The mortality, morbidity and cost benefits of elective total knee arthroplasty in the nonagenarian population

With the increasing life expectancy, a greater number of elderly patients are being referred to an orthopaedic department to have elective total knee arthroplasty (TKA). Total knee arthroplasty should be considered in the very elderly only after carefully balancing the benefits of surgery against the risks of surgery. The aim of this study was to analyse the mortality, morbidity and cost benefits of elective TKA in a cohort group of the nonagenarian population. Between 1990 and 2006, 42 patients ≥90 years of age had TKA surgery. Patient’s notes were retrospectively analysed. A cost-benefit analysis was carried out by comparing the surgical costs against nursing home placement. The mean age at surgery was 90.4 years (range: 90–90.6). There was one major and 11 minor postoperative complications with no immediate or late postoperative deaths. The Knee Society Scores improved from 25 points (range: 8–44) to 81 points (range: 60–95), and the WOMAC Scores improved from 62 points (range: 54–73) to 41 points (range: 34–46) (p < 0.002). The calculated cost-benefit savings for 42 patients at 5 years after TKA was estimated to be £2,746,839. Total knee arthroplasty in the nonagenarian population is safe, beneficial and cost-effective.