104 and walking again: What made this centenarian a candidate for double knee replacement

A 104-year-old Saudi man underwent a double knee replacement surgery, surprising his medical team with his strong bones. Dr Sanjeev Jain, who performed the surgery, recalled that the man's sons insisted on the procedure to alleviate his bedridden pain. Despite his advanced age, the patient returned to Saudi Arabia and began walking again.

Dr Gazanfar Patel, a Senior Consultant Orthopaedic Minimal Invasive/Robotic Joint Replacement and Sports Medicine Specialist, explained that age alone should not determine a person's eligibility for major surgery such as bilateral knee replacement. Instead, doctors consider the patient's overall health, functional status, and various medical factors.

Frailty, heart and lung function, kidney health, diabetes, blood pressure control, nutritional status, mobility, and cognitive function are crucial considerations before undergoing knee surgery.

Dr Patel emphasized that a 90- or 100-year-old who is independent, mentally alert, well-nourished, and physically active may tolerate surgery better than a younger person with multiple uncontrolled health conditions. When considering bilateral knee replacement, the surgical team must determine whether performing both knees simultaneously is appropriate or if staging the procedures would be safer. A detailed pre-operative assessment involving multiple medical teams is essential to ensure individualized care.

Bone strength also plays a role in knee replacement success. Stronger bones provide better support for the implants and reduce concerns such as fractures around the implant or poor fixation. However, bone health does not necessarily decline uniformly with age. Maintaining good bone density and muscle strength through adequate calcium and vitamin D intake, regular weight-bearing or resistance exercise, sufficient protein consumption, and avoiding smoking can contribute to better surgical recovery, even in older adults.