Abstract
An increasing number of total knee replacements (TKRs) are being performed in response to the growing burden of osteoarthritis. Patients <65 years of age represent the fastest growing group of TKR recipients and are expected to account for an increasing number of primary and revision procedures. Concerns have been raised about the outcomes that can be expected by this age demographic who are more active, physically demanding, and have longer life expectancies compared to older TKR recipients. This systematic review and meta-analysis evaluated the effectiveness of TKR for osteoarthritis in patients <65 years of age, compared to older individuals. A systematic search of Embase and Medline was conducted to identify studies which examined patient-reported outcomes measured using disease-specific and generic health-related quality of life instruments. Ten studies met our inclusion criteria and were included in this review. These studies comprised 1747 TKRs performed between 1977 and 2014. In the meta-analysis of two prospective studies (288 TKRs), patients <65 years of age were able to attain large and clinically meaningful improvements in pain, function, and quality of life. One of these studies (61 TKRs) suggested that patients <55 years of age attained a larger degree of improvement compared to older individuals. Results into the second postoperative decade were less certain, with some data suggesting a high prevalence of pain and patterns of functional decline. Further research is required to investigate longer-term outcomes following TKR for osteoarthritis in younger patients.
Highlights
Total knee replacement (TKR) remains a successful and effective procedure in the treatment of knee osteoarthritis [1]
The findings of this review suggest that younger patients attain clinically meaningful improvements exceeding minimal clinically important difference (MCID) across patient-reported pain, function, and quality of life following TKR for osteoarthritis
We suggest that due consideration should be provided to alternative strategies that can address symptoms and potentially delay the need for arthroplasty until later stages where outcomes are more predictable and the lifetime risk of revision is lowered
Summary
Total knee replacement (TKR) remains a successful and effective procedure in the treatment of knee osteoarthritis [1]. As the osteoarthritis burden grows, an increasing number of TKRs are being performed; high-volume countries like the United States are projecting nearly 3.5 million procedures for the year 2030 [2]. The excellent pain, function, and quality of life outcomes reported in the literature have mostly related to older and less active patient populations, and may not translate to younger patients [8]. Given these complex considerations, the decision to perform TKR in younger patients should be fully informed by an understanding of the risk-benefit profile of the procedure, ensuring that this procedure is able to meet patient expectations (performance and longevity) in terms of what can be realistically achieved through surgery
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