The Long-term Results of Total Knee Arthroplasty in Octogenarian

The Long-term Results of Total Knee Arthroplasty in Octogenarian | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Long-term Results of Total Knee Arthroplasty in Octogenarian Rex Wang-Fung Mak, Wai-Wang Chau, Kwong-Yin Chung, Kwok-Hing Chiu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-152940/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Sep, 2021 Read the published version in Journal of Orthopaedic Surgery → Version 1 posted You are reading this latest preprint version Abstract Background : With increasing life expectancy and aging population, more octogenarians would benefit from total knee arthroplasty (TKA). The aim of this study is to evaluate the survivorship of TKA in octogenarian and their long-term outcomes. Methods : This was a retrospective review of 67 patients aged above 80 years who had primary TKA performed between 2005-2013 at a single centre. A sex-matched younger cohort of 67 primary TKAs during the same time-period was recruited for control. 5- and 10-year survival was calculated. Pre- and peri-operative factors were collected and compared. Post-operative range of motion, Knee Society Score (KSS) and Function Score (KFS) were collected and compared. Rate of revision, infection, aseptic loosening and mortality was collected. Results : The mean follow-up period was 10.39±2.29 years. The 5- and 10- year survival of octogenarian group was 85.1% and 54.6% respectively. Pre- and peri-operative factors between the octogenarian and control groups were comparable (p>0.05). Both groups showed improvement in range of motion, KSS and KFS post-operatively. Rate of revision, aseptic loosening and deep infection was 0% in octogenarian and 1.5% in control group. Conclusions : TKA can be performed in patients with age above 80 years old with comparable post-op knee range, complication rate and long-term functional score. Advanced age should not be a limiting factor for TKA. Geriatrics & Gerontology total knee arthroplasty long term survivorship octogenarian Figures Figure 1 Figure 2 Background Osteoarthritis (OA) of the knee is a common disease globally. The lifetime risk of developing symptomatic knee OA is estimated to be up to 47%, which further increases after the age of 60[ 1 ]. Total knee arthroplasty (TKA) is effective treatment for treating patients with end-stage osteoarthritis of the knee[ 2 – 4 ]. In the US alone, more than 600,000 TKA were performed in 2010[ 5 ]. According to local published statistics in 2017, the elderly (age > 65) is expected to increase from 16% of the total population in 2016 to 29% by 2036[ 6 ]. This aging population are expected to present with symptomatic knee OA indicated for TKA. Due to increasing age and medical morbidities, TKAs in octogenarian have been shown to be associated with higher post-operative complications, mortality and longer length of stay in comparison with younger patients[ 7 – 9 ]. At the same time, patients aged 80 and over would still benefit greatly from the improved pain, function and quality of life. This has been well supported by current literature regarding short term benefit[ 10 – 15 ], however mid- to long-term results of TKA in octogenarian has been scarcely reported. This study aims to compare the safety and outcomes of TKA in the octogenarian population. Methods Ethics approval was obtained from the Research Ethics Review Board (CREC Ref. No. 2015.433). All methods in the study were carried out in accordance with the Helsinki guidelines and declaration or any other relevant guidelines. This was a retrospective review of all patients aged 80 years old and above who underwent elective TKA between December 2005 and August 2013 in the orthopaedic unit of a tertiary hospital. The data for this study were retrieved from the electronic record system from the hospital. Pre-operative, peri-operative and post-operative factors were collected. A sex-matched group of patients aged 70–80 years, from a total of 950 TKAs performed within the same period, was selected as a comparison. Pre-operative factors included comorbidities, indications of surgery (e.g. OA, rheumatoid arthritis, post-traumatic arthritis, etc), Knee Society Score (KSS) and Functional Score (KFS), age at time of surgery, history of knee surgery, steroid usage, smoking status, pre-op knee range and fixed flexion deformity. Peri-operative factors included the type of anaesthesia, American Society of Anaesthesiologists (ASA) grading, the model of implant, duration of surgery, length of stay (LOS), ambulatory status on discharge and discharge status (direct home or to convalescence). Post-operative factors included implant survivorship, KSS and KFS, range of motion, Charnley Functional Score[ 16 ], as well as rate of revision, infection or aseptic loosening. Intra- and post-operative complications were also recorded and divided into major and minor complications. Major complications included deep infection of implant, vascular injury, myocardial infarction, fast atrial fibrillation, stroke, pulmonary embolism and cardiac arrest. Minor complications included superficial wound infection, acute retention of urine, deep vein thrombosis, pneumonia and urinary tract infection. The primary outcome is the survivorship of TKA in this age group. Complications such as aseptic loosening, infection and revision TKA was considered a failure of TKA. Secondary outcomes include the functional benefit and rate of complication following TKA. Statistical analysis Pre-, peri- and post-operative factors between the above-80 and the control group were compared using Student’s t-test. Pre- and post-operative functional score, flexion range were compared using paired t-test. Kaplan-Meier survival analysis was done comparing the above-80 and control groups. Revision TKA was considered as the end-point. Patient mortality was also an end-point to investigate the viability, longevity, and success of TKA in their 80’s. Data analysis was performed using IBM SPSS 26.0 (Armonk, New York). A p-value of ≤ 0.05 was considered statistically significant. Results A total of 67 patients above aged 80 years had TKA performed, with 23 of them being male (34.3%). This ratio was the same in our sex-matched control group. All patients in our study underwent TKA due to primary osteoarthritis of the knee, except one patient in the 70–80 group which was due to psoriatic arthropathy. Mean age of the octogenarian group was 82.49 ± 1.97 (1SD) years. Mean age of the control group was 73.90 ± 2.78 (1SD) years. Overall mean follow-up period was 10.39 ± 2.29 years (95% CI: 10.00-10.78). Mean follow-up for the octogenarian group and control group was 10.43 ± 2.41 years (95% CI: 9.85–11.01) and 10.35 ± 2.18 years (95% CI: 9.83–10.88) respectively. Pre-operative factors such as sex distribution, laterality, body weight, steroid usage, smoking status, indication of surgery, previous knee surgery, pre-op deformity, range of motion did not show statistical difference (p > 0.05)(Table 1 ). Table 1 Pre-operative factors between the two groups of patients Baseline characteristics Age ≥ 80 (N = 67) Age 70–80 (N = 67) P value Age at surgery Mean ± SD (Range) 82.49 ± 1.97 (80.10, 89.07) 73.90 ± 2.78 (70.00, 79.00) < 0.01 Median 82.00 74.00 Sex 1.00 Male 44 (65.7%) 44 (65.7%) Female 23 (34.3%) 23 (34.3%) Side 0.39 Left 38 (56.7%) 32 (47.8%) Right 29 (43.3%) 35 (52.2%) Body weight (kg) 0.23 Mean ± SD (Range) 61.68 ± 8.80 (46.60, 83.00) 63.97 ± 10.50 (38.00, 88.00) Median 60.00 64.20 Steroid user 1.00 Yes 2 (3.0%) 2 (3.0%) No 65 (97.0%) 65 (97.0%) Smoker 0.62 Yes 1 (1.5%) 3 (4.5%) No 66 (98.5%) 64 (95.5%) Diagnosis 1.00 Osteoarthritis 67 (100.0%) 69 (98.6%) Other 0 (0.0%) 1 (1.4%) Previous knee operation 1.00 Yes 0 (0.0%) 1 (1.5%) No 67 (100.0%) 66 (98.5%) Pre-op deformity 0.49 Varus 61 (91.0%) 64 (95.5%) Valgus 6 (9.0%) 3 (4.5%) Degree of deformity 0.88 Mean ± SD (Range) 11.31 ± 4.78 (5, 25) 11.44 ± 4.87 (5, 25) Median 10.00 10.00 Pre-op flexion Contracture 0.11 Mean ± SD (Range) 10.37 ± 7.03 (0, 30) 8.65 ± 5.28 (0, 26) Median 10.00 10.00 Mean surgical time was lower for the octogenarian group (97.21 ± 18.75min) in comparison with the control group (104.61 ± 18.64min, p = 0.02). (Table 2 ) Mean LOS was comparable in both groups, with 9.55 ± 3.28 days (above-80 group) vs 9.23 ± 3.19 days (control group) (p = 0.56). Peri-operative factors such as type of anaesthesia, model of implant, post-op haemoglobin (Hb) drop, post-op complication, discharge status and post-op Charnley classification did not show statistical difference (p > 0.05). Both groups had a majority of ASA grade 2, however more of the octogenarian group had ASA grading of 3 (26.7% vs 10.4%), which did not reach statistical significance (p = 0.072). Referring to the local statistics report on mortality in year 2018, the age-specific mortality rate of population at age ≥ 80 was 14.3% (or 143.3 deaths per 1000 population). Mortality rate for the octogenarian group was higher than the control group (43.3% vs 19.4% respectively, p < 0.01). The deceased patients had a mean survival of 6.30 years (octogenarian group) vs 6.38 years (control group) post-operatively. The most common cause of death for both octogenarian and control groups was pneumonia (41.4% and 30.8% respectively) which was unrelated to the index operation. One patient in the control group suffered from cardiac arrest on post-op day 12; otherwise all patients were either discharged home or to convalescence hospital. 3 patients (4.5%) in the octogenarian group suffered from major complications in comparison to 5 from the control group (7.5%). (Table 3 ) Overall complication rate was 32.8% in octogenarian versus 25.4% in control group. Major complications included deep implant infection, vascular injury, myocardial infarction, fast atrial fibrillation, stroke and pulmonary embolism, which was 4.5% vs 7.5% (octogenarian vs control). Minor complications included superficial wound infection, acute retention of urine, deep vein thrombosis, pneumonia and urinary tract infection, which was 28.3% vs 19.4% (octogenarian vs control). All complications, major and minor, were charted in Table 3 . The most common complication for both octogenarian and control groups was deep vein thrombosis (16.4% and 14.9% respectively). Rate of revision due to infection or aseptic loosening was 0% and 1.5%. Table 2 Intra- and post-operative outcomes Intra- and post-operative outcomes Age ≥ 80 (N = 67) Age 70–80 (N = 70) P value Anesthesia 0.545 CSE 22 17 GA 6 10 GA + Epidural 0 1 GA + Femoral nerve block 2 1 SA 36 35 SA + Femoral nerve block 0 2 Unknown 1 1 ASA 0.072 1 3 4 2 35 47 3 18 7 4 1 2 Model of implant 0.538 Genesis II 6 6 LCCK 2 0 Legacy 38 40 LPS-Flex 0 1 PFC 11 14 Scorpio 1 2 TC3 1 1 Triathlon 8 3 Tourniquet Time (mins) 74.96 ± 17.14 83.06 ± 17.56 0.01 Surgical time (mins) 97.21 ± 18.75 104.61 ± 18.64 0.02 Post-op Hb drop (g/dL) 3.71 ± 1.24 3.95 ± 1.16 0.25 Length of stay (days) 9.55 ± 3.28 9.23 ± 3.19 0.56 Post-op complication 0.440 Yes 45 50 No 22 17 Discharge status 0.779 Direct home 8 6 Convalescent 59 61 Post-op Charnley Functional Classification 0.693 A 41 43 B 18 18 C 8 5 Revision 1.000 Yes 0 1 No 67 66 Infection 1.000 Yes 0 1 No 67 66 Aseptic loosening No 67 67 - Last seen status Alive 38 (56.7%) 54 (80.6%) < 0.01 Deceased 29 (43.3%) 13 (19.4%) Table 3 Post-op complications. Post-op complications Age ≥ 80 Age 70–80 Number (%) Number (%) Major complications Deep implant infection 0 (0) 1 (1.5%) Vascular injury 0 (0) 1 (1.5%) Myocardial infarction 1 (1.5%) 0 (0) Fast atrial fibrillation 1 (1.5%) 1 (1.5%) Stroke 1 (1.5%) 0 (0) Pulmonary embolism 0 (0) 1 (1.5%) Cardiac arrest 0 (0) 1 (1.5%) Minor complications Superficial wound infection 2 (3.0%) 0 (0) Acute retention of urine 2 (3.0%) 2 (3.0%) Deep vein thrombosis 11 (16.4%) 10 (14.9%) Pneumonia 3 (4.5%) 1 (1.5%) Urinary tract infection 1 (1.5%) 0 (0) Major complication rate 3 (4.5%) 5 (7.5%) Minor complication rate 19 (28.3%) 13 (19.4%) Overall complication rate 22 (32.8%) 17 (25.4%) There was no difference between the pre-op flexion range and Knee Society Score (KSS) between the two groups. The control group had a higher pre-op Function Score (KFS) which was statistically significant (p < 0.01). (Table 4 ) Both groups showed improvement in knee flexion range, KSS and KFS post-operatively. (Table 5 ) There was an overall improvement in KFS of the above-80 group, however it was not statistically significant (p = 0.16). Table 4 Functional outcomes between the octogenarian and control groups. Pre-op Post-op Age ≥ 80 Age 70–80 P value Age ≥ 80 Age 70–80 P value Flexion range (± SD) 91.34 ± 15.07 93.08 ± 15.10 0.50 104.63 ± 14.65 105.92 ± 11.77 0.59 KSS (± SD) 34.48 ± 12.73 34.75 ± 10.86 0.90 94.22 ± 6.70 94.62 ± 6.06 0.73 KFS (± SD) 42.39 ± 17.80 50.71 ± 16.18 0.01 46.46 ± 27.82 61.00 ± 23.15 < 0.01 KSS: Knee Society Score, KFS: Knee Society Function Score *Student’s T-test Table 5 Comparison of functional outcomes pre- and post-operatively. Age ≥ 80 P value Age 70–80 P value Pre-op Post-op Pre-op Post-op Flexion range (± SD) 91.34 ± 15.07 104.63 ± 14.65 < 0.01 93.08 ± 15.10 105.92 ± 11.77 < 0.01 KSS (± SD) 34.48 ± 12.73 94.22 ± 6.70 < 0.01 34.75 ± 10.86 94.62 ± 6.06 < 0.01 KFS (± SD) 42.39 ± 17.80 46.46 ± 27.82 0.21 50.71 ± 16.18 61.00 ± 23.15 < 0.01 KSS: Knee Society Score, KFS: Knee Society Function Score *Paired T-test Five-year and 10-year survival of the above-80 group was 86.6% and 55.9% respectively. (Table 6 , Fig. 1 ) In comparison, the 5- and 10-year survival of the control group was 92.5% and 81.4% respectively. This was statistically significant with p < 0.01. 5-year and 10-year implant survival was 1.000 and 1.000 in the octogenarian group; the control group had 5- and 10-year implant survival of 0.985 and 0.985. (Table 7 , Fig. 2 ) This difference was not statistically significant with p = 0.32. Table 6 Patient survival rate and standard error (SE) of the two groups using Kaplan-Meier product limit method. Years since TKR Age ≥ 80 Age 70–80 Log rank P value Estimate SE Estimate SE 5 0.851 0.044 0.953 0.026 20.87 < 0.01 10 0.546 0.069 0.913 0.037 Table 7 Implant survival rate and standard error (SE) of the two groups using Kaplan-Meier product limit method. Implant survival (Years) Age ≥ 80 Age 70–80 Log rank P value Estimate SE Estimate SE 5 1.000 - 0.985 0.015 1.000 0.32 10 1.000 - 0.985 0.015 Discussion TKAs are a common, safe and effective procedure. However, some healthcare providers may be averse to offer TKAs in patients aged above 80 due to concerns of higher risk of surgery as well as patient survivorship. Many studies in different specialties have shown the pervasiveness of ageism in healthcare systems around the world resulting in poorer patient outcomes[ 17 – 21 ]. With better healthcare and longer average life expectancy[ 22 ], we can anticipate more and more healthy and active elderly who would benefit from the improved function that TKAs can provide. Here we have shown that TKAs are safe and effective in the octogenarian population with comparable rate of revision and post-operative outcome. To the authors’ best knowledge, this was the first study to investigate the long-term results of TKA in octogenarian. In terms of implant survival, our study correlates with Klasan et al. , who looked at the medium-term outcomes of TKAs in octogenarians in Australia[ 23 ]. Implant survivorship at 10 years was reported at 99.5%, and patient survivorship was 26% at 10 years; mean follow-up was 7.76 years. Joshi[ 15 ] reported a 10-year patient survival of 34% in octogenarian TKAs in 2003. Our study observed a 10-year implant and patient survivorship of 100% and 54.6% respectively. As expected, the elderly enjoyed excellent implant survival but had poorer patient survival. The difference in patient survival between our study and Klasan’s may be explained by our higher life expectancy than Australia[ 24 ]. Tay et al. [ 25 ] found the 2-year revision rate was higher in octogenarians (2.9% vs 1.4%), but this was not statistically significant (p = 0.31). Klasan[ 23 ] reported a revision rate of 0.46% (versus 1.55% in younger patients, p = 0.51) with mean follow-up of 7.76 years. The lower rate of revision is likely due to lower functional demand and higher threshold for performing revision arthroplasty in the elderly. In our study, the rate of revision was comparable to the younger cohort; only 1 patient in the control group required revision TKA, which may be due to smaller sample size. Multiple studies have shown a correlation between advanced age with increasing LOS[ 25 , 26 ]. Tay et al. reported a mean LOS of 6.3 vs 5.4 days in octogenarian vs younger cohort. Austin et al . reported a mean LOS of 3.30 vs 2.91 days, with 37% requiring facility discharge. In comparison, our LOS was 9.55 ± 3.28 vs 9.23 ± 3.19 days (octogenarian vs control), with 87% discharged to convalescent hospital. This is likely due to old practice; with introduction of newer surgical practice and accelerated rehabilitation protocols[ 27 ], most our patients currently have shorter length of stay and are discharged home directly. Yohe et al. studied the complication rate of octogenarians according to the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database in USA[ 28 ]. Rate of major complications such as stroke, myocardial infarction, sepsis and revision surgery was found to be 3.5%, with overall rate of revision 1.2%. 4.7% patients presented with unplanned readmissions within 30 days. In comparison, our rate of major complications in octogenarian was 4.5%, and revision rate was 0%. The slightly higher complication rate and difference in rate of revision may be due to small sample size or overall low TKA volume at our hospital. We report a high minor complication rate in our study (28.3%), with a majority due to deep vein thrombosis (DVT). This is due to the lack of modern multi-modal DVT prophylaxis such as early mobilisation, thromboembolism-deterrent stockings, sequential compression devices and direct oral anticoagulants which are now routine in our unit. Overall mortality rate in Yohe’s study was found to be 0.3%, which was increased in patients with dependent functional status and ASA > 2 (OR 8.94 and 6.11 respectively). This was comparable with our findings of 0%. Cher et al . studied the functional scoring between octogenarians and younger patients in TKA at 6 and 24 months[ 29 ]. Both groups showed statistical improvement in KSS and KFS post-operatively. In the octogenarian group, mean KSS improved from 36.77 to 84.44 (p < 0.05), while mean KFS improved from 39.50 to 55.77 (p < 0.05). In our study, mean KSS in octogenarian improved from 34.48 to 94.22 (p < 0.01) which was comparable. This improvement was maintained during the lifetime of the prosthesis as well as the patient. KFS in our study was not significantly improved, this may be due to deterioration in our patients’ overall ambulatory status with longer follow-up and increasing age. There are limitations in our study. This study was retrospective in nature; octogenarians with poor premorbid status and deemed surgically unfit would naturally not be included. There would also be inherent bias from healthcare providers and relatives to opt for a more conservative management in marginal patients. Using revision as an end-point for TKA survivorship in these patients may therefore underestimate the true figure. In this study, our control group was chosen to be aged between 70 to 80. This was intentionally done to provide a more comparable cohort to the above-80 group. We would anticipate a larger difference in pre-operative functional score, post-op improvement as well as complication rate with a control group that included all ages. Our moderate sample size of 67 patients at a single centre may also affect the power of our study. This study was performed more than a decade ago; evolving surgical methods, different surgeons as well as introduction of multi-disciplinary approach to accelerated TKA rehabilitation may also introduce heterogeneity between earlier and later cases in our study. Here we have shown that TKA in octogenarian has similar complication rate and functional outcome compared to a younger age group. Despite the higher ASA grading overall, post-operative complications were comparable to those aged between 70–80 years old. While there was a lower patient survivorship in the elderly group due to age difference, implant survivorship was comparable. Function score remains poor in octogenarian without significant difference in comparison to the younger cohort; this is to be expected as they often have impaired muscle strength, coordination and balance. However, patients are still able to benefit from TKA with improved knee range of movement and pain which is reflected in KSS. Clear surgical objective, addressing patients’ concern and expectation is paramount in order to achieve good outcome following TKA. Conclusions TKA can be performed in patients with age above 80 years old with comparable post-op knee range, complication rate and long-term functional score. Advanced age should not be a limiting factor for TKA. Declarations Ethics approval and consent to participate: Ethical approval was obtained from the ethics review board of the Joint NTEC/CUHK Ethics Committee (Research Ethics Committee approval number: 2015.433). Written informed consent was obtained from every participant for informed consent. Informed consent was obtained from legally authorized representatives of the deceased patients. Consent for publication: Written informed consent was obtained from every participant. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author upon request. Competing interests: The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author’s contributions Kevin Ki Wai Ho, Kwong-Yin Chung, Kwok-Hing Chiu and Rex Wang-Fung Mak designed the research, collected and assembled the data, and wrote the paper. Wai-Wang Chau analysed and interpreted the data and contributed to the writing of the paper. All authors took part in the writing and final editing of the manuscript. All authors have been given a copy of the manuscript, all have approved the final version of the manuscript, and all are prepared to take public responsibility for the work and share responsibility and accountability for the results. Acknowledgements Not applicable. 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Cher EWL, Tay KS, Zhang K, Tan SB, Howe TS, Koh JSB: The Effect of Comorbidities and Age on Functional Outcomes After Total Knee Arthroplasty in the Octogenarian: A Matched Cohort Study . Geriatr Orthop Surg Rehabil 2018, 9 :2151459318769508. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Sep, 2021 Read the published version in Journal of Orthopaedic Surgery → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-152940","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":8924997,"identity":"e32288af-082d-4fc5-980a-5d923a378df7","order_by":0,"name":"Rex Wang-Fung Mak","email":"","orcid":"","institution":"Prince of Wales Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rex","middleName":"Wang-Fung","lastName":"Mak","suffix":""},{"id":8924998,"identity":"c276e7c3-f85b-446c-a770-04069a65325c","order_by":1,"name":"Wai-Wang Chau","email":"","orcid":"","institution":"Chinese University of Hong Kong","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wai-Wang","middleName":"","lastName":"Chau","suffix":""},{"id":8924999,"identity":"6bab25fa-2e2c-4f5a-95f3-896569390994","order_by":2,"name":"Kwong-Yin Chung","email":"","orcid":"","institution":"Prince of Wales Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kwong-Yin","middleName":"","lastName":"Chung","suffix":""},{"id":8925000,"identity":"05b59381-a46a-475a-890b-26f065f3d489","order_by":3,"name":"Kwok-Hing Chiu","email":"","orcid":"","institution":"Prince of Wales Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kwok-Hing","middleName":"","lastName":"Chiu","suffix":""},{"id":8925001,"identity":"3ed6173f-81a6-4b8b-a573-58ff5f36064f","order_by":4,"name":"Kevin Ki-Wai Ho","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIie3RPQrCMBTA8RTBqeL6Sv24QkrG9jAJQrK0gpuDQ0CIi9C13sLRsRLQpQfwBE4OgruYuLnEuDnkDw+y/B4PglAo9IeBmTaSaIJQ3DNvM9D3I+Q3ggxh0pskm22mF4dC1E2lMVrmTKaKOkkad1jvOl41l/mMok4wOTq1TjIBTvVA6WoPJWkjpZkEId1ken0Tgd/k6UFS6LWWUEtoJC3h7sOS7cwSnjXdjWB6EkSZU50Ezsf1Y6CK6XBTEriv8nENHDvJZ3b9l18JhUKhkE8vv5NFBwMiI9cAAAAASUVORK5CYII=","orcid":"","institution":"Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Kevin","middleName":"Ki-Wai","lastName":"Ho","suffix":""}],"badges":[],"createdAt":"2021-01-22 05:44:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-152940/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-152940/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1177/23094990211055226","type":"published","date":"2021-09-01T06:32:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":5349692,"identity":"9e0a36ac-17bb-4342-b715-f1a869bf42cc","added_by":"auto","created_at":"2021-01-28 19:27:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24809,"visible":true,"origin":"","legend":"Kaplan-Meier curve of patient survival time in above-80 and control groups. ","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-152940/v1/d079017693438ef95ea5cad6.png"},{"id":5349693,"identity":"dbead9c8-9d7d-43e9-ad35-83abc0ca47d4","added_by":"auto","created_at":"2021-01-28 19:27:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":24508,"visible":true,"origin":"","legend":"Kaplan-Meier curve of implant survival time in above-80 and control groups.","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-152940/v1/464cf10fdccd53b1fc6cec53.png"},{"id":16265981,"identity":"17714b16-8510-428f-91f4-5690c7e0ad0a","added_by":"auto","created_at":"2021-12-08 06:32:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":827931,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-152940/v1/7d454ea3-3476-4196-a0c6-ba963567c83c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Long-term Results of Total Knee Arthroplasty in Octogenarian\u003c/p\u003e","fulltext":[{"header":"Background","content":" \u003cp\u003eOsteoarthritis (OA) of the knee is a common disease globally. The lifetime risk of developing symptomatic knee OA is estimated to be up to 47%, which further increases after the age of 60[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Total knee arthroplasty (TKA) is effective treatment for treating patients with end-stage osteoarthritis of the knee[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In the US alone, more than 600,000 TKA were performed in 2010[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to local published statistics in 2017, the elderly (age\u0026thinsp;\u0026gt;\u0026thinsp;65) is expected to increase from 16% of the total population in 2016 to 29% by 2036[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This aging population are expected to present with symptomatic knee OA indicated for TKA. Due to increasing age and medical morbidities, TKAs in octogenarian have been shown to be associated with higher post-operative complications, mortality and longer length of stay in comparison with younger patients[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. At the same time, patients aged 80 and over would still benefit greatly from the improved pain, function and quality of life. This has been well supported by current literature regarding short term benefit[\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], however mid- to long-term results of TKA in octogenarian has been scarcely reported.\u003c/p\u003e \u003cp\u003eThis study aims to compare the safety and outcomes of TKA in the octogenarian population.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003e Ethics approval was obtained from the Research Ethics Review Board (CREC Ref. No. 2015.433). All methods in the study were carried out in accordance with the Helsinki guidelines and declaration or any other relevant guidelines.\u003c/p\u003e\u003cp\u003eThis was a retrospective review of all patients aged 80 years old and above who underwent elective TKA between December 2005 and August 2013 in the orthopaedic unit of a tertiary hospital. The data for this study were retrieved from the electronic record system from the hospital. Pre-operative, peri-operative and post-operative factors were collected. A sex-matched group of patients aged 70\u0026ndash;80 years, from a total of 950 TKAs performed within the same period, was selected as a comparison.\u003c/p\u003e\u003cp\u003ePre-operative factors included comorbidities, indications of surgery (e.g. OA, rheumatoid arthritis, post-traumatic arthritis, etc), Knee Society Score (KSS) and Functional Score (KFS), age at time of surgery, history of knee surgery, steroid usage, smoking status, pre-op knee range and fixed flexion deformity. Peri-operative factors included the type of anaesthesia, American Society of Anaesthesiologists (ASA) grading, the model of implant, duration of surgery, length of stay (LOS), ambulatory status on discharge and discharge status (direct home or to convalescence). Post-operative factors included implant survivorship, KSS and KFS, range of motion, Charnley Functional Score[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], as well as rate of revision, infection or aseptic loosening. Intra- and post-operative complications were also recorded and divided into major and minor complications. Major complications included deep infection of implant, vascular injury, myocardial infarction, fast atrial fibrillation, stroke, pulmonary embolism and cardiac arrest. Minor complications included superficial wound infection, acute retention of urine, deep vein thrombosis, pneumonia and urinary tract infection. The primary outcome is the survivorship of TKA in this age group. Complications such as aseptic loosening, infection and revision TKA was considered a failure of TKA. Secondary outcomes include the functional benefit and rate of complication following TKA.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003ePre-, peri- and post-operative factors between the above-80 and the control group were compared using Student\u0026rsquo;s t-test. Pre- and post-operative functional score, flexion range were compared using paired t-test. Kaplan-Meier survival analysis was done comparing the above-80 and control groups. Revision TKA was considered as the end-point. Patient mortality was also an end-point to investigate the viability, longevity, and success of TKA in their 80\u0026rsquo;s. Data analysis was performed using IBM SPSS 26.0 (Armonk, New York). A p-value of \u0026le;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":" \u003cp\u003eA total of 67 patients above aged 80 years had TKA performed, with 23 of them being male (34.3%). This ratio was the same in our sex-matched control group. All patients in our study underwent TKA due to primary osteoarthritis of the knee, except one patient in the 70\u0026ndash;80 group which was due to psoriatic arthropathy. Mean age of the octogenarian group was 82.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97 (1SD) years. Mean age of the control group was 73.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78 (1SD) years. Overall mean follow-up period was 10.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29 years (95% CI: 10.00-10.78). Mean follow-up for the octogenarian group and control group was 10.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41 years (95% CI: 9.85\u0026ndash;11.01) and 10.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18 years (95% CI: 9.83\u0026ndash;10.88) respectively. Pre-operative factors such as sex distribution, laterality, body weight, steroid usage, smoking status, indication of surgery, previous knee surgery, pre-op deformity, range of motion did not show statistical difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05)(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre-operative factors between the two groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge 70\u0026ndash;80\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003cp\u003e(Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003c/p\u003e \u003cp\u003e(80.10, 89.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e \u003cp\u003e(70.00, 79.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (65.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (65.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (56.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (47.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (43.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (52.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003cp\u003e(Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.68\u0026thinsp;\u0026plusmn;\u0026thinsp;8.80\u003c/p\u003e \u003cp\u003e(46.60, 83.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.97\u0026thinsp;\u0026plusmn;\u0026thinsp;10.50\u003c/p\u003e \u003cp\u003e(38.00, 88.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSteroid user\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (97.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (97.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (98.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (95.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOsteoarthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (98.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious knee operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (98.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op deformity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVarus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61 (91.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (95.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValgus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegree of deformity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003cp\u003e(Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.31\u0026thinsp;\u0026plusmn;\u0026thinsp;4.78\u003c/p\u003e \u003cp\u003e(5, 25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.44\u0026thinsp;\u0026plusmn;\u0026thinsp;4.87\u003c/p\u003e \u003cp\u003e(5, 25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op flexion Contracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003cp\u003e(Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.37\u0026thinsp;\u0026plusmn;\u0026thinsp;7.03\u003c/p\u003e \u003cp\u003e(0, 30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.65\u0026thinsp;\u0026plusmn;\u0026thinsp;5.28\u003c/p\u003e \u003cp\u003e(0, 26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMean surgical time was lower for the octogenarian group (97.21\u0026thinsp;\u0026plusmn;\u0026thinsp;18.75min) in comparison with the control group (104.61\u0026thinsp;\u0026plusmn;\u0026thinsp;18.64min, p\u0026thinsp;=\u0026thinsp;0.02). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) Mean LOS was comparable in both groups, with 9.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28 days (above-80 group) vs 9.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19 days (control group) (p\u0026thinsp;=\u0026thinsp;0.56). Peri-operative factors such as type of anaesthesia, model of implant, post-op haemoglobin (Hb) drop, post-op complication, discharge status and post-op Charnley classification did not show statistical difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Both groups had a majority of ASA grade 2, however more of the octogenarian group had ASA grading of 3 (26.7% vs 10.4%), which did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.072). Referring to the local statistics report on mortality in year 2018, the age-specific mortality rate of population at age\u0026thinsp;\u0026ge;\u0026thinsp;80 was 14.3% (or 143.3 deaths per 1000 population). Mortality rate for the octogenarian group was higher than the control group (43.3% vs 19.4% respectively, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The deceased patients had a mean survival of 6.30 years (octogenarian group) vs 6.38 years (control group) post-operatively. The most common cause of death for both octogenarian and control groups was pneumonia (41.4% and 30.8% respectively) which was unrelated to the index operation. One patient in the control group suffered from cardiac arrest on post-op day 12; otherwise all patients were either discharged home or to convalescence hospital. 3 patients (4.5%) in the octogenarian group suffered from major complications in comparison to 5 from the control group (7.5%). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) Overall complication rate was 32.8% in octogenarian versus 25.4% in control group. Major complications included deep implant infection, vascular injury, myocardial infarction, fast atrial fibrillation, stroke and pulmonary embolism, which was 4.5% vs 7.5% (octogenarian vs control). Minor complications included superficial wound infection, acute retention of urine, deep vein thrombosis, pneumonia and urinary tract infection, which was 28.3% vs 19.4% (octogenarian vs control). All complications, major and minor, were charted in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The most common complication for both octogenarian and control groups was deep vein thrombosis (16.4% and 14.9% respectively). Rate of revision due to infection or aseptic loosening was 0% and 1.5%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntra- and post-operative outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra- and post-operative outcomes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge 70\u0026ndash;80\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;70)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA\u0026thinsp;+\u0026thinsp;Epidural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA\u0026thinsp;+\u0026thinsp;Femoral nerve block\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSA\u0026thinsp;+\u0026thinsp;Femoral nerve block\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel of implant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGenesis II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLCCK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLegacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLPS-Flex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePFC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScorpio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriathlon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTourniquet Time (mins)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.96\u0026thinsp;\u0026plusmn;\u0026thinsp;17.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.06\u0026thinsp;\u0026plusmn;\u0026thinsp;17.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical time (mins)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97.21\u0026thinsp;\u0026plusmn;\u0026thinsp;18.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104.61\u0026thinsp;\u0026plusmn;\u0026thinsp;18.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-op Hb drop (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-op complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.440\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDischarge status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.779\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConvalescent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-op Charnley Functional Classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.693\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRevision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAseptic loosening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast seen status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (56.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (80.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeceased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (43.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePost-op complications.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-op complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge 70\u0026ndash;80\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eMajor complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeep implant infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVascular injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMyocardial infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFast atrial fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulmonary embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiac arrest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMinor complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuperficial wound infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute retention of urine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeep vein thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (16.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (14.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor complication rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinor complication rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (28.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall complication rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (32.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (25.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere was no difference between the pre-op flexion range and Knee Society Score (KSS) between the two groups. The control group had a higher pre-op Function Score (KFS) which was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) Both groups showed improvement in knee flexion range, KSS and KFS post-operatively. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) There was an overall improvement in KFS of the above-80 group, however it was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.16).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFunctional outcomes between the octogenarian and control groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-op\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePost-op\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge 70\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAge 70\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlexion range (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.34\u0026thinsp;\u0026plusmn;\u0026thinsp;15.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.08\u0026thinsp;\u0026plusmn;\u0026thinsp;15.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e104.63\u0026thinsp;\u0026plusmn;\u0026thinsp;14.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e105.92\u0026thinsp;\u0026plusmn;\u0026thinsp;11.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKSS (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.48\u0026thinsp;\u0026plusmn;\u0026thinsp;12.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.75\u0026thinsp;\u0026plusmn;\u0026thinsp;10.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.22\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94.62\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKFS (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.39\u0026thinsp;\u0026plusmn;\u0026thinsp;17.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.71\u0026thinsp;\u0026plusmn;\u0026thinsp;16.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.46\u0026thinsp;\u0026plusmn;\u0026thinsp;27.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.00\u0026thinsp;\u0026plusmn;\u0026thinsp;23.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eKSS: Knee Society Score, KFS: Knee Society Function Score\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*Student\u0026rsquo;s T-test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of functional outcomes pre- and post-operatively.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAge 70\u0026ndash;80\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-op\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-op\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePre-op\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePost-op\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlexion range (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.34\u0026thinsp;\u0026plusmn;\u0026thinsp;15.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104.63\u0026thinsp;\u0026plusmn;\u0026thinsp;14.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.08\u0026thinsp;\u0026plusmn;\u0026thinsp;15.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e105.92\u0026thinsp;\u0026plusmn;\u0026thinsp;11.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKSS (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.48\u0026thinsp;\u0026plusmn;\u0026thinsp;12.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.22\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.75\u0026thinsp;\u0026plusmn;\u0026thinsp;10.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94.62\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKFS (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.39\u0026thinsp;\u0026plusmn;\u0026thinsp;17.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.46\u0026thinsp;\u0026plusmn;\u0026thinsp;27.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.71\u0026thinsp;\u0026plusmn;\u0026thinsp;16.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.00\u0026thinsp;\u0026plusmn;\u0026thinsp;23.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eKSS: Knee Society Score, KFS: Knee Society Function Score\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*Paired T-test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFive-year and 10-year survival of the above-80 group was 86.6% and 55.9% respectively. (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) In comparison, the 5- and 10-year survival of the control group was 92.5% and 81.4% respectively. This was statistically significant with p\u0026thinsp;\u0026lt;\u0026thinsp;0.01. 5-year and 10-year implant survival was 1.000 and 1.000 in the octogenarian group; the control group had 5- and 10-year implant survival of 0.985 and 0.985. (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) This difference was not statistically significant with p\u0026thinsp;=\u0026thinsp;0.32.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient survival rate and standard error (SE) of the two groups using Kaplan-Meier product limit method.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears since TKR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge 70\u0026ndash;80\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLog rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.953\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImplant survival rate and standard error (SE) of the two groups using Kaplan-Meier product limit method.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImplant survival (Years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge 70\u0026ndash;80\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLog rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e "},{"header":"Discussion","content":" \u003cp\u003eTKAs are a common, safe and effective procedure. However, some healthcare providers may be averse to offer TKAs in patients aged above 80 due to concerns of higher risk of surgery as well as patient survivorship. Many studies in different specialties have shown the pervasiveness of ageism in healthcare systems around the world resulting in poorer patient outcomes[\u003cspan additionalcitationids=\"CR18 CR19 CR20\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. With better healthcare and longer average life expectancy[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], we can anticipate more and more healthy and active elderly who would benefit from the improved function that TKAs can provide. Here we have shown that TKAs are safe and effective in the octogenarian population with comparable rate of revision and post-operative outcome. To the authors\u0026rsquo; best knowledge, this was the first study to investigate the long-term results of TKA in octogenarian.\u003c/p\u003e \u003cp\u003eIn terms of implant survival, our study correlates with Klasan \u003cem\u003eet al.\u003c/em\u003e, who looked at the medium-term outcomes of TKAs in octogenarians in Australia[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Implant survivorship at 10 years was reported at 99.5%, and patient survivorship was 26% at 10 years; mean follow-up was 7.76 years. Joshi[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] reported a 10-year patient survival of 34% in octogenarian TKAs in 2003. Our study observed a 10-year implant and patient survivorship of 100% and 54.6% respectively. As expected, the elderly enjoyed excellent implant survival but had poorer patient survival. The difference in patient survival between our study and Klasan\u0026rsquo;s may be explained by our higher life expectancy than Australia[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTay \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] found the 2-year revision rate was higher in octogenarians (2.9% vs 1.4%), but this was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.31). Klasan[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] reported a revision rate of 0.46% (versus 1.55% in younger patients, p\u0026thinsp;=\u0026thinsp;0.51) with mean follow-up of 7.76 years. The lower rate of revision is likely due to lower functional demand and higher threshold for performing revision arthroplasty in the elderly. In our study, the rate of revision was comparable to the younger cohort; only 1 patient in the control group required revision TKA, which may be due to smaller sample size.\u003c/p\u003e \u003cp\u003eMultiple studies have shown a correlation between advanced age with increasing LOS[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Tay \u003cem\u003eet al.\u003c/em\u003e reported a mean LOS of 6.3 vs 5.4 days in octogenarian vs younger cohort. Austin \u003cem\u003eet al\u003c/em\u003e. reported a mean LOS of 3.30 vs 2.91 days, with 37% requiring facility discharge. In comparison, our LOS was 9.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28 vs 9.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19 days (octogenarian vs control), with 87% discharged to convalescent hospital. This is likely due to old practice; with introduction of newer surgical practice and accelerated rehabilitation protocols[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], most our patients currently have shorter length of stay and are discharged home directly.\u003c/p\u003e \u003cp\u003eYohe \u003cem\u003eet al.\u003c/em\u003e studied the complication rate of octogenarians according to the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database in USA[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Rate of major complications such as stroke, myocardial infarction, sepsis and revision surgery was found to be 3.5%, with overall rate of revision 1.2%. 4.7% patients presented with unplanned readmissions within 30 days. In comparison, our rate of major complications in octogenarian was 4.5%, and revision rate was 0%. The slightly higher complication rate and difference in rate of revision may be due to small sample size or overall low TKA volume at our hospital. We report a high minor complication rate in our study (28.3%), with a majority due to deep vein thrombosis (DVT). This is due to the lack of modern multi-modal DVT prophylaxis such as early mobilisation, thromboembolism-deterrent stockings, sequential compression devices and direct oral anticoagulants which are now routine in our unit. Overall mortality rate in Yohe\u0026rsquo;s study was found to be 0.3%, which was increased in patients with dependent functional status and ASA\u0026thinsp;\u0026gt;\u0026thinsp;2 (OR 8.94 and 6.11 respectively). This was comparable with our findings of 0%.\u003c/p\u003e \u003cp\u003eCher \u003cem\u003eet al\u003c/em\u003e. studied the functional scoring between octogenarians and younger patients in TKA at 6 and 24 months[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Both groups showed statistical improvement in KSS and KFS post-operatively. In the octogenarian group, mean KSS improved from 36.77 to 84.44 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while mean KFS improved from 39.50 to 55.77 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In our study, mean KSS in octogenarian improved from 34.48 to 94.22 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) which was comparable. This improvement was maintained during the lifetime of the prosthesis as well as the patient. KFS in our study was not significantly improved, this may be due to deterioration in our patients\u0026rsquo; overall ambulatory status with longer follow-up and increasing age.\u003c/p\u003e \u003cp\u003eThere are limitations in our study. This study was retrospective in nature; octogenarians with poor premorbid status and deemed surgically unfit would naturally not be included. There would also be inherent bias from healthcare providers and relatives to opt for a more conservative management in marginal patients. Using revision as an end-point for TKA survivorship in these patients may therefore underestimate the true figure. In this study, our control group was chosen to be aged between 70 to 80. This was intentionally done to provide a more comparable cohort to the above-80 group. We would anticipate a larger difference in pre-operative functional score, post-op improvement as well as complication rate with a control group that included all ages. Our moderate sample size of 67 patients at a single centre may also affect the power of our study. This study was performed more than a decade ago; evolving surgical methods, different surgeons as well as introduction of multi-disciplinary approach to accelerated TKA rehabilitation may also introduce heterogeneity between earlier and later cases in our study.\u003c/p\u003e \u003cp\u003eHere we have shown that TKA in octogenarian has similar complication rate and functional outcome compared to a younger age group. Despite the higher ASA grading overall, post-operative complications were comparable to those aged between 70\u0026ndash;80 years old. While there was a lower patient survivorship in the elderly group due to age difference, implant survivorship was comparable. Function score remains poor in octogenarian without significant difference in comparison to the younger cohort; this is to be expected as they often have impaired muscle strength, coordination and balance. However, patients are still able to benefit from TKA with improved knee range of movement and pain which is reflected in KSS. Clear surgical objective, addressing patients\u0026rsquo; concern and expectation is paramount in order to achieve good outcome following TKA.\u003c/p\u003e "},{"header":"Conclusions","content":" \u003cp\u003eTKA can be performed in patients with age above 80 years old with comparable post-op knee range, complication rate and long-term functional score. Advanced age should not be a limiting factor for TKA.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the ethics review board of the Joint NTEC/CUHK Ethics Committee (Research Ethics Committee approval number: 2015.433).\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from every participant for informed consent.\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from legally authorized representatives of the deceased patients.\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from every participant.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s contributions\u003c/p\u003e\n\u003cp\u003eKevin Ki Wai Ho, Kwong-Yin Chung, Kwok-Hing Chiu and Rex Wang-Fung Mak designed the research, collected and assembled the data, and wrote the paper. Wai-Wang Chau analysed and interpreted the data and contributed to the writing of the paper. All authors took part in the writing and final editing of the manuscript. All authors have been given a copy of the manuscript, all have approved the final version of the manuscript, and all are prepared to take public responsibility for the work and share responsibility and accountability for the results.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMatharu GS, Mouchti S, Twigg S, Delmestri A, Murray DW, Judge A, Pandit HG: \u003cstrong\u003eThe effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients\u003c/strong\u003e. \u003cem\u003eActa Orthop \u003c/em\u003e2019, \u003cstrong\u003e90\u003c/strong\u003e(6):559-567.\u003c/li\u003e\n\u003cli\u003ePrice AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, Carr A, Beard D: \u003cstrong\u003eKnee replacement\u003c/strong\u003e. \u003cem\u003eLancet \u003c/em\u003e2018, \u003cstrong\u003e392\u003c/strong\u003e(10158):1672-1682.\u003c/li\u003e\n\u003cli\u003eSkou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, Rasmussen S: \u003cstrong\u003eA Randomized, Controlled Trial of Total Knee Replacement\u003c/strong\u003e. \u003cem\u003eN Engl J Med \u003c/em\u003e2015, \u003cstrong\u003e373\u003c/strong\u003e(17):1597-1606.\u003c/li\u003e\n\u003cli\u003eLavernia CJ, Guzman JF, Gachupin-Garcia A: \u003cstrong\u003eCost effectiveness and quality of life in knee arthroplasty\u003c/strong\u003e. \u003cem\u003eClin Orthop Relat Res \u003c/em\u003e1997(345):134-139.\u003c/li\u003e\n\u003cli\u003eKurtz S, Ong K, Lau E, Mowat F, Halpern M: \u003cstrong\u003eProjections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030\u003c/strong\u003e. \u003cem\u003eJ Bone Joint Surg Am \u003c/em\u003e2007, \u003cstrong\u003e89\u003c/strong\u003e(4):780-785.\u003c/li\u003e\n\u003cli\u003eCensus_and_Statistics_Department: \u003cstrong\u003eHong Kong Population Projections 2020-2069\u003c/strong\u003e. 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Geneva: World Health Organization; 2018.\u003c/li\u003e\n\u003cli\u003eKlasan A, Putnis SE, Yeo WW, Fritsch BA, Coolican MR, Parker DA: \u003cstrong\u003eAdvanced Age Is Not a Barrier to Total Knee Arthroplasty: A Detailed Analysis of Outcomes and Complications in an Elderly Cohort Compared With Average Age Total Knee Arthroplasty Patients\u003c/strong\u003e. \u003cem\u003eJ Arthroplasty \u003c/em\u003e2019, \u003cstrong\u003e34\u003c/strong\u003e(9):1938-1945.\u003c/li\u003e\n\u003cli\u003e[\u003ca href=\"https://datatopics.worldbank.org/world-development-indicators/\"\u003ehttps://datatopics.worldbank.org/world-development-indicators/\u003c/a\u003e]\u003c/li\u003e\n\u003cli\u003eTay KS, Cher EWL, Zhang K, Tan SB, Howe TS, Koh JSB: \u003cstrong\u003eComorbidities Have a Greater Impact Than Age Alone in the Outcomes of Octogenarian Total Knee Arthroplasty\u003c/strong\u003e. \u003cem\u003eJ Arthroplasty \u003c/em\u003e2017, \u003cstrong\u003e32\u003c/strong\u003e(11):3373-3378.\u003c/li\u003e\n\u003cli\u003eAustin DC, Torchia MT, Moschetti WE, Jevsevar DS, Keeney BJ: \u003cstrong\u003ePatient Outcomes After Total Knee Arthroplasty in Patients Older Than 80 Years\u003c/strong\u003e. \u003cem\u003eJ Arthroplasty \u003c/em\u003e2018, \u003cstrong\u003e33\u003c/strong\u003e(11):3465-3473.\u003c/li\u003e\n\u003cli\u003eIsaac D, Falode T, Liu P, I'Anson H, Dillow K, Gill P: \u003cstrong\u003eAccelerated rehabilitation after total knee replacement\u003c/strong\u003e. \u003cem\u003eKnee \u003c/em\u003e2005, \u003cstrong\u003e12\u003c/strong\u003e(5):346-350.\u003c/li\u003e\n\u003cli\u003eYohe N, Funk A, Ciminero M, Erez O, Saleh A: \u003cstrong\u003eComplications and Readmissions After Total Knee Replacement in Octogenarians and Nonagenarians\u003c/strong\u003e. \u003cem\u003eGeriatr Orthop Surg Rehabil \u003c/em\u003e2018, \u003cstrong\u003e9\u003c/strong\u003e:2151459318804113.\u003c/li\u003e\n\u003cli\u003eCher EWL, Tay KS, Zhang K, Tan SB, Howe TS, Koh JSB: \u003cstrong\u003eThe Effect of Comorbidities and Age on Functional Outcomes After Total Knee Arthroplasty in the Octogenarian: A Matched Cohort Study\u003c/strong\u003e. \u003cem\u003eGeriatr Orthop Surg Rehabil \u003c/em\u003e2018, \u003cstrong\u003e9\u003c/strong\u003e:2151459318769508.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"total knee arthroplasty, long term, survivorship, octogenarian","lastPublishedDoi":"10.21203/rs.3.rs-152940/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-152940/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBackground\u003c/em\u003e: With increasing life expectancy and aging population, more octogenarians would benefit from total knee arthroplasty (TKA). The aim of this study is to evaluate the survivorship of TKA in octogenarian and their long-term outcomes. \u003c/p\u003e\u003cp\u003e \u003cem\u003eMethods\u003c/em\u003e: This was a retrospective review of 67 patients aged above 80 years who had primary TKA performed between 2005-2013 at a single centre. A sex-matched younger cohort of 67 primary TKAs during the same time-period was recruited for control. 5- and 10-year survival was calculated. Pre- and peri-operative factors were collected and compared. Post-operative range of motion, Knee Society Score (KSS) and Function Score (KFS) were collected and compared. Rate of revision, infection, aseptic loosening and mortality was collected.\u003c/p\u003e\u003cp\u003e\u003cem\u003eResults\u003c/em\u003e: The mean follow-up period was 10.39±2.29 years. The 5- and 10- year survival of octogenarian group was 85.1% and 54.6% respectively. Pre- and peri-operative factors between the octogenarian and control groups were comparable (p\u0026gt;0.05). Both groups showed improvement in range of motion, KSS and KFS post-operatively. Rate of revision, aseptic loosening and deep infection was 0% in octogenarian and 1.5% in control group. \u003c/p\u003e\u003cp\u003e\u003cem\u003eConclusions\u003c/em\u003e: TKA can be performed in patients with age above 80 years old with comparable post-op knee range, complication rate and long-term functional score. Advanced age should not be a limiting factor for TKA.\u003c/p\u003e","manuscriptTitle":"The Long-term Results of Total Knee Arthroplasty in Octogenarian","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-01-28 19:24:12","doi":"10.21203/rs.3.rs-152940/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a5bf78ea-0ab6-494b-a635-5a9ca37b7432","owner":[],"postedDate":"January 28th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":2114055,"name":"Geriatrics \u0026 Gerontology"}],"tags":[],"updatedAt":"2021-12-08T06:32:06+00:00","versionOfRecord":{"articleIdentity":"rs-152940","link":"https://doi.org/10.1177/23094990211055226","journal":{"identity":"journal-of-orthopaedic-surgery","isVorOnly":true,"title":"Journal of Orthopaedic Surgery"},"publishedOn":"2021-09-01 06:32:06","publishedOnDateReadable":"September 1st, 2021"},"versionCreatedAt":"2021-01-28 19:24:12","video":"","vorDoi":"10.1177/23094990211055226","vorDoiUrl":"https://doi.org/10.1177/23094990211055226","workflowStages":[]},"version":"v1","identity":"rs-152940","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-152940","identity":"rs-152940","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}