Younger knee replacement patients have more complications

(Reuters Health) - Total knee replacement is increasingly being performed in younger people, and new research suggests younger patients have higher complication rates.

“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, orthopaedic surgeon at the Hospital for Special Surgery in New York, told Reuters Health in a phone interview.

Figgie and colleagues reported their observations March 12 at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting in Las Vegas.

Using a national insurance database, they compared early complication rates and reoperations in seven age groups, from younger than age 40 up to age 90 and older. The analysis included 114,698 patients having knee replacement surgery for the first time.

Diabetes, inflammatory arthritis, smoking and drug abuse were all more common in patients under age 40, compared to the rest of the patients.

After everyone’s medical problems had been taken into account, patients younger than 40 and those ages 40 to 49 had almost three times the risk of early mechanical complications as everyone else. People under age 40 were also 63 percent more likely than other patients to need rehospitalization within 90 days.

In addition, patients under age 40 were more apt to need revision surgery within five years.

“These outcomes may be used to shape preoperative counseling for the young patient,” the investigators suggest.

“The younger patients tend have more challenging problems. They are heavier, more diabetics, more inflammatory arthritis, more failed ACL reconstructions,” Figgie commented.

“Younger patients didn’t have a higher infection rate,” he noted. “Mechanical problems and early failure were the biggest issues.”

SOURCE: American Academy of Orthopaedic Surgeons 2019.