Background/Purpose: Rising rates of total knee arthroplasty (TKA) in younger adults with knee osteoarthritis (OA) has prompted concern about surgical appropriateness. We compared patient appropriateness for TKA, using previously validated criteria, and surgeons’ recommendations for TKA, by patient age.

Methods: This cross-sectional study recruited patients with knee OA referred for TKA consultation to two centralized provincial arthroplasty intake centers in Alberta, Canada. Patients aged 30 years or older and determined by the surgeon to have primary knee OA on physical examination and imaging were eligible. Individuals with inflammatory arthritis were excluded. To examine age effects, recruitment continued until there was at least 200 individuals aged 30-59, 60-69 and ≥ 70 years. A pre-consult questionnaire assessed measures of patients’ TKA appropriateness (need: knee symptoms, prior OA treatment; readiness/willingness to undergo TKA; health status; expectations) and contextual factors. Post-consultation, surgeons reported if TKA had been recommended and if not, why. Using multivariable logistic regression, we assessed the relationships between patient age (< 60 versus ≥ 60) and TKA appropriateness and receipt of surgeon recommendation for TKA.

Results: Of 2,064 participants, 26.0% were < 60 years of age, 68.0% female, 35.6% employed. Compared to older participants, younger participants reported significantly worse knee symptoms, higher use of OA therapies and similar TKA readiness/willingness. They were also more likely to have BMI >40 kg/m², smoke and endorse return to exercise/sports as a very important TKA outcome. TKA was offered to 1,525 individuals (73.9%). In multivariable analyses, controlling for TKA appropriateness, we found no relationship between patient age and surgeons’ recommendations for TKA (OR, odds ratio, 0.81; 95% CI, confidence interval, 0.59 to 1.10). Surgeons were significantly more likely to recommend TKA to those with TKA need, willingness and for whom improved ability to perform daily activities was very important. They were less likely to recommend surgery to smokers and for whom return to exercise/sport was important.

Conclusion: Among individuals referred for surgical consultation regarding TKA for knee OA, we found that younger patients (< 60 years old) had comparable TKA need, readiness and willingness as those aged 60 years or older. However, younger individuals were more likely to be obese, smoke, and desire to return to sport after TKA, which may increase risk for complications, including early revision. Incorporation of TKA appropriateness criteria into patient referral and patient-surgeon decision-making regarding TKA has potential to facilitate a balanced consideration of TKA benefits alongside the risks in a growing population of young, obese individuals with knee OA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/primary-total-knee-arthroplasty-for-knee-osteoarthritis-among-younger-versus-older-individuals-cross-sectional-study-of-surgical-appropriateness-and-surgeon-decision-making/