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Topical Collection "Joint Arthroplasty in the Oldest People"

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A topical collection in Geriatrics (ISSN 2308-3417).

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Prof. Dr. Juan F. Blanco

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Collection Editor

1. Orthopaedic Surgery and Traumatology (Lead), University Hospital of Salamanca, Salamanca, Spain
2. Orthopaedic Surgery and Traumatology, Surgery Department, University of Salamanca (USAL), Salamanca, Spain
3. Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
Interests: orthogeriatrics; surgery; orthopedics; spine surgery; hip; knee
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Dr. Carmen da Casa

E-Mail Website
Collection Editor

Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
Interests: clinical trials; statistics; clinical research

Topical Collection Information

Dear Colleagues,

The increasing life expectancy and improved patient healthcare have led to an increasing number of older patients requiring arthroplasty. The rationale ranges from fracture treatment to osteoarthritis or degenerative pathology treatment. Advanced age should not be per se a contraindication for the performance of an arthroplasty. A significant number of older patients have an active life, and may therefore require this type of surgical treatment.

Arthroplasties in the general population relieve or eliminate joint pain and improve the function of the injured joint, and hence have very satisfactory results, with low complication rates and long implant survival. Advanced age can be a determining factor in the evaluation of the clinical and functional situation of patients, applying the necessary measures to reduce the surgical risk. Likewise, the bone tissue in older patients can condition the type of implant, seeking immediate stabilization and anchorage to allow the early resumption of activity. Currently, the use of cemented implants is broadly accepted in older patients. However, other authors have also reported satisfactory results of cementless implants in older patients.

Finally, it will be necessary to bear in mind the social and family situation of each patient at hospital discharge and postoperative follow-up, ensuring the availability of care structures that allow adequate rehabilitation treatment and return to normal life.

In view of the aforementioned, it seems of interest to study the application of joint arthroplasty in the geriatric population.

Prof. Juan F. Blanco
Dr. Carmen da Casa
Collection Editors

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Keywords

older patients
joint arthroplasty
hip
knee
shoulder
joint replacement

Published Papers (7 papers)

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2021

Open AccessArticle

Total Knee Arthroplasty for the Oldest Old

and

Geriatrics 2021, 6(3), 75; https://doi.org/10.3390/geriatrics6030075 - 04 Aug 2021

Cited by 1 | Viewed by 1566

Abstract

The present study describes and compares the early functional results after total knee arthroplasty (TKA) of the oldest-old population (aged over 84 years) and a randomly matched younger septuagenarian cohort so treated. We aimed to evaluate the early functional outcomes after patients’ rehabilitation and the yearly requirements for hospital readmission and emergency room visits after TKA. We noted a similar length of hospital stay for octogenarian and septuagenarian patients, and we determined that both groups of patients were improving ROM (both flexion and extension) after the rehabilitation program (p < 0.05, in all cases), but there were no significant differences between octogenarian and septuagenarian improvement of the knee function (p > 0.05, in all cases). Patients from both age groups behaved similarly in terms of mobility before starting rehabilitation and after completion of the rehabilitation program. We noted that older octogenarian patients showed a higher one-year hospital readmission rate than younger septuagenarian patients, but similar early emergency room visits for both age groups. The findings of this study allow us to conclude that advanced age in itself should not be a contraindication for TKA. Full article

Open AccessArticle

Total Hip Arthroplasty (THA) for Femoral Neck Fractures: Comparison between Standard and Dual Mobility Implants

and

Geriatrics 2021, 6(3), 70; https://doi.org/10.3390/geriatrics6030070 - 07 Jul 2021

Cited by 4 | Viewed by 2747

Abstract

The purpose of this retrospective study is to compare the short-term clinical and radiological results between standard and dual mobility THA for femoral neck fractures (FNF) in older patients. The hypothesis is that the dual mobility cup (DMC) has the same outcomes but a lower dislocation rate than the standard THA. The study population included 56 patients (mean age 77.7 years, range 71–85) that underwent THA for displaced FNF. Patients were divided in two comparable groups for baseline characteristics (age, sex and comorbidities): 28 patients underwent THA with a standard cup (SC) and 28 THA with DMCs. The clinical records and radiograms were reviewed to search relevant data in their postoperative history. Two postoperative dislocations occurred in the SC group and none in the DMC group. At an average follow up of 23 months (12–40), 48 patients were available for the final evaluation. The WOMAC score for all patients averaged 6.26 (0–46) and was slightly better in the DMC group (4.94 vs. 7.58; p-value = 0.41); scores were significantly better in presence of neurological comorbidities (p-value = 0.04), in the absence of diabetes (p-value = 0.04) and in the case of psychiatric disorders (p-value = 0.02). Radiographic evaluation at one year showed signs of osteointegration in 42/48 (87.5%) acetabular components (20 DMCs, 22 SC). According to our experience, DMCs proved to be a valid option for the treatment of displaced FNF in older patients, since it allowed them to achieve short-term outcomes comparable to conventional THA, while decreasing the incidence of postoperative dislocations. Full article

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Open AccessArticle

Total Knee Arthroplasty in Octogenarians: Should We Still Be so Restrictive?

Jose Maria Trigueros-Larrea

Maria Antonia Gonzalez-Bedia

Jose Maria Lomo-Garrote

Oscar Martin-de la Cal

and

Miguel Angel Martin-Ferrero

Geriatrics 2021, 6(3), 67; https://doi.org/10.3390/geriatrics6030067 - 30 Jun 2021

Cited by 7 | Viewed by 2004

Abstract

Demand for total knee arthroplasty (TKA) in octogenarians will increase in subsequent years as society ages. We conducted a retrospective observational study in octogenarians operated on with TKA between 2015 and 2019, comparing preoperative and postoperative Knee Society Score (KSS), Knee Society Function Score (KSFS), extension and flexion balance, and radiologic alignment using a paired Student t-test. A chi-squared test was used to correlate mortality with Charlson comorbidities index score and with ASA scale. Kaplan–Meier analysis was performed to calculate patient survival. In this period 36 patients ≥80 years underwent TKA, with a mean age of 81.6 years. Of these, 24 patients (66.7%) were classified as ASA II and 12 (33.3%) as ASA III. Sixteen patients (44.4%) were Charlson 0, 14 (38.9%) Charlson 1, two (5.6%) Charlson 2, and four (11.1%) Charlson 3. KSS, KSFS, flexion and extension range, and radiologic alignment were statistically significant (p < 0.001) when comparing preoperatory and post-operatory data. No correlation (p > 0.05) was found between mortality and ASA or Charlson score. Seven patients (19.4%) suffered a medical complication and two patients experienced surgical complications. Four patient died (11.1%) during follow-up. The mean patient survival was 67.4 months. Patients ≥80 years achieve clinical improvement after TKA. Comorbidities, not age, are the burden for surgery in older patients. Full article

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Open AccessArticle

Long-Term Results of Joint Arthroplasty with Total Prosthesis for Trapeziometacarpal Osteoarthritis in Patients over 65 Years of Age

Miguel Angel Martin-Ferrero

Jose Maria Trigueros-Larrea

Elsa Martin-de la Cal

Begoña Coco-Martin

and

Clarisa Simon-Perez

Geriatrics 2021, 6(3), 65; https://doi.org/10.3390/geriatrics6030065 - 29 Jun 2021

Cited by 3 | Viewed by 2230

Abstract

Trapeziometacarpal osteoarthritis (TMCOA) is a highly prevalent disease in the older population. Many different types of surgical treatments are possible, depending on the degree of joint involvement, the personal and professional circumstances of the patient and the preferences of the orthopedic surgeon. This paper evaluated the clinical and radiological results of consecutive cohorts of patients over 65 years old treated with total joint arthroplasties (TJA) of the ball and socket type (B&S) for TMCOA, with a minimum of 10 years follow-up. The survival rate (Kaplan–Meier) of the functional prostheses at 10 years was 92.2% (95% CI (89.1%, 96.1%). These functional arthroplasty patients, after 10 years of follow-up, showed little or no pain, good function and good key pinch, without radiological alterations. TJAs of the B&S type are a long lasting, effective and reliable alternative to surgical treatment of TMCOA in patients over 65 years of age, when they are performed with the patient selection criteria and surgical technique described throughout this study. Full article

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Open AccessArticle

Episode-of-Care Costs for Revision Total Joint Arthroplasties by Decadal Age Groups

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Geriatrics 2021, 6(2), 49; https://doi.org/10.3390/geriatrics6020049 - 11 May 2021

Cited by 4 | Viewed by 1871

Abstract

The demand for revision total joint arthroplasties (rTJAs) is expected to increase as the age of the population continues to rise. Accurate cost data regarding hospital expenses for differing age groups are needed to deliver optimal care within value-based healthcare (VBHC) models. The aim of this study was to compare the total in-hospital costs by decadal groups following rTJA and to determine the primary drivers of the costs for these procedures. Time-driven activity-based costing (TDABC) was used to capture granular hospital costs. A total of 551 rTJAs were included in the study, with 294 sexagenarians, 198 septuagenarians, and 59 octogenarians and older. Sexagenarians had a lower ASA classification (2.3 vs. 2.4 and 2.7; p < 0.0001) and were more often privately insured (66.7% vs. 24.2% and 33.9%; p < 0.0001) as compared to septuagenarians and octogenarians and older, respectively. Sexagenarians were discharged to home at a higher rate (85.3% vs. 68.3% and 34.3%; p < 0.0001), experienced a longer operating room (OR) time (199.8 min vs. 189.7 min and 172.3 min; p = 0.0195), and had a differing overall hospital length of stay (2.8 days vs. 2.7 days and 3.6 days; p = 0.0086) compared to septuagenarians and octogenarians and older, respectively. Sexagenarians had 7% and 23% less expensive personnel costs from post-anesthesia care unit (PACU) to discharge (p < 0.0001), and 1% and 24% more expensive implant costs (p = 0.077) compared to septuagenarians and octogenarians and older, respectively. Sexagenarians had a lower total in-hospital cost for rTJAs by 0.9% compared to septuagenarians but 12% more expensive total in-hospital costs compared to octogenarians and older (p = 0.185). Multivariate linear regression showed that the implant cost (0.88389; p < 0.0001), OR time (0.12140; p < 0.0001), personnel cost from PACU through to discharge (0.11472; p = 0.0007), and rTHAs (−0.03058; p < 0.0001) to be the strongest associations with overall costs. Focusing on the implant costs and OR times to reduce costs for all age groups for rTJAs is important to provide cost-effective VBHC. Full article

Open AccessArticle

Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

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Geriatrics 2021, 6(1), 26; https://doi.org/10.3390/geriatrics6010026 - 09 Mar 2021

Cited by 5 | Viewed by 1579

Abstract

The proportion of patients over the age of 90 years continues to grow, and the anticipated demand for total joint arthroplasty (TJA) in this population is expected to rise concomitantly. As the country shifts to alternative reimbursement models, data regarding hospital expenses is needed for accurate risk-adjusted stratification. The aim of this study was to compare total in-hospital costs following primary TJA in octogenarians and nonagenarians, and to determine the primary drivers of cost. This was a retrospective analysis from a single institution in the U.S. We used time-drive activity-based costing (TDABC) to capture granular total hospital costs for each patient. 889 TJA’s were included in the study, with 841 octogenarians and 48 nonagenarians. Nonagenarians were more likely to undergo total hip arthroplasty (THA) (70.8% vs. 42.4%; p < 0.0001), had higher ASA classification (2.6 vs. 2.4; p = 0.049), and were more often privately insured (35.4% vs. 27.8%; p = 0.0001) as compared to octogenarians. Nonagenarians were more often discharged to skilled nursing facilities (56.2% vs. 37.5%; p = 0.0011), experienced longer operating room (OR) time (142 vs. 133; p = 0.0201) and length of stay (3.7 vs. 3.1; p = 0.0003), and had higher implant and total in-hospital costs (p < 0.0001 and 0.0001). Multivariate linear regression showed implant cost (0.700; p < 0.0001), length of stay (0.546; p < 0.0001), and OR time (0.288; p < 0.0001) to be the strongest associations with overall costs. Primary TJA for nonagenarians was more expensive than octogenarians. Targeting implant costs, length of stay, and OR time can reduce costs for nonagenarians in order to provide cost-effective value-based care. Full article

Open AccessArticle

Cemented Dual Mobility Cup for Primary Total Hip Arthroplasty in Elder Patients with High-Risk Instability

José María Lamo-Espinosa

Andrés Valentí-Azcárate

Matías Alfonso-Olmos

Mikel San-Julián

and

Juan Ramón Valentí-Nin

Geriatrics 2021, 6(1), 23; https://doi.org/10.3390/geriatrics6010023 - 07 Mar 2021

Cited by 9 | Viewed by 2318

Abstract

Several studies have shown that double mobility (DM) cups reduce postoperative dislocations. Does the cemented dual mobility cup reduce dislocations in a specific cohort of elder patients with a high dislocation risk? Our hypothesis is that this implant is optimal for elder patients because it reduces early dislocation. We have retrospectively reviewed elder patients who underwent total hip arthroplasty (THA) with cemented double mobility cup between March 2009 and January 2018. The inclusion criteria were patients (>75 years) who were operated on for primary THA (osteoarthritis or necrosis) with a cemented dual mobility cup and a high-risk instability (at least two patient-dependent risk factors for instability). The exclusion criteria were revision surgeries or hip fracture. In all the cases, the same surgical approach was performed with a Watson Jones modified approach in supine position. We have collected demographic data, instability risk factors. Patients were classified using the Devane’s score, Merle d’Aubigné score and the patient’s likelihood of falling with the Morse Fall Scale. Surgical and follow-up complications were collected from their medical history. Sixty-eight arthroplasties (68 patients) were included in the study. The median age was 81.7 years (SD 6.4), and the American Society of Anesthesiologists (ASA) score showed a distribution: II 27.94%, III 63.24% and IV 8.82%. Devane’s score was less than five in all of the cases. At least two patient-dependent risk factors for instability (87% had three or more) were present in each case. The median follow-up time was 49.04 months (SD 22.6). Complications observed were two cases of infection and one case of aseptic loosening at 15 months which required revision surgery. We did not observe any prosthetic dislocation. The cemented dual mobility cup is an excellent surgical option on primary total hip arthroplasties for elder patients with high-risk instability. Full article

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Topical Collection "Joint Arthroplasty in the Oldest People"

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Published Papers (7 papers)

2021

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