Mid-term lifetime survivals of octogenarians following primary and revision total knee arthroplasties were satisfactory: a retrospective single center study in contemporary period
Bibliographic record
Abstract
BACKGROUND: As life expectancy increases, the number of octogenarians requiring primary and revision total knee arthroplasty (TKA) is increasing. Recently, primary TKA has become a common treatment option in octogenarians. However, surgeons may still be hesitant about performing revision TKA on octogenarians because of concern about risk and cost benefit. The purpose of this study was to investigate clinical outcomes, postoperative complications, and mid-term lifetime survival in octogenarians after primary and revision TKA. MATERIALS AND METHODS: We retrospectively reviewed 231 primary TKAs and 41 revision TKAs performed on octogenarians between 2000 and 2016. The mean age of patients undergoing primary TKA was 81.9 years and that of patients undergoing revision TKA was 82.3 years (p = 0.310). The age-adjusted Charlson comorbidity index was higher in revision TKA (4.4 vs. 4.8, p = 0.003). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. The incidence of postoperative complications (TKA-related, specific or systemic) and lifetime survival rate (endpoint death determined by telephone or mail communication with patient or family) were investigated. RESULTS: The WOMAC and ROM improved significantly after primary and revision TKA, although postoperative results were worse in the revision group (33.1 vs. 47.2; 128.9° vs. 113.6°; p < 0.001, respectively). There were no cases of aseptic or septic component failure in either group. One case of periprosthetic fracture was observed in the revision group (0% vs. 2.4%, p = 0.151), and three cases of deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE) (one case of DVT and two cases of PTE) were observed in the primary group (1.3% vs. 0%, p = 1.000). The most common systemic complication in both groups was delirium (7.4% vs. 14.6%, p = 0.131). There were no differences between the two groups in the other systemic complication rates. The 5-year and 10-year lifetime survival rates were 87.2% and 62.9%, respectively, in primary TKA and 82.1% and 42.2%, respectively, in revision TKA (p = 0.017). CONCLUSIONS: Both primary and revision TKA are viable options for octogenarians, based on the satisfactory clinical outcomes, TKA-related complication rates, and mid-term lifetime survival. Delirium needs to be managed appropriately as the most common systemic complication in both primary and revision TKA in octogenarians. LEVEL OF EVIDENCE: IV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".