Comparable Survivorship at Five Years Between Octogenarians and Younger Controls Undergoing Revision Total Knee...

There is limited and conflicting evidence regarding the clinical outcomes of octogenarian patients following revision total knee arthroplasty (rTKA), particularly at longer follow-up intervals. This study aimed to compare (1) 90-day, (2) 2-year, and (3) 5-year outcomes between octogenarians and younger matched controls.

A national administrative claims database was queried to identify patients undergoing rTKA between 2010 and 2023. Patients undergoing one- or two-component rTKA for any indication, with a minimum 5-year follow-up, were included. Octogenarians (patients aged 80 to 89 years) were matched in a 1:1 manner to patients aged 70 to 79 years (n = 687) and to patients aged 60 to 69 years (n = 679) based on sex, Elixhauser Comorbidity Index, components revised, revision indication, and comorbidity burden. Multivariate regressions were used to compare medical and surgical complications between the age groups at 90 days, two years, and five years postoperatively. A log-rank test was used to compare 5-year survivorship free of death or all-cause revision between octogenarians and each matched cohort.

Octogenarians had a significantly higher risk of surgical site infection at 90 days relative to patients aged 70 to 79 years (odds ratio: 2.3, 95% confidence interval: 1.3 to 4.4; P = 0.007). Additionally, urinary tract infection incidence was higher relative to patients aged 60 to 69 years (odds ratio: 3.1, 95% confidence interval: 1.4 to 6.7; P = 0.005). There were no differences in revision rates at 2- or 5-year follow-up seen between octogenarians and the other younger age groups. Survivorship free of mortality or all-cause revision at five years was comparable between octogenarians and patients aged 70 to 79 years (53.9 versus 55.7%; P = 0.400) and patients aged 60 to 69 years (52.0 versus 51.1%; P = 0.800).

The present analysis demonstrated comparable rTKA outcomes between octogenarians and matched younger patients at 5-year follow-up, including no differences in survivorship from death or all-cause revision. These findings suggest that octogenarians may safely undergo rTKA if appropriately indicated despite their increased age.