We assessed the effect of social deprivation
upon the Oxford knee score (OKS), the Short-Form 12 (SF-12) and patient
satisfaction after total knee replacement (TKR). An analysis of
966 patients undergoing primary TKR for symptomatic osteoarthritis
(OA) was performed. Social deprivation was assessed using the Scottish
Index of Multiple Deprivation. Those patients that were most deprived
underwent surgery at an earlier age (p = 0.018), were more likely
to be female (p = 0.046), to endure more comorbidities (p = 0.04)
and to suffer worse pain and function according to the OKS (p <
0.001). In addition, deprivation was also associated with poor mental
health (p = 0.002), which was assessed using the mental component
(MCS) of the SF-12 score. Multivariable analysis was used to identify
independent predictors of outcome at one year. Pre-operative OKS,
SF-12 MCS, back pain, and four or more comorbidities were independent
predictors of improvement in the OKS (all p <
0.001). Pre-operative
OKS and improvement in the OKS were independent predictors of dissatisfaction
(p = 0.003 and p <
0.001, respectively). Although improvement
in the OKS and dissatisfaction after TKR were not significantly
associated with social deprivation Cite this article:
We report the ten-year survival of a cemented
total knee replacement (TKR) in patients aged <
55 years at the
time of surgery, and compare the functional outcome with that of
patients aged >
55 years. The data were collected prospectively
and analysed using Kaplan-Meier survival statistics, with revision
for any reason, or death, as the endpoint. A total of 203 patients
aged <
55 years were identified. Four had moved out of the area
and were excluded, leaving a total of 221 TKRs in 199 patients for
analysis (101 men and 98 women, mean age 50.6 years (28 to 55));
171 patients had osteoarthritis and 28 had inflammatory arthritis.
Four patients required revision and four died. The ten-year survival
using revision as the endpoint was 98.2% (95% confidence interval
94.6 to 99.4). Based on the Oxford knee scores at five and ten years,
the rate of dissatisfaction was 18% and 21%, respectively. This
was no worse in the patients aged <
55 years than in patients
aged >
55 years. These results demonstrate that the cemented PFC Sigma knee has
an excellent survival rate in patients aged <
55 ten years post-operatively,
with clinical outcomes similar to those of an older group. We conclude
that TKR should not be withheld from patients on the basis of age.
We report the general mortality rate after total
knee replacement and identify independent predictors of survival. We
studied 2428 patients: there were 1127 men (46%) and 1301 (54%)
women with a mean age of 69.3 years (28 to 94). Patients were allocated
a predicted life expectancy based on their age and gender. There were 223 deaths during the study period. This represented
an overall survivorship of 99% (95% confidence interval (CI) 98
to 99) at one year, 90% (95% CI 89 to 92) at five years, and 84%
(95% CI 82 to 86) at ten years. There was no difference in survival
by gender. A greater mortality rate was associated with increasing
age (p <
0.001), American Society of Anesthesiologists (ASA)
grade (p <
0.001), smoking (p <
0.001), body mass index (BMI)
<
20 kg/m2 (p <
0.001) and rheumatoid arthritis
(p <
0.001). Multivariate modelling confirmed the independent
effect of age, ASA grade, BMI, and rheumatoid disease on mortality.
Based on the predicted average mortality, 114 patients were predicted
to have died, whereas 217 actually died. This resulted in an overall
excess standardised mortality ratio of 1.90. Patient mortality after
TKR is predicted by their demographics: these could be used to assign
an individual mortality risk after surgery.