Complex Reconstruction in the Elderly - POGOe



Complex Reconstruction in the Elderly

Pre and post assessment questions

1. As the demographics of the US population ages the demand for joint replacement has risen. Many factors influence the overall success of these procedures as well as the risk of complications. However, the best predictor of overall post-operative

outcome is:

A. Patient Age

B. Gender

C. Baseline health status and fitness

D. Pre-existing cardiovascular disease

E. Serum Albumin level of 3.5 mg/dl or less

The best predictor of success and outcome is the overall preinjury assessment of health and fitness. Although age and gender are associated with perioperative risk the preinjury overall health status is the best predictor of outcome.

2. Although elderly patients experience a higher risk of perioperative complications compared to younger patients overall in hospital mortality is low. The most common complications following total joint replacement in the elderly include all of the following except:

A. Pneumonia

B. Delerium

C. Decubitus ulceration

D. Urinary tract infection

E. Aseptic component loosening

Common post-op complications in the elderly include a higher incidence of pneumonia, UTI and decubitus ulceration. Delerium is possibly the most common post-op complication seen in this population of patients. Aseptic loosening is not reported in most case series of elderly joint replacement patients.

3. With respect to total joint replacement in the elderly, the following statements are true except:

A. Total knee replacement will significantly raise health related quality of life assessments in most elderly patients suffering from severe osteoarthritis.

B. Elderly patients are at higher risk for venous thromboembolism and require more aggressive DVT prophylaxis than younger patients.

C. Delerium occurs frequently but usually resolves to baseline mental status after the acute post-operative period.

D. Elderly patients with severe bilateral disease are best served by performing simultaneous bilateral arthroplasties under a single anesthesia.

E. The demand for total knee replacement is roughly double that for total hip replacement.

Total knee replacement has been shown to raise nearly all health related quality of life assessments and some studies suggest that successful joint replacement can increase life expectancy. Elderly patients are at greater risk of DVT and Pulmonary embolism than younger counterparts and more aggressive prophylaxis( i.e. warfarin/LMWH as opposed to aspirirn) is required. Delerium occurs commonly but is usually transient and mental status can be expected to return to baseline after the acute post-op period. Total knee replacement is currently performed with twice the frequency of total hip replacement. The incorrect answer is D. The incidence of severe perioperative complications when simultaneous bilateral arthroplasties is performed in the elderly is prohibitive and staged procedures should be planned.

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