Youngest and oldest patients more likely to report pain, lower activity levels following

While all age groups report comparable improvement in range of motion following total knee replacement surgery (TKR), new research presented today at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that patients age 45 and younger, and those age 75 and older, report more pain and less activity following the procedure.

Total knee replacement (TKR) is one of the most popular elective orthopaedic surgeries, with the overall incidence increasing by 120 percent from 2000 to 2009: 188 percent for patients ages 45 to 64, and 89 percent for patients ages 65 to 84.

"Knee replacement is a common, successful surgery in orthopaedics," said Randa Elmallah, MD, lead study author and research fellow working under the supervision of Michael Mont, MD, at Sinai Hospital's Rubin Institute in Baltimore. However, despite comparable clinical results, "some patients are not satisfied, and we are trying to explore the potential reasons why."

In this study, researchers post-operatively reviewed the progress of 278 patients (108 men and 170 women) from seven medical institutions according to five age groups: 45 years and under, ages 45 to 54, 55 to 64, 65 to 74, and 75 years and older. Patients rated their status before the procedure and at different intervals after surgery—range of motion, pain, and activity levels associated with everyday tasks—for up to seven years using several common assessment tools: the Knee Society Scoring system (KSS), Short Form Health Survey (SF-36) and the lower extremity activity scale (LEAS).

All age groups reported improvements in range of motion following surgery, with no significant differences between age groups. In addition:

• Patients age 75 and older reported greater pain at six weeks and one year after surgery.
• The 75 and older and under 45 age groups reported the lowest activity scores at three months, and at five and seven years following surgery.
• At two years post-surgery, patients age 45 to 74 had significantly higher function scores than the 75 and older group and the under 45 group.
• Scores measuring functional health and wellbeing were lowest for patients age 45 and younger.

"Our study points out that surgeons need to thoroughly discuss and manage patient's expectations and recovery, particularly with patients at either end of the age spectrum," said Dr. Mont.