Bilateral Simultaneous Total Knee Arthroplasty (SBTKA) in patients above 70 years old Dr (Prof) Raju Vaishya (MBBS, MS, MCh, FRCS) Sr Consultant Orthopaedics & Joint Replacement Surgery Indraprastha Apollo Hospitals, New Delhi, INDIA

Simultaneous Bilateral Total Knee Arthroplasty in elderly greater than 70 years (Paper number - #886) Authors: Raju Vaishya, Vipul Vijay, Kapil Mani KC Institution: Indraprastha Apollo Hospitals, N Delhi, INDIA

SBTKA in elderly Increasing need for TKAs in elderly Only few published reports in octogenerians & nonagenarians The results of SBTKA have not been reported 

Problems in Octo & Nonagenarians Age related physical & medical issues (Hilton et al 2004) Severe & complex deformities (Zicat et al, 1993) Associated osteoporosis Lesser response to rehabilitation More post-operative assistance required Total cost of treatment higher (Brander et al, 1997) Willful neglect of even eligible patients by the family & doctors (Hamel et al 2008)

Criteria for selection Remaining life expectancy (>5yrs) Enthusiasm of the patient & family members Willingness to cooperate in rehab post operatively No major medical co morbidities Availability of back up medical care facilities

Advantages of TKA in elderly Significant freedom for ADL Decreased dependence and improved quality of life (Laskin RS, CORR 1999) Reduction in subsequent risk of serious cardiovascular events (Ravi et al, BMJ 2014)

Our experience 177 SBTKA between 2003 and 2012 Retrospective cohort study of 46 patients (92 knees) of age >70 years Combined spinal/epidural anesthesia (93.5%) or general anesthesia (6.5%) More painful side operated first and 2nd side done during same anesthesia

Demographics Mean/number Standard deviation/percentage Age Male Female BMI ASA Grade I Grade II Grade III Grade IV Grade V Preoperative Hb Postoperative Hb Tourniquet time ( in minutes) Postoperative blood loss in drain (ml) 80.13 25 21 29.4 12 8 1 12.6 9.94 44.43 45.56 968.19 5.25 54.4% 45.6% 5.36 26.08% 54.34% 17.4% 2.2% 0% 1.62 1.1 14.01 16.63 495.7

Co-morbidities

Results 24% - no significant co-morbidity 80% ASA grade 1 or 2 Significant improvement in post op KSS No hospital mortality or till one year after surgery

Complications Most common post op complication – delirium. Renal dysfunction (2), Angina (2), UTI (2), MI (1). Average time of death after surgery 5.6 years (none surgery related).

How old is old?? These elderly people are a ‘special class’ Healthy life style Minimal medical problems Good quality of life

How old is old for a SBTKA? Safe & effective procedure for carefully selected elderly adults The individuals and family members understand and accept the risks Should not be deprived of potential benefits of this surgery

Conclusions Biological age is more important than the chronological age SBTKA cannot add years to the lives, but can add quality to the remaining years

Our oldest couple to undergo Bilateral TKA in a single sitting (makes a record!)

THANKS & Welcome to Delhi