A total knee arthroplasty has been performed on a vastly number of younger patients with osteoarthritis and a few studies have shown prevalence of residual symptoms among total knee arthroplasty patients and functional activity lower than expectations based on age and the preoperative diagnosis.
Just a few studies have specifically focus on techniques or implant designs for the younger patients and none of them has identified ideal approaches.
It is important to ensure both short-term symptom resolution and long-term implant survivorship.
A series of studies reported, in 2010, that the outcomes of a total knee arthroplasty were largely successful among these youngsters, with substantial upturns in both pain-predominated clinical activity scales and function based outcome scores.
Most authors have described these young patients as “active”, but the overall population do not support this definition. Odland et al noted that 65% of their patients had returned to active labor and reported the highest level of activity or some form of recreational sport activity.
Deciding on what implant is the most appropriated for an individual patient takes in consideration the nature of the arthritic disease process on the knee joint. Patients with a crucial disease process localized to a single joint compartment such as medial, lateral, or patellofemoral, may benefit from a unicompartmental (partial) knee replacement, if they are reasonably willing to modify activity levels. Non-arthroplasty options, such as proximal tibial osteotomy, distal femoral osteotomy, or tibial tubercle osteotomy, must be taken seriously for high activity patients with malalignment and mild to moderate radiographic arthritis.
Patients with more diffuse arthritic disease will benefit more predictably from a total knee arthroplasty.
On a recent study affiliated with the Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States, published online on 2016 December 5th, 100 total knee arthroplasties performed for 82 patients with less than 55 years old were compared to 100 gender-matched total knee arthroplasties performed for 85 patients between 65 and 75 years old. These study cases represented 25% and 21%, respectively, of total knee arthroplasties performed between January 2006 and June 2011 and the radiographic disease severity was determined from preoperative weight and lateral radiographs.
As results from this study, younger patients showed less articular cartilage loss and less osteoarthritis. With less severe radiographic arthritis, they experienced significant improvement with total knee arthroplasty, but the outcome scores do not match those attained by older patients with more severe radiographic disease.