/19476035231164733. Epub 2023 Apr 19.

Total Knee Arthroplasty (TKA): When Do the Risks of TKA Overcome the Benefits? Double Risk of Failure in Patients up to 65 Years Old

Francesco Perdisa  1 , Barbara Bordini  2 , Manuela Salerno  3 , Francesco Traina  4 , Stefano Zaffagnini  5 , Giuseppe Filardo  3
Affiliations

Total Knee Arthroplasty (TKA): When Do the Risks of TKA Overcome the Benefits? Double Risk of Failure in Patients up to 65 Years Old

Francesco Perdisa et al. Cartilage. 2023 Sep.

Abstract

Objective: The aim of this study was to document the survival rate in the middle-aged patient group up to 65 years old and to compare it with other age groups of patients undergoing total knee arthroplasty (TKA) for knee osteoarthritis (OA).

Design: The Register of Orthopaedic Prosthetic Implants (RIPO) regional registry was used to analyze the results of patients <80 years old affected by primary OA and treated with TKA from 2000 to 2019. The database was investigated according to the age group: younger than 50 years, 50-65 years, or 66-79 years, with the aim to estimate revision surgeries and implant survivorship.

Results: A total of 45,488 TKAs for primary OA were included in the analysis (M: 11,388; F: 27,846). The percentage of patients <65 years old increased from 13.5% to 24.8% between 2000 and 2019 (P < 0.0001). The survival analysis showed an overall influence of age on the implant revision rate (P < 0.0001), with an estimated survival rate of 78.7%, 89.4%, and 94.8% at 15 years in the 3 groups, respectively. Compared with the older-aged group, the relative risk of failure was 3.1 (95% confidence interval [CI] = 2.2-4.3; P < 0.001) higher in patients <50 years old and 1.8 (95% CI = 1.6-2.0; P < 0.001) higher in patients 50-65 years old.

Conclusions: TKA use in the middle-aged patient population up to 65 years old increased significantly over time. These patients present a double risk of failure with respect to older patients. This is particularly important considering the increasing life expectancy and the emergence of new joint preserving strategies, which could postpone the need for TKA to an older age.

Keywords: failure; knee; osteoarthritis; survival rate; total knee arthroplasty.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: S.Z. reports nonfinancial support and personal fees from I+SRL and grants from Fidia Farmaceutici S.p.A., CartiHeal, IGEA clinical biophysics, BIOMET, and Kensey Nash, outside the submitted work.

Figures

Figure 1.
Figure 1.
Kaplan-Meier survivorship analysis by age group. Total knee arthroplasties in both the younger age groups presented more failures compared with the older ones.
See this image and copyright information in PMC

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