You can do arthroplasty in a young patient, but...: Commentary on articles by John P. Meehan, MD, et al.: 'Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty,' and Vinay K. Aggarwal, et al.: 'Revision total knee arthroplasty in the young patient: is there trouble on the horizon?'
| Autor: | Kelly G. Vince |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Younger age Prosthesis-Related Infections media_common.quotation_subject medicine.medical_treatment MEDLINE Total knee arthroplasty Periprosthetic medicine Humans Orthopedics and Sports Medicine Arthroplasty Replacement Knee media_common business.industry General surgery Mechanical failure General Medicine Arthroplasty Prosthesis Failure Feeling Physical therapy Surgery Female business Knee Prosthesis Revision total knee arthroplasty |
| Zdroj: | The Journal of bone and joint surgery. American volume. 96(7) |
| ISSN: | 1535-1386 |
| Popis: | Years ago I received sage advice from a surly senior surgeon: “you can do arthroplasty in a young patient,” he growled, “but you better do it perfect” (sic). Perhaps more threat than advice, it may have marked the point when I approached the young arthritic patient with “trepidation” rather than the simple “caution” that Meehan et al. recommend in the conclusion to their valuable study documenting higher early septic and aseptic failure rates in total knee arthroplasty patients under the age of fifty years. These rates were identified in more than 120,000 such patients in the California Patient Discharge Database. Caution implies taking care to avoid mistakes; trepidation describes the feeling that something untoward is imminent, no matter how much care one might take. So what should the young patient expect: poor results no matter what, or good results provided extraordinary care could be taken? Assume perfection in the surgical technique and the best imaginable implant for a hypothetical patient. Now consider this thought experiment: if that patient remains active indefinitely, how will the arthroplasty fail? Most surgeons would agree that, barring infection, wear and particle-induced osteolysis ultimately result in loosening. Indeed, that is how we conceptualize arthroplasty in the younger patient and why we try to avoid it out of fear of failure resulting from accelerated wear: not “early” or immediate failure, but premature failure that would lead to revision arthroplasty in a patient with potentially several more decades of life still ahead. Registry data from New Zealand, evaluated by Wainwright et al., indicated that patients younger than fifty years of age at the time of primary total knee arthroplasty had a greater chance of requiring a revision than of dying, those around fifty-eight years had a 50:50 chance of needing a revision, and those older than sixty-two years … |
| Databáze: | OpenAIRE |
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