Aseptic Revision Total Knee Arthroplasty in Octogenarians: A Matched Cohort Comparison of Early Clinical Outcomes

With increasing volume and life expectancy of patients undergoing total knee arthroplasty (TKA), the incidence of octogenarian patients requiring revision TKA (rTKA) will similarly rise. There remains limited evidence regarding the safety of revision procedures in octogenarians who may carry an increased risk of medical and surgical complications. Therefore, the purpose of our analysis was to evaluate early clinical outcomes following rTKA in patients aged ≥ 80 years compared with younger matched controls.

Patients who underwent aseptic all-component rTKA between 2010 and 2020 at a multiple-surgeon, single-site institution were reviewed. Patients aged ≥ 80 years were matched to cohorts of patients aged ≥ 40 to 59 years and ≥ 60 to 79 years undergoing rTKA based on sex, American Society of Anesthesiologists score, and body mass index. Multivariate regression analysis of 90-day postoperative medical and surgical complications, controlling for comorbidity burden, smoking status, and revision etiology, was conducted. A total of 210 patients (n = 70 per cohort) were evaluated.

There were no differences between octogenarians and younger patients for medical (odds ratio [OR]: 0.32; 95% confidence interval [CI]: 0.053 to 1.91; P = 0.2), surgical (OR: 1.61, 95% CI: 0.42 to 6.19; P = 0.5), and overall complications (OR: 0.52, 95% CI: 0.17 to 1.60; P = 0.3) at 90 days. Octogenarians had a statistically lower risk of reoperation relative to younger controls (OR: 0.22, 95% CI: 0.054 to 0.85; P = 0.03).

Octogenarians undergoing rTKA had comparable early postoperative clinical outcomes compared to younger matched controls. These findings suggest that appropriately indicated octogenarians requiring all-component rTKA may safely undergo these procedures. Adult reconstruction surgeons must consider both age and comorbidity burden when counseling these patients regarding the risks associated with revision surgery.