Older TKA Patients Fare Better Than Young in Massive Study

Nearly 12,000 patients have “spoken” with new research indicating that patients 75 years and older had better pain, function, and quality of life following total knee arthroplasty (TKA) than those who were 55 and younger.

The study, “Age-Related Differences in Pain, Function and Quality of Life Following Primary Total Knee Arthroplasty,” was presented at the 2023 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Led by David Ayers, M.D., an orthopedic surgeon at the University of Massachusetts Chan Medical School, the team used the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) consortium, which is managed by Dr. Ayers at the University of Massachusetts Department of Orthopedics and Physical Rehabilitation. This consortium includes over 235 surgeons from hospitals across the country, providing a representative sample of national data.

The 11,602 patients were separated into four cohorts:

• less than 55,
• 55-64,
• 65-74 and
• 75 years and older.

The researcher team obtained demographics, comorbidities, patient reported outcome measures (including Knee Injury and Osteoarthritis Outcomes Scores) and a short-form health survey with a Physical Composite Score and Mental Composite Score.

Preoperatively, patients aged 55 and younger reported worse pain, function, and quality of life compared to older patients, especially those 75 years of age and older.

At one year after TKA, younger patients still reported slightly worse pain, function, and quality of life, but better function scores than patients older than 75.

“Because of the successful nature of TKAs and with improved anesthetic techniques and rapid recovery protocols, age does not always correlate to being an optimal candidate for TKA, as it has more to do with a patient’s medical fitness level,” said Dr. Ayers.

When it comes to talking with a patient about what to expect, Dr. Ayers told OTW, “It is important to discuss patients’ expectations before TKA with all patients, but particularly for patients in the youngest age group studied (less than 55 years of age). This group of patients remember have more pain, lower function, and worse quality of life than the other three age groups before TKA. They are also more often obese, more likely to smoke and often have other medical comorbidities in addition to their knee pain.”

“One year after TKA, these patients still report more pain than the other three groups studied even though they have improved dramatically. It is helpful to discuss with these patients that they will not be pain free after TKA and there will still be good days and bad days and soft tissue discomfort in the replaced knee. The youngest group also may have higher expectations regarding activities after surgery. It is therefore important to review that hiking, biking, swimming, doubles tennis, and cross-country skiing are all good activities to engage in after TKA.”

“High impact activities like running jogging, squash, handball, and moguls downhill skiing are not. Patients less than 55 years of age often compare their post op activities to peers their own age who are still doing these activities and if they are not aware of the limitations after TKA they may be dissatisfied.”

Dr. Ayers and his colleagues are now developing a program that will provide a predictive algorithm based on a patient’s demographics and comorbidities. Patients will receive an analysis of their expected pain, function, and quality of life scores one year after surgery.

Providing OTW with details on the algorithm, Dr. Ayers noted, “We have done a multivariate regression analysis to determine all the independent predictors of pain, function, and quality of life after TKA from the extensive FORCE-TJR comparative effectiveness database. We then use all the demographic and pre-op clinical variables available before surgery to match individual patients to other patients in the FORCE-TJR database to predict what that individual patient’s pain, function, and quality of life scores will be one year after TKA.”