In an aging population, the incidence of severe knee osteoarthritis in very elderly patients increases, leading to functional impairment and loss of independence. Knee replacement could be an effective treatment but is often denied due to fear of increased complication rate with advanced age. The objective of this study was to investigate complication rate, mortality, clinical outcome, and quality-adjusted life years (QALYs) of primary knee replacement in very elderly patients, defined as 83 years or older. Medical records of 85 cases, receiving a primary total (total knee arthroplasty [TKA]) or unicompartmental (unicompartmental knee arthroplasty [UKA]) knee replacement, aged 83 years or older at the time of surgery, were retrospectively reviewed for surgical and medical complications as well as survivorship. Functional outcome was obtained by Oxford Knee Score (OKS) and QALY. At a mean follow-up of 21 months (TKA) and 24 months (UKA), surgical and medical complication rates were 9.7 and 8.1% for TKA and 4.3 and 4.3% for UKA, respectively. One-year survival rate was 98.4% in TKA and 98.8% in UKA, the 5-year survival rate was 83.1 and 86.6%, respectively. OKS improved from 19 to 41 points in TKA and 23 to 40 points in UKA. Mean QALYs were 4.1 years for TKA and 3.9 years for UKA. TKA and UKA are safe and reliable surgical procedures in treating end-stage osteoarthritis in very elderly patients. Patients might benefit from improved pain, function, and quality of life. The mortality rate and overall complication rate were low, although slightly higher than reported in cohorts with younger patients. If the patient is suitable, UKA might be preferred over TKA, as the complication rate was significantly lower. Patients should not be excluded from knee replacement based on their age alone, but careful patient selection, peri- and postoperative optimization, and awareness for complications are quintessential for successful treatment.

在人口老龄化中，高龄患者严重膝骨关节炎的发病率增加，导致功能障碍和独立性丧失。膝关节置换术可能是一种有效的治疗方法，但由于担心随着年龄的增长并发症发生率会增加，因此常常被拒绝。本研究的目的是调查高龄患者（定义为 83 岁或以上）初次膝关节置换术的并发症发生率、死亡率、临床结果和质量调整生命年 (QALY)。回顾性审查了 85 例接受初次全膝关节置换术（全膝关节置换术 [TKA]）或单间室膝关节置换术（单间室膝关节置换术 [UKA]）膝关节置换术的病例的医疗记录，手术时年龄为 83 岁或以上，以了解手术和医疗并发症的情况以及生存情况。功能结果通过牛津膝关节评分 (OKS) 和 QALY 获得。在平均随访 21 个月 (TKA) 和 24 个月 (UKA) 时，TKA 的手术和医疗并发症发生率分别为 9.7% 和 8.1%，UKA 的手术和医疗并发症发生率分别为 4.3% 和 4.3%。TKA 和 UKA 的一年生存率分别为 98.4% 和 98.8%，5 年生存率分别为 83.1% 和 86.6%。OKS 在 TKA 中从 19 分提高到 41 分，在 UKA 中从 23 分提高到 40 分。TKA 的平均 QALY 为 4.1 年，UKA 的平均 QALY 为 3.9 年。TKA 和 UKA 是治疗高龄患者终末期骨关节炎的安全可靠的外科手术。患者可能会受益于疼痛、功能和生活质量的改善。死亡率和总体并发症发生率较低，但略高于年轻患者队列中报道的水平。如果患者适合，UKA 可能优于 TKA，因为并发症发生率明显较低。患者不应仅因年龄而被排除在膝关节置换术之外，但仔细的患者选择、围手术期和术后优化以及对并发症的认识是成功治疗的关键。