Complications following single-stage bilateral total knee arthroplasty and unilateral procedures: experience of a high-volume community hospital

Comparative Outcomes of Bilateral Versus Unilateral Total Knee Arthroplasty: A Big Data Analysis

Background: Bilateral total knee arthroplasty (B-TKA) is a surgical option for patients with bilateral osteoarthritis, offering potential efficiency and cost advantages but with increased perioperative risk. Methods: We conducted a retrospective analysis of 2,299,979 elective TKA cases from the Nationwide Inpatient Sample (2016-2019). Propensity score matching (PSM) was used to compare 83,980 B-TKA patients with matched unilateral TKA (U-TKA) patients. Outcomes included in-hospital mortality, complications, length of stay, and hospital charges. Results: B-TKA patients had higher rates of complications such as deep vein thrombosis (OR 1.798) and pulmonary embolism (OR 1.883), longer hospital stays (3.03 vs. 2.49 days), and higher charges (USD 83,639 vs. USD 59,215; all p < 0.001). Conclusions: Although B-TKA is associated with increased perioperative risk, it may offer logistical and economic advantages in well-selected patients. These findings support the need for risk stratification in surgical decision-making.

Simultaneous bilateral total knee arthroplasty has higher risk of asymptomatic deep vein thrombosis in patients in their 80s compared with unilateral total knee arthroplasty: a propensity score-matched comparative study across different age groups

INTRODUCTION

This study compared complications and clinical outcomes between simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral total knee arthroplasty (UTKA) across different age groups.

MATERIALS AND METHODS

This retrospective single-center study included 939 consecutive patients aged 60-89 years who underwent primary total knee arthroplasty between 2019 and 2023. After applying propensity score matching for preoperative deep vein thrombosis (DVT), American Society of Anesthesiologists (ASA) classification, and preoperative functional activity according to the Knee Society Score 2011 (KSS) to 223 patients who underwent SBTKA and 716 patients who underwent UTKA, SBTKA and UTKA were compared in the following age groups: 60s (28 vs. 28), 70s (110 vs. 110), and 80s (60 vs. 60). Perioperative complications and clinical outcomes at 1 year after surgery were compared between SBTKA and UTKA. Lower limb Doppler ultrasound was performed to screen for asymptomatic DVT preoperatively and on postoperative day 7.

RESULTS

Average ASA classification ranged from 2.0 to 2.2 across all age groups, with no difference between SBTKA and UTKA. Compared with UTKA, the decrease in hemoglobin was significantly greater after SBTKA in patients in their 70s and 80s (both p < 0.001). The proportion of blood transfusion showed no significant difference across all age groups. Asymptomatic DVT was more frequent after SBTKA than after UTKA in patients in their 80s (58.3% vs. 40.0%, p < 0.045), but not those in their 60s (42.9% vs. 32.1%) or 70s (50.9% vs. 46.3%). Clinical outcomes (knee symptoms, patient satisfaction, patient expectations, functional activity according to the KSS) were comparable between SBTKA and UTKA across all age groups at 1 year postoperatively.

CONCLUSIONS

SBTKA had higher risk of asymptomatic DVT in patients in their 80s. With evaluation of risk factors and careful patient selection, SBTKA is a valid option in terms of safety and clinical outcomes in elderly patients with ASA 2.

The prevalence of bilateral and ipsilateral radiographic osteoarthritis is high in White, Asian and Native Hawaiian/Pacific Islanders presenting for unilateral knee or hip arthroplasty

BACKGROUND

It is estimated that one-third of patients presenting with unilateral joint pain have contralateral osteoarthritis (OA) at first presentation. Most studies have primarily examined White patient cohorts. The purpose of this study was to determine the prevalence of contralateral joint OA for patients presenting for unilateral total knee (TKA), unicompartmental knee (UKA) or total hip arthroplasty (THA) among Asian, Native Hawaiian/Pacific Islander and White patients.

METHODS

Bilateral radiographic reports at initial presentation of 2,312 subjects who underwent unilateral arthroplasties (332 UKAs, 933 TKAs and 1,047 THAs) were reviewed. The presence of contralateral OA was recorded and compared by racial group and type of arthroplasty performed. Parametric statistical analyses were performed to determine differences between groups. Multivariable analyses were completed for each arthroplasty group to determine the influence on the presence of contralateral OA, presented as odds ratios and 95% confidence intervals.

RESULTS

Contralateral joint OA was present in 86.7%, 90.4% and 70.4% of UKA, TKA and THA patients, respectively. Concurrent hip OA was present in 41.6% and 59.5% of UKA and TKA patients. No racial differences in the prevalence of contralateral knee OA were found for knee arthroplasty patients. White patients (74.6%) had a greater prevalence of contralateral hip OA compared to Asians (66.5%, p = 0.037) amongst THA recipients. Increased age and body mass index were significantly associated with the presence of contralateral knee OA. Increased age, being male and being White were significant contributors for the presence of contralateral hip OA.

CONCLUSION

The prevalence of contralateral joint OA and concurrent hip OA is high in all three racial groups. Due to the extensive prevalence of contralateral and concurrent knee and hip OA, bilateral radiographic evaluation should be considered for all patients presenting with unilateral hip or knee pain due to OA.