CURRENT PRACTICE OF KNEE ARTHROPLASTY SURGERY FOR OSTEOARTHRITIS IN PATIENTS AGED 55 YEARS OR LESS

Abstract

Purpose: To determine current practice in knee Arthroplasty surgery for osteoarthritis in young patients for the population registered on the Trent and Wales Arthroplasty Database. Is there a ‘gold standard’? If there is what is it?

Method: The Trent Arthroplasty Audit Group collects prospective data on all knee Arthroplasty surgery performed in Trent Region and North and West Wales (population 6.2 million). In 2000/2001 7% of knee arthroplasties were performed on osteoarthritic patients aged 55 years or less. We analysed the database to reach the following results.

Results: In 2000/01 208 arthroplasties were performed in this group of patients. The youngest patient was 36 yrs. Seventy per cent of the patients were aged between 50 and 55 years. 114 were female. 27 had a unicompartmental knee replacement, mobile bearing in 25. Where the patient had a condylar knee replacent a mobile bearing design was implanted in 10 knees. A PCL sacrificing implant was used in 36% of cases. The patella was resurfaced in 31%. An uncemented prosthesis was used in 19 knees. An 8mm tibial insert was implanted in 32 cases and an insert of less than 10mm in a further eight cases. The surgery was performed by a Consultant in 65% of cases. A Consultant assisted in a further 14% of cases. The arthroplasty was the first surgical procedure to the knee in 38% of cases. The arthroplasty followed arthroscopic procedures in a further 41% of cases.

Conclusions: The surgeons of the Trent Arthroplasty Audit Group are offering knee Arthroplasty to their patients at an earlier stage. Surgeons don’t appear to change their surgical practice or choice of implant when operating on young osteoarthritic patients. Given that we have previously shown that 20% of these patients are disappointed by the pain relief and 38% by their level of function what should we recommend?