Is Anyone Too Old for a Total Knee Replacement?

The decision on whether to perform a total knee replacement in extremely elderly patients is controversial. To assess the influence of age as an independent factor for early postoperative morbidity and mortality, we did a case-control study comparing a group of 22 patients 85 years or older that was matched for known predictive factors of nonsurgical postoperative complications with a younger control group. Both groups received the same perioperative and postoperative management. We then compared the number of postoperative complications. Standardized mortality ratios were performed to assess the influence of knee replacement on mortality. The 11 patients (50%) in the elderly group had one or more medical complications, which was similar to those of the five patients (23%) in the control group. Mortality in the elderly group who had knee replacements was almost ½ that of the general population (standardized mortality ratio, 0.53). We think age should not be a limitation for total knee replacements in elderly patients, although they should be given consideration for special care while in the hospital.

Level of Evidence: Therapeutic study, Level III (Case control study). See the Guidelines for Authors for a complete description of levels of evidence.