Safety and efficacy of ambulatory total knee arthroplasty with enhanced recovery after surgery protocols in well-selected patients aged 80 years and older.

Introduction: An enhanced recovery after surgery protocol following total knee arthroplasty (TKA) offers multiple benefits. However, there are concerns about whether old age should be a criterion for exclusion from this protocol. This study aimed to determine the safety and outcomes of ambulatory TKA for patients aged ≥80 years.

Methods: A retrospective study was conducted using data from our hospital knee registry database (2021-2024). We compared the length of hospital stay, complication rate, readmission rate, three-month postoperative functional outcomes and overall experiences of patients (aged ≥80 years) who underwent ambulatory TKA with patients (aged ≥80 years) who underwent non-ambulatory TKA and younger patients who underwent ambulatory TKA. Functional outcomes were evaluated using Oxford Knee Score (OKS), Knee Society Clinical Score (KSS) and Knee Society Functional Score (KSFS). The minimal clinically important difference cutoffs for OKS, KSFS and KSS were 5.0, 6.4 and 5.9, respectively.

Results: There were clinically significant improvements in the three-month postoperative functional scores compared to preoperative scores in all patient groups. Patients aged ≥80 years who underwent ambulatory TKA had lower complication and readmission rates compared to the other patient groups. They also had better three-month postoperative functional scores than patients who underwent non-ambulatory TKA ( P = 0.004 for OKS, P = 0.003 for KSFS), and similar outcomes as younger patients ( P > 0.050 for OKS, KSFS). Length of hospital stay, satisfaction rates and rates of expectation met were comparable between patients aged ≥80 years and younger patients who underwent ambulatory TKA.

Conclusion: In carefully selected patients aged ≥80 years, ambulatory TKA is safe and yields outcomes comparable to those of younger patients.