Clinical outcomes of fast-track total knee arthroplasty for patients aged >80 years.

INTRODUCTION: Because of the ageing population in Hong Kong, there is an increasing incidence of total knee arthroplasties (TKA) conducted in patients aged >80 years. METHODS: This retrospective case-control study enrolled all patients who were aged >80 years and underwent fast-track primary TKA between 2011 and 2015. Their outcomes were compared with the outcomes of a matched control group of younger patients who underwent fast-track TKA in the same period. RESULTS: In total, 220 patients were included in this study with a follow-up period of at least 2 years (mean=3.2 years; range, 2-5 years); 112 (51%) were octogenarians and 108 (49%) were non-octogenarians. Greater improvement in Knee Society Score was found in the octogenarian group at 1 year after surgery (46 ± 19 vs 39 ± 16, P=0.018). The incidence of complications was higher in the octogenarian group (15.2% vs 4.6%, P=0.009). There were no significant differences in the incidence of major complications, the rate of intensive care unit admission, or the 1-year mortality rate between the two groups. After adjustment for confounding factors, Charlson Comorbidity Index >5, history of major cerebrovascular accident, and history of peptic ulcer disease were predictive of complications after fast-track TKA (P=0.039, P=0.016, and P=0.007, respectively); octogenarian status was not predictive of complications. CONCLUSIONS: Octogenarians had greater improvement in Knee Society Score at 1 year after fast-track TKA, compared with non-octogenarians, but there were no significant differences in the incidences of mortality or major complications.

Local infiltration analgesia in primary total knee arthroplasty.

INTRODUCTION: Postoperative pain in total knee arthroplasty (TKA) can hinder rehabilitation and cause morbidity. Local infiltration analgesia (LIA), comprising an anaesthetic drug, non-steroidal anti-inflammatory drug, and adrenaline, has been introduced to reduce pain and systemic side-effects. This study evaluated the efficacy of LIA in TKA with respect to morphine consumption and postoperative pain score. METHODS: This single-centre retrospective cohort study recruited patients with knee osteoarthritis who were scheduled for primary TKA during the period from January 2017 to December 2017. Patients with chronic inflammatory joint disease, contra-indications for LIA, or dementia were excluded. Patients in the LIA group were administered single-dose LIA intra-operatively, while those in the control group were not. Primary outcomes were postoperative pain score, morphine demand, and morphine consumption; secondary outcomes were range of motion, quadriceps power, and postoperative length of stay. RESULTS: In total, 136 patients were recruited (68 per group). Total postoperative morphine demand and consumption, as well as pain scores from postoperative day (POD) 1 to POD 4, were lower in the LIA group than in the control group. The range of motion from POD 1 to POD 4 and quadriceps power on POD 1 were higher in the LIA group than in the control group. Quadriceps power from POD 2 to POD 4 and postoperative length of stay were not significantly different between groups. CONCLUSIONS: Intra-operative single-dose LIA can effectively reduce postoperative pain, morphine demand, and morphine consumption. Therefore, the use of LIA is recommended during TKA.