Fortune-telling may reside in the realm of superstition, but data-driven prediction anchors itself firmly within the domain of science. A prime example of this scientific approach is the life table, which marked the initiation of using statistics for forecasting future events.1 Currently, life tables are critical in establishing national healthcare policies as well as treatment protocol of each patient.
Life tables afford detailed predictions about mortality based on factors like age and sex. When predicting the life expectancy of patients with specific disease conditions, a disease-specific life table is mandatory.2 This tailored life table significantly enhances the precision and applicability of decision-making processes and policy development.
Total joint arthroplasty (TJA) stands out as a surgical intervention that significantly improves the quality of life for patients suffering from end-stage arthritis.3 Total knee arthroplasties (TKAs) are globally practiced to reduce pain and functional disability of knee osteoarthritis patients.4,5
However, as the average lifespan extends, some patients outlive the TKA and might necessitate revision surgery in the future.6
Globalization has not mitigated the distinct differences in lifestyle, genetic backgrounds, and health care system across the world. Despite the importance of region-specific life expectancy data after TKA, there was a lack in research within South Korea and across Asia.
The study of Kim et al.7 investigated the 15-year survival rate of 601 patients who underwent TKA at a single institution between 2005 and 2011. The study showed that the age-standardized mortality ratio (SMR) of the cohort was lower than that of the general population, especially in the age group of 70 years and older. The cause-specific SMRs for circulatory disease, neoplasm, and digestive disease were also lower than those of the general population. Circulatory disease and neoplasm are the first to third leading causes of death in Koreans.8
This study and previous studies have reported that TKA has a cardioprotective effect by increasing the functional capacity of patients and reducing the use of drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs).9,10 In addition, reducing drug use can also help reduce digestive disease. The study also suggests that preoperative screening and regular follow-up after surgery can reduce cancer mortality.
More than 30% of patients, who have knee osteoarthritis, undergo TKA during their life, and deep understanding of post-operative life of these patients is crucial.11 Through this study, we can provide information that TKA can reduce long-term mortality as well as improve pain in patients over 70 years of age. However, in the younger age group of 50s to 60s, this effect is less pronounced, and further research is needed in this younger group.
This knowledge is beneficial for pre-operative counseling, post-operative care, and establishment of healthcare policies. It is imperative to disinter tailored relevant data to predict postoperative life of TJA patients.
Footnotes
Disclosure: The authors have no potential conflicts of interest to disclose.
References
- 1.Bellhouse DR. A new look at Halley’s life table. J R Stat Soc Ser A Stat Soc. 2011;174(3):823–832. [Google Scholar]
- 2.Vestergaard P, Rejnmark L, Mosekilde L. Loss of life years after a hip fracture. Acta Orthop. 2009;80(5):525–530. doi: 10.3109/17453670903316835. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Lee YM, Kim GW, Lee CY, Song EK, Seon JK. No difference in clinical outcomes and survivorship for robotic, navigational, and conventional primary total knee arthroplasty with a minimum follow-up of 10 years. Clin Orthop Surg. 2023;15(1):82–91. doi: 10.4055/cios21138. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Kwak WK, Seon JK. Comparison of survival rate between posterior-stabilized and constrained condylar articulations in revision total knee arthroplasty: a minimum 5-year follow-up analysis. Clin Orthop Surg. 2023;15(4):589–596. doi: 10.4055/cios22012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Lee NK, Won SJ, Lee JY, Kang SB, Yoo SY, Chang CB. Presence of night pain, neuropathic pain, or depressive disorder does not adversely affect outcomes after total knee arthroplasty: a prospective cohort study. J Korean Med Sci. 2022;37(43):e309. doi: 10.3346/jkms.2022.37.e309. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Na BR, Kwak WK, Lee NH, Song EK, Seon JK. Trend shift in the cause of revision total knee arthroplasty over 17 years. Clin Orthop Surg. 2023;15(2):219–226. doi: 10.4055/cios21106. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Kim S, Won J, Lee NK, Chang CB. Life expectancy of patients undergoing total knee arthroplasty: comparison with general population. J Korean Med Sci. 2024;39(11):e106. doi: 10.3346/jkms.2024.39.e106. [DOI] [PubMed] [Google Scholar]
- 8.Tai SY, Cheon S, Yamaoka Y, Chien YW, Lu TH. Changes in the rankings of leading causes of death in Japan, Korea, and Taiwan from 1998 to 2018: a comparison of three ranking lists. BMC Public Health. 2022;22(1):926. doi: 10.1186/s12889-022-13278-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Lin WY, Lee CC, Hsu CW, Huang KY, Lyu SR. Patients with knee osteoarthritis undergoing total knee arthroplasty have a lower risk of subsequent severe cardiovascular events: propensity score and instrumental variable analysis. PLoS One. 2015;10(5):e0127454. doi: 10.1371/journal.pone.0127454. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Ravi B, Croxford R, Austin PC, Lipscombe L, Bierman AS, Harvey PJ, et al. The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis. BMJ. 2013;347:f6187. doi: 10.1136/bmj.f6187. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Burn E, Murray DW, Hawker GA, Pinedo-Villanueva R, Prieto-Alhambra D. Lifetime risk of knee and hip replacement following a GP diagnosis of osteoarthritis: a real-world cohort study. Osteoarthritis Cartilage. 2019;27(11):1627–1635. doi: 10.1016/j.joca.2019.06.004. [DOI] [PubMed] [Google Scholar]