Abstract
Total hip arthroplasty (THA) and Total knee arthroplasty (TKA) are successful operations that predictably restore function and provide pain relief for up to 20 years. What happens if they fail in the elderly patient? The purpose of this review was to evaluate pain relief, function and quality of life (QOL) in octogenarian patients undergoing revision total joint arthroplasty (TJA).
We reviewed our surgical database to find all patients who were 80 years or older at the time of revision surgery. From 1993 through 2008, there were 61 revision THAs (52 patients) and 33 revision TKAs (29 patients). This represented 3% and 8% respectively of all arthroplasties and revision arthroplasties done during the same period. Outcomes evaluated include Harris Hip Scores (HHS), Knee Society Scores (KSS), complications, and QOL.
The average follow-up for revision THA patients with completed Harris Hip Evaluations was 27 months (range: 3 – 126 months). HHS improved from 47 pre-operatively to 74 at most recent follow-up. Pain Scores improved from 20 to 39, Function Scores from 11 to 16, Activities Scores from 9 to 10, Deformity Scores from 2 to 4 and ROM Scores from 5 to 6. Complications occurred in 34% of these cases. The average follow-up for revision TKA patients with completed Knee Society Evaluations was 38 months (range: 11 – 98 months). KSS improved from 48 preoperatively to 84 at the most recent follow-up. Pain Scores improved from 22 to 43 and Function Scores from 20 to 34. Complications occurred in 47% of these cases.
Total HHS and KSS greatly improved postoperatively with the most notable improvement in the Pain category. Complications were common, although most were considered minor. More severe complications occurred when revisions of all components were needed, more likely in TKA than THA. With careful selection, patient education and preoperative planning, revision TJA can be done safely and provide benefit for the elderly patient.
Correspondence should be addressed to Diane Przepiorski at ISTA, PO Box 6564, Auburn, CA 95604, USA. Phone: +1 916-454-9884; Fax: +1 916-454-9882; E-mail: ista@pacbell.net
