J. A. Garcia1, M. Hess1, H. Siegel1 1University of Alabama at Birmingham School of Medicine, Orthopedics, Birmingham, AL, USA
Introduction:
Knee arthrodesis (KA) is a procedure in which the knee joint is fused between the tibia and femur. In most cases, KA is performed in order to salvage the lower limb and avoid above the knee amputation (AKA). Two common indications for knee arthrodesis are traumatic injury and recurrent infection of a total knee arthroplasty (TKA). An assumption of this study is that patients with infected TKA’s will be older, while those with traumatic injury will be younger. In addition, we presume that older patients with infected TKA’s will have less baseline lower limb functionality pre-operatively as compared to those with traumatic injury. Factors that will affect the outcome from KA include post-operative lower limb functionality and longevity of the KA. We hypothesize that older patients will have a greater amount of infected TKAs and better outcomes from KA due to a lower expectation of lower limb functionality and less longevity required from the KA. To our knowledge no current literature has addressed the outcomes of KA in regard to patient age and represents a novel idea regarding advocacy for KA in an elderly patient population.
Methods:
An IRB protocol was established and approved for this retrospective analysis. A retrospective chart review was then conducted on 49 patients who underwent KA at our institution from 2005 to 2020. Patients from the cohort were separated by age into a cohort of young and old. The cohort was then contacted by telephone and asked to answer a Visual Analog Scale (VAS) assessment for pain and a qualitative assessment of patient satisfaction.
Results:
There were 27 patients in the old category and 22 patients in the young category. In the old cohort, 75% had a septic TKA, 37% required revision surgery, and only 3% had a revision AKA. In the young cohort, 60% had a traumatic injury, 48% required revision surgery, and 24% required a revision AKA. The old cohort had an average VAS of 2 and 88% chose a KA over an AKA. The young cohort had an average VAS of 8 and only 15% chose KA over an AKA.
Conclusion:
This study showed a greater amount of infected TKA’s present in the old patient cohort and greater traumatic injury in the young cohort. In addition, fewer revision surgeries and far less revision AKA’s were performed on the old patient cohort. The overall patient satisfaction was greater and pain was less among the old patient population. Therefore, this investigation has supported the hypothesis that older age is associated with better outcomes from KA. Due to the frequency of failed TKA among the elderly patient population, the KA should be considered as a viable and preferred method of treatment for these patients.
