Under-40 TKA Patients Have Higher Complication Rates

New research from Hospital for Special Surgery (HSS) in New York City has found, perhaps unexpectedly, that younger patients had higher rates of early mechanical complications than older patients.

Co-author Mark P. Figgie, M.D., professor of orthopedic surgery and the Allan E. Inglis, Chair in Surgical Arthritis at HSS, described the study to OTW, “Clinically, we are seeing a fairly dramatic increase in younger patients having knee replacement and we wanted to figure out how they were doing against older patients. We wanted to determine if the durability was as good if not better than that of the older patients.”

The authors wrote, “A national insurance database was queried from 2007-2015 for all patients who underwent primary TKA…. There were 114,698 patients included in the analysis. Patients under age 40 years had higher rates of diabetes mellitus, inflammatory arthritis, drug abuse, and smoking status compared to the rest of the cohort. After controlling for baseline comorbidities using multiple logistic regressions, patients under age 40 and those age 40-49 had an increased rate of early mechanical complications. Ninety-day readmission rates were significantly higher in the under-age 40 group. Revision-free survivorship at 5 years was significantly worse in patients less than 60 years of age.”

Asked about using 40 as the cutoff age, Dr. Figgie said, “The data was provided to us by decades. While other studies have looked at 50 and below, we wanted to look at the youngest group separately since they need the best durability.”

“These younger patients don’t have the same survivorship and are having more mechanical problems. They are less healthy, some have diabetes, have had prior surgeries and have more instability and swelling after surgery.”

“We are finalizing the manuscript and will likely submit for publication within the next three months.”