Patients under 40 at higher risk of complications after knee replacement surgery

LAS VEGAS: A recent study has found that younger patients have a higher risk of complications from total knee replacement (TKA) compared with older patients. The study is significant as TKA is increasingly being performed in younger patients.

The findings were reported at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting in Las Vegas.

"The number of knee replacements we are doing in younger and younger patients keeps increasing every year and we need to let these patients know that their failure rate is potentially higher," Dr. Mark Figgie, an orthopedic surgeon at the Hospital for Special Surgery in New York, told Reuters Health.

The researchers compared early complication rates and revisions between seven age groups spanning younger than age 40 up to age 90 and older undergoing primary TKA using a national insurance database. the analysis involved 114,698 patients.

Key findings of the study include:

• Patients younger than 40 had higher rates of diabetes, inflammatory arthritis, and drug abuse, and were more likely to smoke, compared to the rest of the cohort.


• After controlling for baseline comorbid conditions, patients younger than 40 and those aged 40 to 49 had an increased rate of early mechanical complications.


• Readmission rates at 90 days were also significantly higher in patients younger than age 40, as well as those over age 90.


• Patients under 40 years of age were more apt to need early revision surgery. The revision-free rate at five years was 77% in those younger than age 40, compared with 89% in those 40 to 49, and 92% in those 50 to 59.

"These outcomes may be used to shape preoperative counseling for the young patient," wrote the researchers.

"The younger patients tend have more challenging problems. They are heavier, more diabetics, more inflammatory arthritis, more failed ACL reconstructions, so previous surgery. Younger patients didn't have a higher infection rate; mechanical problems and early failure were the biggest issues," Dr. Figgie commented.