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다국어 초록 (Multilingual Abstract)

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.
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.
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).
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.IV

참고문헌 (Reference)

1 송상준, "What to Know for Selecting Cruciate-Retaining or Posterior-Stabilized Total Knee Arthroplasty" 대한정형외과학회 11 (11): 142-150, 2019

2 Giesinger JM, "WOMAC, EQ-5D and Knee Society score thresholds for treatment success after total knee arthroplasty" 30 (30): 2154-2158, 2015

3 Pagnano MW, "Total knee arthroplasty for patients 90 years of age and older" 418 : 179-183, 2004

4 Rubin LE, "Total hip and knee arthroplasty in patients older than age 80 years" 24 (24): 683-690, 2016

5 Yang CC, "The age-adjusted Charlson comorbidity index is a better predictor of survival in operated lung cancer patients than the Charlson and Elixhauser comorbidity indices" 53 (53): 235-240, 2018

6 Lizaur-Utrilla A, "Ten-year mortality risk predictors after primary total knee arthroplasty for osteoarthritis" 23 (23): 1848-1855, 2015

7 Bovonratwet P, "Revision total knee arthroplasty in octogenarians : an analysis of 957 cases" 33 (33): 178-184, 2018

8 Bin Abd Razak HR, "Postoperative delirium in patients undergoing total joint arthroplasty : a systematic review" 30 (30): 1414-1417, 2015

9 Fehring TK, "Mortality following revision joint arthroplasty: is age a factor?" 33 (33): 715-, 2010

10 Bae DK, "Mid-term survival analysis of closed wedge high tibial osteotomy : a comparative study of computerassisted and conventional techniques" 23 (23): 283-288, 2016