Is there an optimal age for total knee arthroplasty?: A systematic review
Knee Surgery & Related Research volume 32, Article number: 60 (2020)
The purpose of this systematic review was to elucidate the optimal age for patients undergoing total knee arthroplasty (TKA), to optimize the balance between the benefits and risks by analyzing patient-reported outcome measurements (PROM), revision rate, and mortality according to age.
Materials and methods
A rigorous and systematic approach was used and each of the selected studies was evaluated for methodological quality. Data were extracted according to the following: study design, patients enrolled, patient age at the time of surgery, follow-up period, PROM, revision rate, and mortality.
Thirty-nine articles were included in the final analysis. The results were inconsistent in the PROM analysis, but there was consensus that PROM were good in patients in their 70s
. In the revision rate analysis, there was consensus that the revision rate tends to increase in TKA in younger patients, but no significant difference was observed in patients > 70 years of age. In the mortality analysis, there was consensus that the mortality was not significantly different in patients < 80 years of age, but tended to increase with age.
This systematic review shows that the PROM were good when TKA was performed in patients between 70 and 80 years of age; the best PROM could be achieved around 70 years of age, and no significant difference in the revision or mortality rates was observed between 70 and 80 years of age; however, mortality tended to increase with age. Therefore, the early 70s could be recommended as an optimal age to undergo TKA.
Total knee arthroplasty (TKA) is generally accepted as a cost-effective and successful treatment option for end-stage knee osteoarthritis (OA) . The prevalence of OA is expected to increase in the future and the use of TKA will be expanded along with increased life expectancy, emphasis on quality of life, and implant development. Therefore, there is a possibility that this will result in an increased need for TKA. This also raises the possibility of increased uptake of TKA in younger and older patients (“extreme” age groups) [2, 3]. Therefore, TKA in the extreme age groups could proportionally increase as the volume of TKAs performed increases .
TKA can reduce pain and improve patient-reported outcome measures (PROM) and ability to perform activities of daily living. However, TKA can also be accompanied by unexpected complications such as bleeding, acute kidney injury, postoperative delirium, venous thromboembolism, pneumonia, cardiovascular complication, and infection [5,6,7,8,9,10,11,12,13]. High mortality and morbidity are more frequently observed in older patients . Another important consideration in TKA is the longevity of the implants. Long-term survivorship of a TKA implant up to 20 years after surgery was reported as 97.8% . Considering the average age of the patients, there can be increased need of revision TKA in a younger patient due to aseptic loosening, implant wear, and other reasons related to longevity.
Generally, surgeons are concerned about the outcomes after TKA such as PROM, pain reduction, and patient satisfaction. Moreover, surgeons are also concerned about complications. Risk of revision and mortality are the most important considerations in decision-making when performing TKA. In particular, when performing TKA in the extreme age groups, surgeons are concerned about the risk of revision in younger patients and medical comorbidity and mortality in older patients. In recent studies, it is reported that TKA is a good treatment option for knee OA in the extreme age groups, that is for patients age > 90 years or < 55 years [16,17,18,19].
However, the impact of age on patient satisfaction is still debated even though the incidence of TKA uptake among younger (< 55 years) and geriatric (> 80 years) patients is increasing [18, 20]. Some studies have shown good treatment results for TKA even when performed at extreme ages. However, the results of these studies were not analyzed by age [16,17,18, 21]. Therefore, a better understanding of the effect of age on TKA outcomes, considering the balance between the benefits and risks of TKA, can improve the outcome and facilitate better control of patient expectations . The purpose of this systematic review was to elucidate the optimal age for performing TKA that optimizes the balance between the benefits and risks of TKA, by analyzing PROM results, revision rate, and mortality according to age.
Materials and methods
To verify the research question, a rigorous and systematic approach conforming to the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines was used . In phase 1 of the PRISMA search process, selected databases were searched, including the MEDLINE, EMBASE, and Cochrane database (31 March 2019). This systematic review of the available literature was performed using the keywords: “total knee arthroplasty”, “total knee replacement”, “age factor”, “aged”, “young”, “extreme age”, “old”, “octogenarian”, “nonagenarian”, “treatment outcome”, “revision”, “mortality”, in several combinations. The citations in the included studies were screened, and unpublished articles were also checked with a manual search using Google Scholar. The bibliographies of the relevant articles were subsequently cross-checked for articles not identified in the search. In phase 2, abstracts and titles were screened for relevance. In phase 3, the full text of the selected studies was reviewed according to the inclusion criteria and methodological appropriateness was determined using a predetermined question. In phase 4, the studies were systematically reviewed, if appropriate.
Studies meeting the following criteria were included: (1) studies on TKA, (2) articles written in English, (3) articles with full text available, (4) human in vivo studies, (5) articles including PROM or revision rate or mortality, and (6) comparative study of results according to age. The exclusion criteria were the following: (1) not related to TKA, 2) no direct comparison according to age category, (3) published before 2000, (4) not a clinical study (review article), (5) TKA not performed for treatment of OA, (6) simultaneous evaluation of TKA and total hip arthroplasty, and (7) not a comparison study by age.
Each of the selected studies was evaluated for methodological quality by two independent authors. Data were extracted using the following standardized protocol: first author, publication year, publication journal, study type, number of cases, age of the patient at the time of surgery, follow-up period, PROM, revision rate, and mortality, among others. The extracted data were then cross-checked for accuracy, and any disagreements were settled by a third author.
The methodological quality of the studies was assessed using the modified Coleman criteria (Additional file 1) . The modified Coleman criteria have a scaled potential score ranging from 0 to 100. Scores of 85–100 are considered excellent, 70–84 good, 55–69 fair, and < 55 poor. The criteria are used to assess the quality of surgical studies.
The initial electronic search yielded 3337 articles. After removing duplicate studies, and applying the inclusion and exclusion criteria, 39 articles were included in the final analysis. Some articles were studies based on registry data, some involved retrospective cohorts, some enrolled prospective cohorts, and some were case-control studies. The PRISMA flow chart is shown in Fig. 1.
The quality of all articles was assessed using the modified Coleman criteria . The studies included and the modified Coleman criteria scores are presented in Table 1. The average modified Coleman criteria score of the studies we analyzed was 56.7, and the scores were good in 3 of the studies, fair in 20 studies, and poor in 16 studies.
Twenty-two of the studies reviewed provided data based on PROM outcomes. The results were inconsistent and are presented in Table 2. Among the 22 studies, age was not related to PROM in 9 studies but differed according to age in another 9 studies.
In studies where no differences in PROM were reported, patients age 75, 80, and 85 years were used as age-related references [33, 35, 40, 44, 48, 50, 53]. PROM were compared in regression analysis in another two studies, and the authors reported no age-related differences [31, 47].
Among the nine studies in which PROM differed according to age, two studies reported that better PROMs were achieved after TKA in older patients [29, 54] and five studies reported that younger patients had better PROM after TKA [26, 28, 36, 57, 60]. However, the baseline age of the patients was 80 years in two of the studies, and in one study the patients’ limitation of activity increased fourfold over the age of 80 years, and it was difficult to compare the differences in PROM in patients age < 80 years. In two studies only, regression analysis showed that physical activity decreased as age increased [28, 36]. Pitta et al.  reported that the best PROM was achieved at 68 years of age, and Elmallah et al.  reported that the effects of age on Knee Society scores, the Short Form-36 findings, and the lower extremity activity scale were different.
Four studies reported outcomes in the extreme age groups. In the very oldest patients, only one study reported on PROM after TKA: there was no difference between nonagenarians and younger patients in the degree of improvement in PROM . In the very youngest patients, three studies reported PROM after TKA; in all three there was a relatively smaller improvement in clinical outcome in patients < 55 years of age [19, 27, 32].
Nine studies in this review provided data on revision rates, and the results are presented in Table 3. Eight studies reported that younger patients were more likely to undergo revision until death, and one study reported no difference in revision rates according to age [24, 30, 38, 41, 45, 49, 55, 56].
The baseline age of the patients was 65 years in four studies, and high revision rates were reported in the younger group in these studies [38, 41, 45, 49]. Similar results were reported in another study in which the baseline age of the patients was 55 years. Bayliss et al.  also reported that the younger age group had higher revision rates, with the lowest implant survival rates seen in patients in their 50s at the time of index surgery and decrease in revision rates seen after 70 years of age. Meehan et al.  reported that the revision rate was 4.7 times higher in patients < 50 years of age, and 2.1 times higher in patients 50–64 years of age compared to that noted in patients > 65 years of age. Julin et al.  also reported that the revision rate was 5 times higher in patients < 55 years of age and 2 times higher in patients 55–64 years of age compared to that noted in patients > 65 years of age. Wainwright et al.  reported that patients < 50 years of age at the time of surgery have a greater chance of requiring revision surgery than of dying, and those around the age of 58 years have a 50:50 chance of requiring revision. In addition to group comparisons, Namda et al.  reported a 38% reduction in revision rates with every 10-year increase in age.
Only one study reported no significant difference in revision rates between patients < 55 and ≥ 55 years of age . However, the median follow-up period was 12 years, therefore, the revision rates thereafter could not be confirmed.
Mortality outcomes are presented in Table 4. Fourteen studies in this review provided data on mortality. Among the 14 studies, 12 reported high mortality rates in older patients, whereas 2 studies reported no difference in mortality rates according to age or that younger patients had increased mortality.
Mortality among patients > 90 years of age was reported in three studies [37, 39, 43]. Two studies reported higher mortality rates in this age group than that in the control group [39, 43], but in another study, mortality rates were higher in the nonagenarian group; however, these were in accordance with life expectancy projections identified by the Office for National Statistics .
In four studies, there was an increase in mortality rates with age [42, 52], but there was a sharp rise at around 85 years of age [46, 51]. In three studies, the mortality rate in patients ≥ 80 years of age was higher than that in the control groups [48, 59, 60]. In another study, the mortality rate in patients ≥ 65 years of age was higher than that in patients < 65 years of age .
The purpose of this study was to elucidate the optimal age to perform TKA when considering PROM, revision rate, and mortality factors. Based on several studies, the principal findings were as follows: (1) there was no significant difference in the PROM before the age of 80 years, and it is best to perform TKA around 70 years of age; (2) there was no significant difference in the TKA revision rate in patients older than 70 years, but the rate tended to decrease with age; and (3) there was no significant difference in mortality at the age of 80 years, but it tended to increase with age. Therefore, it is considered that TKA should be performed in patients in their early 70s because the PROM would be relatively good, the revision rate would not increase, and the risk of mortality would not be high.
In terms of PROM, the effects of age were inconsistent. Some studies reported that age was not related to PROM, while some reported that older patients have better PROM, and other studies reported the opposite. In addition, some studies reported a relationship between age and PROM, but it was not a linear relationship. However, the age standard was around the 70s in studies that reported that older patients have better PROM and around the 80s in studies that reported that younger patients have better PROM. In a study that found no linear relationship, the best PROM were reported in patients in their 70s. Therefore, there was consensus that PROM were good between 70 and 80 years of age and the best PROM could be achieved in patients in their 70s. Even among the very oldest patients, those > 90 years of age also had good PROM; however, this age range was not considered to be optimal for performing TKA [17, 18]. A previous meta-analysis showed good results even among patients < 55 years of age, but this study did not compare the results according to age.
Most studies were consistent on revision rates, showing mostly that the younger the patient at the time of TKA, the greater is the probability of revision during their lifetime, and most studies compared the revision rate based on 65 or 70 years of age as the reference standard. Therefore, there was consensus that the revision rate tends to increase in younger patients, but there is no significant difference in patients > 70 years of age.
Most studies were consistent on mortality, showing mostly that the older the patient at the time of TKA, the higher is the risk of mortality. Most studies that reported high mortality rates in older patients used the 90s or 80s as the standard age. Only one study compared mortality at the age of 65 years. Some studies did not show an increased mortality rate among these patients in contrast to that in the general population; one study reported that younger patients have higher risk of mortality compared to older patients, but this may be due to selection bias [37, 58]. Therefore, there was consensus that the mortality rate was not significantly different at 80 years of age, but tended to increase with age. In summary, TKA performed between the ages of 70 and 80 years has the best outcome. With respect to mortality, it would be better to perform TKA when the patients are younger. Therefore, the authors of these studies believe that from 70 to 80 years of age is the optimal range for undergoing TKA.
There are many factors that are influenced by age when performing TKA. Older age is the predictive factor for postoperative pneumonia and for postoperative delirium after TKA [8, 61,62,63]. Some studies report that the risk of infection is high in older patients [45, 64]. The transfusion rate and ICU care are also age-related factors [9, 12, 13, 65]. These complications should also be considered in determining when to perform TKA. In general, however, PROM, revision rate, and mortality are the most common considerations in determining when to perform TKA by considering the patients age. The strength of this study is that the authors only considered patient benefit, revision risk, and mortality when evaluating the outcomes of TKA according to the patient’s age.
This study has several limitations. First, there have been many studies using registry data; however, only some small cohort or comparative study was included. However, the results of these studies were mostly consistent. Second, meta-analysis was not performed due to differences in the age-related criteria used in the studies. Nonetheless, this did not influence the results significantly, because we did not analyze the exact age, but the age-related trends. Third, the possibility of errors due to different follow-up duration and PROM measurement indices in each study cannot be ignored. Fifth, life expectancy differs in each country, and thus, comparison of the results based on specific country may not be possible. Furthermore, we did not take into account the increase in life expectancy, which is another limitation of this study.
This systematic review shows that the PROM were good when TKA was performed in patients between 70 and 80 years of age; the best PROM could be achieved around 70 years of age, and no significant difference in the revision rate and mortality rate was observed between 70 and 80 years of age; however, mortality after TKA tended to increase with age. Therefore, the early 70s could be recommended as an optimal age to undergo TKA.
Availability of data and materials
All data generated or analyzed during this study are included in this published article.
Patient-reported outcome measures
Total knee arthroplasty
Jones CA, Beaupre LA, Johnston DW, Suarez-Almazor ME (2005) Total joint arthroplasties: current concepts of patient outcomes after surgery. Clin Geriatr Med 21:527–541 vi
Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 87:1487–1497
Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, Beard DJ (2012) Knee replacement. Lancet 379:1331–1340
Christensen K, Doblhammer G, Rau R, Vaupel JW (2009) Ageing populations: the challenges ahead. Lancet 374:1196–1208
Petersen PB, Kehlet H, Jorgensen CC (2018) Myocardial infarction following fast-track total hip and knee arthroplasty-incidence, time course, and risk factors: a prospective cohort study of 24,862 procedures. Acta Orthop 89:603–609
Plante S, Belzile EL, Frechette D, Lefebvre J (2017) Analysis of contributing factors influencing thromboembolic events after total knee arthroplasty. Can J Surg 60:30–36
Petersen PB, Jørgensen CC, Kehlet H, Madsen F, Hansen TB, Husted H, Laursen MB, Hansen LT, Kjærsgaard-Andersen P, Solgaard S (2017) Delirium after fast-track hip and knee arthroplasty – a cohort study of 6331 elderly patients. Acta Anaesthesiol Scand 61:767–772
Huang J, Razak HRBA, Yeo SJ (2017) Incidence of postoperative delirium in patients undergoing total knee arthroplasty - an Asian perspective. Ann Transl Med 5
Courtney PM, Melnic CM, Gutsche J, Hume EL, Lee GC (2015) Which patients need critical care intervention after total joint arthroplasty? : a prospective study of factors associated with the need for intensive care following surgery. Bone Joint J 97-b:1512–1518
Markovic-Denic L, Zivkovic K, Lesic A, Bumbasirevic V, Dubljanin-Raspopovic E, Bumbasirevic M (2012) Risk factors and distribution of symptomatic venous thromboembolism in total hip and knee replacements: prospective study. Int Orthop 36:1299–1305
Sehgal V, Bajwa SJS, Sehgal R, Eagan J, Reddy P, Lesko SM (2014) Predictors of acute kidney injury in geriatric patients undergoing total knee replacement surgery. Int J Endocrinol Met 12
Frisch NB, Wessell NM, Charters MA, Yu S, Jeffries JJ, Silverton CD (2014) Predictors and complications of blood transfusion in total hip and knee arthroplasty. J Arthroplasty 29:189–192
Hart A, Khalil JA, Carli A, Huk O, Zukor D, Antoniou J (2014) Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am 96:1945–1951
Murphy BPD, Dowsey MM, Choong PFM (2018) The impact of advanced age on the outcomes of primary total hip and knee arthroplasty for osteoarthritis: a systematic review. JBJS Rev 6:e6
Ritter MA (2009) The Anatomical Graduated Component total knee replacement: a long-term evaluation with 20-year survival analysis. J Bone Joint Surg Brit 91:745–749
Mont MA, Lee CW, Sheldon M, Lennon WC, Hungerford DS (2002) Total knee arthroplasty in patients </=50 years old. J Arthroplast 17:538–543
Berend ME, Thong AE, Faris GW, Newbern G, Pierson JL, Ritter MA (2003) Total joint arthroplasty in the extremely elderly: hip and knee arthroplasty after entering the 89th year of life. J Arthroplast 18:817–821
Pagnano MW, McLamb LA, Trousdale RT (2004) Total knee arthroplasty for patients 90 years of age and older. Clin Orthop Relat Res 2004;(418)179–183
Clement ND, Walker LC, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ (2018) Patient age of less than 55 years is not an independent predictor of functional improvement or satisfaction after total knee arthroplasty. Arch Orthop Trauma Surg 138:1755–1763
Shah SH, Schwartz BE, Schwartz AR, Goldberg BA, Chmell SJ (2017) Total knee arthroplasty in the younger patient. J Knee Surg 30:555–559
Aujla RS, Esler CN (2017) Total knee arthroplasty for osteoarthritis in patients less than Fifty-five years of age: a systematic review. J Arthroplasty 32:2598–2603 e2591
Swarup I, Henn CM, Gulotta LV, Henn RF 3rd (2019) Patient expectations and satisfaction in orthopaedic surgery: a review of the literature. J Clin Orthop Trauma 10:755–760
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012
Jorgensen NB, McAuliffe M, Orschulok T, Lorimer MF, de Steiger R (2019) Major aseptic revision following total knee replacement: a study of 478,081 total knee replacements from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 101:302–310
Pitta M, Khoshbin A, Lalani A, Lee LY, Woo P, Westrich GH, Lyman S (2019) Age-related functional decline following total knee arthroplasty: risk adjustment is mandatory. J Arthroplasty 34:228–234
Yun ST, Kim BK, Ahn BM, Oh KJ (2018) Difference in the degree of improvement in patient-reported outcomes after total knee arthroplasty between octogenarians and sexagenarians: a propensity score matching analysis. Aging Clin Exp Res 30:1379–1384
Lange JK, Lee YY, Spiro SK, Haas SB (2018) Satisfaction rates and quality of life changes following total knee arthroplasty in age-differentiated cohorts. J Arthroplast 33:1373–1378
Naylor JM, Pocovi N, Descallar J, Mills KA (2019) Participation in regular physical activity after total knee or hip arthroplasty for osteoarthritis: prevalence, associated factors, and type. Arthritis Care Res 71:207–217
Townsend LA, Roubion RC, Bourgeois DM, Leonardi C, Fox RS, Dasa V, Pollock GR (2018) Impact of age on patient-reported outcome measures in total knee arthroplasty. J Knee Surg 31:580–584
Bayliss LE, Culliford D, Monk AP, Glyn-Jones S, Prieto-Alhambra D, Judge A, Cooper C, Carr AJ, Arden NK, Beard DJ, Price AJ (2017) The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet 389:1424–1430
Escobar A, Garcia Perez L, Herrera-Espineira C, Aizpuru F, Sarasqueta C, Gonzalez Saenz de Tejada M, Quintana JM, Bilbao A (2017) Total knee replacement: are there any baseline factors that have influence in patient reported outcomes? J Eval Clin Pract 23:1232–1239
Haynes J, Sassoon A, Nam D, Schultz L, Keeney J (2017) Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty. Knee 24:663–669
Sveikata T, Porvaneckas N, Kanopa P, Molyte A, Klimas D, Uvarovas V, Venalis A (2017) Age, sex, body mass index, education, and social support influence functional results after total knee arthroplasty. Geriatr Orthop Surg Rehabil 8:71–77
Elmallah RD, Jauregui JJ, Cherian JJ, Pierce TP, Harwin SF, Mont MA (2016) Effect of age on postoperative outcomes following total knee arthroplasty. J Knee Surg 29:673–678
Lizaur-Utrilla A, Martinez-Mendez D, Miralles-Munoz FA, Marco-Gomez L, Lopez-Prats FA (2017) Comparable outcomes after total knee arthroplasty in patients under 55 years than in older patients: a matched prospective study with minimum follow-up of 10 years. Knee Surg Sport Traumatol Arthrosc 25:3396–3402
Razak HRBA, Tan CS, Chen YJD, Pang HN, Darren Tay KJ, Chin PL, Chia SL, Lo NN, Yeo SJ (2016) Age and preoperative knee society score are significant predictors of outcomes among asians following total knee arthroplasty. J Bone Joint Surg Am 98:735–741
Skinner D, Tadros BJ, Bray E, Elsherbiny M, Stafford G (2016) Clinical outcome following primary total hip or knee replacement in nonagenarians. Ann R Coll Surg Engl 98:258–264
Callaghan JJ, Martin CT, Gao Y, Pugely AJ, Liu SS, Goetz DD, Kelley SS, Johnston RC (2015) What can be learned from minimum 20-year followup studies of knee arthroplasty? Clin Orthop Relat Res 473:94–100
Jauregui JJ, Boylan MR, Kapadia BH, Naziri Q, Maheshwari AV, Mont MA (2015) Total joint arthroplasty in nonagenarians: what are the risks? J Arthroplast 30:2102–2105 e2101
Maempel JF, Riddoch F, Calleja N, Brenkel IJ (2015) Longer hospital stay, more complications, and increased mortality but substantially improved function after knee replacement in older patients. Acta Orthop 86:451–456
Shin CH, Chang CB, Cho SH, Jeong JH, Kang SB (2015) Factors associated with the incidence of revision total knee arthroplasty in Korea between 2007 and 2012: an analysis of the National Claim Registry. BMC Musculoskelet Disord 16:320
Belmont PJ Jr, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ (2014) Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am 96:20–26
D'Apuzzo MR, Pao AW, Novicoff WM, Browne JA (2014) Age as an independent risk factor for postoperative morbidity and mortality after total joint arthroplasty in patients 90 years of age or older. J Arthroplast 29:477–480
Kuo FC, Hsu CH, Chen WS, Wang JW (2014) Total knee arthroplasty in carefully selected patients aged 80 years or older. J Orthop Surg Res 9:61
Meehan JP, Danielsen B, Kim SH, Jamali AA, White RH (2014) Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty. J Bone Joint Surg Am 96:529–535
Easterlin MC, Chang DG, Talamini M, Chang DC (2013) Older age increases short-term surgical complications after primary knee arthroplasty. Clin Orthop Relat Res 471:2611–2620
Hamilton DF, Lane JV, Gaston P, Patton JT, Macdonald D, Simpson AH, Howie CR (2013) What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement. BMJ Open 2013;3(4):e002525
Kennedy JW, Johnston L, Cochrane L, Boscainos PJ (2013) Total knee arthroplasty in the elderly: does age affect pain, function or complications? Clin Orthop Relat Res 471:1964–1969
Namba RS, Cafri G, Khatod M, Inacio MC, Brox TW, Paxton EW (2013) Risk factors for total knee arthroplasty aseptic revision. J Arthroplast 28:122–127
Williams DP, Price AJ, Beard DJ, Hadfield SG, Arden NK, Murray DW, Field RE (2013) The effects of age on patient-reported outcome measures in total knee replacements. Bone Joint J 95-b:38–44
Jamsen E, Puolakka T, Eskelinen A, Jantti P, Kalliovalkama J, Nieminen J, Valvanne J (2013) Predictors of mortality following primary hip and knee replacement in the aged. A single-center analysis of 1,998 primary hip and knee replacements for primary osteoarthritis. Acta Orthop 84:44–53
Singh JA, Lewallen DG (2012) Ninety-day mortality in patients undergoing elective total hip or total knee arthroplasty. J Arthroplast 27:1417–1422 e1411
Clement ND, MacDonald D, Howie CR, Biant LC (2011) The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more. J Bone Joint Surg Brit 93:1265–1270
Merle-Vincent F, Couris CM, Schott AM, Conrozier T, Piperno M, Mathieu P, Vignon E (2011) Factors predicting patient satisfaction 2 years after total knee arthroplasty for osteoarthritis. Joint Bone Spine 78:383–386
Wainwright C, Theis JC, Garneti N, Melloh M (2011) Age at hip or knee joint replacement surgery predicts likelihood of revision surgery. J Bone Joint Surg Brit 93:1411–1415
Julin J, Jamsen E, Puolakka T, Konttinen YT, Moilanen T (2010) Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis. A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthop 81:413–419
Singh JA, O'Byrne M, Harmsen S, Lewallen D (2010) Predictors of moderate-severe functional limitation after primary total knee arthroplasty (TKA): 4701 TKAs at 2-years and 2935 TKAs at 5-years. Osteoarthr Cartil 18:515–521
Robertsson O, Stefansdottir A, Lidgren L, Ranstam J (2007) Increased long-term mortality in patients less than 55 years old who have undergone knee replacement for osteoarthritis: results from the Swedish Knee Arthroplasty Register. J Bone Joint Surg Brit 89:599–603
Kreder HJ, Berry GK, McMurtry IA, Halman SI (2005) Arthroplasty in the octogenarian: quantifying the risks. J Arthroplast 20:289–293
Murphy BPD, Dowsey MM, Spelman T, Choong PFM (2018) The impact of older age on patient outcomes following primary total knee arthroplasty. Joint Bone Spine 100-b:1463–1470
Bohl DD, Saltzman BM, Sershon RA, Darrith B, Okroj KT, Della Valle CJ (2017) Incidence, risk factors, and clinical implications of pneumonia following total hip and knee arthroplasty. J Arthroplast 32:1991–1995 e1991
Chen W, Ke X, Wang X, Sun X, Wang J, Yang G, Xia H, Zhang L (2017) Prevalence and risk factors for postoperative delirium in total joint arthroplasty patients: a prospective study. Gen Hosp Psychiatry 46:55–61
Petersen PB, Kehlet H, Jørgensen CC, Madsen F, Hansen TB, Husted H, Laursen MB, Hansen LT, Kjærsgaard-Andersen P, Solgaard S, Krarup NH (2019) Incidence and risk factors for stroke in fast-track hip and knee arthroplasty—a clinical registry study of 24,862 procedures. J Arthroplasty 2019;34(4):743-749.e2
Bohl DD, Sershon RA, Fillingham YA, Della Valle CJ (2016) Incidence, risk factors, and sources of sepsis following total joint arthroplasty. J Arthroplast 31:2875–2879 e2872
AbdelSalam H, Restrepo C, Tarity TD, Sangster W, Parvizi J (2012) Predictors of intensive care unit admission after total joint arthroplasty. J Arthroplast 27:720–725
There was no funding source.
Ethics approval and consent to participate
This is a systematic review article and Institutional Review Board approval was waived.
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Lee, S.H., Kim, D.H. & Lee, Y.S. Is there an optimal age for total knee arthroplasty?: A systematic review. Knee Surg & Relat Res 32, 60 (2020). https://doi.org/10.1186/s43019-020-00080-1
- Total knee arthroplasty
- Patient-reported outcome measurement