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

In-hospital outcomes following primary and revision total hip arthroplasty in nonagenarian patients

PURPOSE

The primary goal of this study was to assess the risk of postoperative surgical and medical complications and problems among nonagenarian patients operated with hip arthroplasty.

METHODS

Data from a specific high-volume arthroplasty clinic, were collected to evaluate postoperative morbidity and complication rates after hip arthroplasty in nonagenarians, compared with a control group of younger, but similar patients. Outcomes evaluated included length of stay, transfusion rate, and postoperative medical and surgical complication rates.

RESULTS

A total of 97 nonagenarian patients (mean age 91.4 years) were included, and compared with 89 control group patients (mean age 70.18 years). Nonagenarian patients had significantly longer length of stay (11.44 vs. 7.98 days, p < 0.01), significantly higher risk of needing a transfusion (11.30% vs. 3.40%, p = 0.04), and significantly higher risk of a postoperative medical complication (28.90% vs. 11.20%, p = 0.03). There was no difference in postoperative surgical complication rate (7.20% vs. 2.20%, p = 0.12).

CONCLUSION

Nonagenarian patients, when compared to a younger control group, experience significantly longer hospital stays, and risk of non-surgical complications. Arthroplasty in nonagenarian patients carries with it a high risk of complications, and thus careful pre-operative evaluation and the care of these patients at high volume, specialized clinics is important to optimize outcomes.

LEVEL OF EVIDENCE

Level III retrospective cohort analysis.

Equivalence of clinical and radiological outcomes in cruciate-retaining and cruciate-substituting total knee arthroplasty with medial pivot knee: A comparative study

Introduction

Total knee arthroplasty (TKA) has been recognized as the most efficacious surgical intervention for individuals suffering from advanced arthritis; however, there is ongoing debate on the technical details of the procedure. It remains unknown whether preservation of the posterior cruciate ligament (PCL) significantly affects the mid-to long-term performance of ADVANCE® medial-pivotal (AMP) knee implants to enhance patient satisfaction. The hypothesis of this study was to investigate whether the preservation of the PCL has a substantial impact on the functional outcomes of medial pivot (MP) implants in patients undergoing TKA. Therefore, this study aimed to compare the midterm clinical and radiographic outcomes of cruciate-retaining (CR) and cruciate-substituting (CS) TKA using MP prostheses.

Methods

We included 376 consecutive patients who underwent unilateral TKA between January 2011 and April 2014. Follow-up evaluations were conducted in April 2021. After propensity score matching analysis, clinical and radiological outcomes and complication rates were compared between patients in the CR and CS groups.

Results

The postoperative outcomes in the two groups significantly improved the preoperative conditions of the patients (all p > 0.05). The postoperative outcomes (WOMAC score, p = 0.517; KSS, p = 0.107; KSFS, p = 0.240; ROM, p = 0.795; FJS, p = 0.822) and radiographic outcomes (preoperative FTA, p = 0.997; postoperative FTA, p = 0.646; aLDFA, p = 0.094; aMPTA, p = 0.970; PTS, p = 0.243) were comparable between the two groups. The complication and revision rates between the groups were not statistically significant (p = 0.34). The Kaplan-Meier cumulative survival of patients in the CRTKA and CSTKA groups was 100 % and 98.6 %, respectively.

Conclusions

This study supports the hypothesis that when MP prostheses are used, both CR and CS procedures achieve equally good mid-to long-term clinical and radiographic outcomes and complication rates. These findings suggest that PCL preservation may not significantly affect the overall performance of MP implants in patients undergoing TKA.