Knee replacement complications in elderly patients

An April 2022 study (1) examined outcomes and side effects of unicompartmental knee arthroplasty or partial knee replacement in patients over 80 years old. The authors write: “Little research to date has explored the complication profile of unicompartmental knee arthroplasty in an older population. (This) study uses a large national surgical database to examine the 30-day postoperative adverse events in octogenarians compared with those in nonoctogenarians.”

  • A total of 728 octogenarians cases were examined. In this group the patients had significantly higher comorbidity burden than nonoctogenarians.
  • Octogenarians had higher 30-day odds of death, minor adverse events, prolonged hospital length of stay, nonhome (assisted care) discharge, and readmission, but did not experience increased odds of serious adverse events or return to the operating room.

Conclusion: “The present study found a statistically significant increase in several adverse events within 30 days of surgery for patients aged more than 80 years when compared with patients younger than 80 years. Namely, unicompartmental knee arthroplasty in octogenarians was associated with significantly increased odds of short-term mortality, urinary tract infection, transfusion, prolonged hospital stay, and readmission.”

The 80 plus year old patient and the 90 year old plus patient


A June 2022 study (3) assessed the mortality and complication rates in nonagenarians (90 year olds plus) and octogenarians (80 year olds patients plus) undergoing total hip and knee replacement. The researchers write: “Advancing age is a significant risk factor for the development of perioperative complications and mortality in patients undergoing total hip or knee replacement  due to their compromised health status and the associated medical comorbidities. The purpose of this review is to identify if nonagenarians patients over 90 having a total hip and knee replacement are associated with a higher incidence of mortality and morbidity compared to octogenarians (80 plus year olds). The researchers found: “Although nonagenarians undergoing total hip or knee replacement can achieve the same clinical benefit as octogenarians, they have a higher risk of perioperative complications and one-year mortality. Therefore, meticulous preoperative screening, proper patient selection and optimization of comorbidities are essential to minimize any postoperative side effects in patients over 90 years of age.”

Nitrazepam


Australian researchers released their study findings that older people taking nitrazepam, a medicine used to treat anxiety and insomnia, as well as those patients on antidepressants, are twice as likely to suffer postoperative delirium after hip and knee surgery. Writing in a November 2021 study, (2) the researchers concluded: “People who developed delirium following hip or knee surgery were more likely to be exposed to nitrazepam, sertraline, mirtazapine, venlafaxine, citalopram, escitalopram or fluvoxamine at the time of admission for surgery. Planning to reduce use of these medicines well prior to surgery may decrease the risk of postoperative delirium.”

1 Moore HG, Schneble CA, Kahan JB, Grauer JN, Rubin LE. Unicompartmental Knee Arthroplasty in Octogenarians: A National Database Analysis Including Over 700 Octogenarians. Arthroplasty today. 2022 Jun 1;15:55-60.
2 Kassie GM, Roughead EE, Nguyen TA, Pratt NL, Kalisch Ellett LM. The Risk of Preoperative Central Nervous System-Acting Medications on Delirium Following Hip or Knee Surgery: A Matched Case-Control Study. Drug Safety. 2022 Jan;45(1):75-82.
3 Kitridis D, Tsikopoulos K, Givissis P, Chalidis B. Mortality and complication rates in nonagenarians and octogenarians undergoing total hip and knee arthroplasty: a systematic review and meta-analysis. European Geriatric Medicine. 2022 Jan 24:1-9.

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