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Park KK, Kwon HM, Cho BW, Lee TS, Lee WS, Park JY. Clinical safety and efficacy of simultaneous bilateral total knee arthroplasty in an Asian population: a propensity score-matched analysis. J Orthop Surg Res 2025; 20:508. [PMID: 40410882 PMCID: PMC12102920 DOI: 10.1186/s13018-025-05933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2025] [Accepted: 05/14/2025] [Indexed: 05/25/2025] Open
Abstract
BACKGROUND Clear clinical guidelines on performing simultaneous bilateral total knee arthroplasty (BTKA) are lacking. We compare the clinical outcomes between BTKA and unilateral total knee arthroplasty (UTKA) using propensity score matching to assess safety and clinical efficacy, hypothesizing no difference in clinical safety. METHODS Among 1,665 BTKA and UTKA cases, patients were matched in a 1:1 ratio by age, sex, body mass index, follow-up, and comorbidities, resulting in 653 patients per group. Primary outcomes included 30-day complication rates and intensive care unit (ICU) admission rates. Secondary outcomes included length of stay (LOS), transfusion rate, estimated blood loss, hemoglobin (Hb) levels (preoperative and two days postoperative), Hb decrease, and 1-year mortality rate. The patient-reported outcomes (PROMs) was measured preoperatively and at 3, 6, and 12 months postoperatively using the American Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and EuroQol 5-Dimension. RESULTS There were no differences in the 30-day complication rates and ICU admission rate between the BTKA and UTKA groups after matching (1.4% vs. 0.9%; p = 0.60, 0.5% vs. 0.6%; p = 1.00). However, patients who underwent BTKA had a longer LOS, a higher incidence of transfusion (7.2% vs. 2.1%; p < 0.001), greater blood loss (128.6 ± 75.5 vs. 72.5 ± 45.6 mL; p < 0.001), and a more pronounced decrease in Hb levels (3.1 vs. 2.9 g/dL; p < 0.001) than those who underwent UTKA. No significant differences were observed in PROMs at one year postoperatively. CONCLUSIONS Patients who underwent BTKA reported similar 30-day complication rates, ICU admissions, and PROMs compared to UTKA. Despite higher LOS, transfusion rates, blood loss, and Hb decrease, BTKA remains a safe, effective option. It should be performed cautiously, considering patient comorbidities and overall health in treating bilateral knee OA.
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Affiliation(s)
- Kwan Kyu Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuck Min Kwon
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Woo Cho
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Sung Lee
- Department of Orthopaedic Surgery, Heung-K Hospital, Gyeonggi-do, Republic of Korea
| | - Woo-Suk Lee
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Young Park
- Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, 16995, Gyeonggi-do, Republic of Korea.
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Quinlan ND, Miner TM, Jennings JM, Dennis DA. Timing and Selection of Lower Extremity Arthroplasty Procedures: Which to Perform First and When to Consider Simultaneous Bilateral Procedures. JBJS Rev 2025; 13:01874474-202505000-00001. [PMID: 40388546 DOI: 10.2106/jbjs.rvw.25.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2025]
Abstract
» For patients with both lumbar spine pathology, hip and knee degenerative joint disease, it is important to consider the implications of surgically addressing each anatomic region first.» Performing total hip arthroplasty before lumbar spine fusion may decrease the risk of dislocation and revision surgery; however, if spinal fusion is performed first, it may be protective to wait 1 to 2 years to lower the risk of complications.» In all patients with concurrent hip and low back symptoms, it is recommended that an evaluation of both areas is performed before proceeding with either surgical intervention.» If arthroplasty procedures are to occur in a staged fashion, adverse events in high-risk patients may be mitigated by waiting for more than 1 year between procedures. Staged procedures performed less than 30 days apart are at increased risk of medical and surgical complications.» Simultaneous bilateral total joint arthroplasty procedures should likely be avoided in more elderly patients, those with higher body mass index and those with a greater burden of medical comorbidities due to the increased risks of postoperative complications.
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Affiliation(s)
| | | | - Jason M Jennings
- Colorado Joint Replacement, Denver, Colorado
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
| | - Douglas A Dennis
- Colorado Joint Replacement, Denver, Colorado
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
- Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado
- Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
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Postler AE, Krull P, Wu Y, Günther KP, Melsheimer O, Steinbrück A, Lützner J. Best timing of bilateral knee arthroplasty- an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD). BMC Musculoskelet Disord 2025; 26:311. [PMID: 40165173 PMCID: PMC11956241 DOI: 10.1186/s12891-025-08548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2024] [Accepted: 03/18/2025] [Indexed: 04/02/2025] Open
Abstract
BACKGROUND The burden of osteoarthritis (OA) in multiple joints is high. For patients with bilateral knee OA there is no clear recommendation when to time the second surgery. The purpose of this study was therefore to compare revision and mortality rate in bilateral unicondylar and bicondylar knee arthroplasties after different strategies of surgical timing in bilateral knee OA from the German Arthroplasty Registry (EPRD). METHODS Data from the German Arthroplasty Registry (EPRD) was used. Since 2012 a total of 15,154 patients had bilateral knee arthroplasty within one year. Patellofemoral arthroplasties and constraint total knee arthroplasties (TKA) were excluded. 1,144 TKA and 682 unicondylar arthroplasties (UKA) were simultaneously performed, 772 TKA and 292 UKA between 1 and 90 days (short interval) and 24,496 TKA and 2,922 UKA between 91 and 365 days (intermediate interval). Revision and mortality rates were analyzed up to 7 years after surgery. Cox regression was performed to evaluate the influence of different patient characteristics on these outcomes. RESULTS The highest cumulative revision rate for any of the bilateral TKA was found for simultaneous surgery with 3.4% (95% CI 2.1-5.5). Lower risk for revision was seen in two-staged surgery in short interval (HR 0.42; 95% CI 0.20-0.90) and intermediate interval (HR 0.58; 95% CI 0.39-0.85). The cumulative one year mortality rate for TKA was comparable in all three groups with 0.8% for simultaneous TKA, 1.3% for short interval two-staged and 0.7% for intermediate interval. In UKA there were no differences between the groups regarding cumulative revision rate and mortality rate. CONCLUSION TKA should be performed simultaneously in selected patients only, the two-staged procedure demonstrated lower revision risks. For UKA we found no differences in timing, simultaneous surgery seems to be a safe option. TRIAL REGISTRATION Clinical trial number not applicable. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anne Elisabeth Postler
- University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Paula Krull
- German Arthroplasty Registry (EPRD), Berlin, Germany
| | - Yinan Wu
- German Arthroplasty Registry (EPRD), Berlin, Germany
| | - Klaus-Peter Günther
- University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany
| | | | | | - Jörg Lützner
- University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany
- German Arthroplasty Registry (EPRD), Berlin, Germany
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Ichinose R, Aubin PM, Schumacker ST, Cushner FD. Recovery of Ambulation After Staged Bilateral Total Knee Arthroplasty Is Not Affected by Timing of Second Side Surgery: A Retrospective Analysis of Implanted Sensor Data. J Arthroplasty 2025:S0883-5403(25)00222-0. [PMID: 40089123 DOI: 10.1016/j.arth.2025.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 03/03/2025] [Accepted: 03/05/2025] [Indexed: 03/17/2025] Open
Abstract
BACKGROUND Bilateral knee osteoarthritis is often treated with staged bilateral total knee arthroplasty (BTKA). However, the optimal surgical timing for staging remains contended. In this study, a smart implant sensor was used to assess the association between surgical timing of stages and recovery of ambulation after the second total knee arthroplasty (TKA). METHODS Overall, 246 staged bilateral and 2,209 unilateral TKA patients received a sensor-enabled knee implant between 2021 and 2023. Staged BTKA patients were stratified into three subgroups based on time intervals between surgeries: extra early (< 6 weeks), early (< 13 weeks), or standard (≥ 13 weeks). Mixed effects repeated measures modeling methods were used to compare daily qualified step count, walk speed, and functional knee range of motion (ROM) during ambulation between the groups. RESULTS The three BTKA groups had significantly different daily step counts, walking speed, and knee ROM during the preoperative period before the second TKA. The extra early bilateral group took fewer qualified steps (P < 0.05), walked slower (P < 0.05), and had less knee ROM (P < 0.05) than both the early and standard groups at the 2-week point before their second TKA (P < 0.0 5). At 26 weeks after the second TKA, walking speed, and knee ROM showed no significant difference across the extra early, early, standard, and unilateral groups (P > 0.05). CONCLUSIONS Close staging of BTKA surgeries, even less than 6 weeks apart, did not negatively affect the recovery of postoperative ambulation after the second TKA. Our results may help inform surgeons and patients on timing for staging, especially if a shorter staging is preferred for convenience and shorter overall recovery time. LEVEL OF EVIDENCE III Retrospective Cohort Study.
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Affiliation(s)
- Rika Ichinose
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | | | | | - Fred D Cushner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York; Canary Medical USA LLC, Carlsbad, California
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Tsui OWK, Chan PK, Cheung A, Chan VWK, Luk MH, Cheung MH, Lau LCM, Leung TKC, Fu H, Chiu KY. Comparison of the Cost-Effectiveness and Safety between Staged Bilateral Total Knee Arthroplasty and Simultaneous Bilateral Total Knee Arthroplasty: A Retrospective Cohort Study between 2001 and 2022. J Knee Surg 2024; 37:916-923. [PMID: 39019474 DOI: 10.1055/a-2368-4516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
A substantial proportion of Hong Kong's aging population suffers from osteoarthritis in both knees. Bilateral total knee arthroplasty (BTKA) is a surgical option for addressing this condition and can be performed via two approaches: simultaneous BTKA (SimBTKA) and staged BTKA (StaBTKA). We compared the cost-effectiveness and safety of these two methods in our institution. We retrospectively reviewed 2,372 patients (SimBTKA, 772; StaBTKA, 1,600; females, 1,780; males, 592; mean age at SimBTKA, 70.4 ± 7.99 years; mean age at StaBTKA, 66.4 ± 7.50 years; p < 0.001) who underwent BTKA in our institution from 2001 to 2022. Patients were categorized according to the surgical approach. Patients undergoing BTKA in our institution were included. Particularly for SimBTKA, patients were assessed by anesthetists to be medically fit before undergoing the procedure according to their age, American Society of Anesthesiologists status, and osteoarthritis severity. The primary outcome was the length of stay (LOS) after surgery. The secondary outcomes were the 30-day unintended readmission, intensive care unit (ICU) admission, and death. SimBTKA had a shorter mean total LOS (acute hospital + rehabilitation center; SimBTKA, 13.09 days; StaBTKA, 18.12 days; p < 0.001) and mean LOS in acute hospital (SimBTKA, 7.70 days; StaBTKA, 10.42 days; p < 0.001). However, no significant difference was found in the mean LOS in rehabilitation centers (SimBTKA, 5.47 days; StaBTKA, 6.32 days; p > 0.05) between the two approaches. The 30-day unintended readmission rate was lower in SimBTKA (SimBTKA, 2.07%; StaBTKA, 3.30%; odds ratio [OR] = 1.60; p > 0.05) but statistically insignificant. SimBTKA was less costly than StaBTKA by US$ 8,422.22 per patient. No significant differences in ICU admission and death rates were found (p > 0.05) between the two groups. SimBTKA had a shorter LOS and lower cost than StaBTKA and comparable complication rates. Therefore, SimBTKA should be indicated in medically stable patients.
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Affiliation(s)
- Omar W K Tsui
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ping-Keung Chan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Amy Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Vincent W K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Michelle H Luk
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Man-Hong Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lawrence C M Lau
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Thomas K C Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Henry Fu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kwong-Yuen Chiu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Chang WL, Lee KH, Tsai SW, Chen CF, Wu PK, Chen WM. Age-adjusted Charlson Comorbidity Index as an effective tool for the choice between simultaneous or staged bilateral total knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:3591-3597. [PMID: 38972903 DOI: 10.1007/s00402-024-05435-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/27/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION The choice between simultaneous and staged bilateral total knee arthroplasty (BTKA) remains controversial. Age-adjusted Charlson Comorbidity Index(CCI) is a promising tool for risk-stratification. We aimed to compare the outcomes between patients who underwent simultaneous and staged BTKA, stratified by age-adjusted CCI scores. MATERIALS AND METHODS We conducted this retrospective, single-surgeon case series from 2010 to 2020. This study consisted of 1558 simultaneous BTKA and 786 staged BTKA procedures. The outcome domains included 30-day and 90-day readmission and 1-year reoperation events. We performed multivariate regression analysis to compare the risk of readmission and reoperation following simultaneous and staged BTKA. Other factors included age, sex, body mass index, diabetes mellitus, rheumatoid arthritis, smoking, receiving thromboprophylaxis and blood transfusion. RESULTS The rates of 30-day, 90-day readmission and 1-year reoperation following simultaneous BTKA was 1.99%, 2.70% and 0.71%, respectively. The rates of 30-day, 90-day readmission and 1-year reoperation following staged BTKA was 0.89%, 1.78% and 0.89%, respectively. For patients with age-adjusted CCI ≥ 4 points, simultaneous BTKA was associated with a higher risk of 30-day (aOR:3.369, 95% CI:0.990-11.466) and 90-day readmission (aOR:2.310, 95% CI:0.942-5.668). In patients with age-adjusted CCI ≤ 3 points, the risk of readmission and reoperation was not different between simultaneous or staged BTKA. CONCLUSION Simultaneous BTKA was associated with an increased risk of short-term readmissions in patients with age-adjusted CCI ≥ 4 points but not in those with age-adjusted CCI ≤ 3 points. Age-adjusted CCI can be an effective index for the choice between simultaneous and staged BTKA procedures.
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Affiliation(s)
- Wei-Lin Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kun-Han Lee
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Sustich SJ, Stambough JB, Hui R, Siegel ER, Barnes CL, Mears SC. Postoperative Opioid Consumption is Greater after Simultaneous versus Staged Bilateral Total Knee Arthroplasty. J Knee Surg 2024; 37:436-443. [PMID: 37852291 DOI: 10.1055/s-0043-1775872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Increased exposure to opioids around total knee arthroplasty (TKA) can lead to a risk of long-term dependence. We hypothesized that performing simultaneous bilateral total knee arthroplasty (simBTKA) over staged surgery (staged bilateral total knee arthroplasty [stgBTKA]) may decrease the total amount of opiates used. We retrospectively reviewed 29 patients who underwent simBTKAs performed between February 2015 and November 2020 and identified 23 that did not use opioids ≤90 days prior to surgery. These were frequency matched for gender and body mass index to 50 stgBTKAs completed within 6 months who also were opioid-free ≤90 days prior to their first surgery. Using our state's prescription database, we reviewed postsurgery opioid refills and morphine milligram equivalents (MMEs) for the two groups and compared their initial MME prescription at discharge and their total MME consumption 6 months postoperatively. Total MME consumption for the stgBTKA group included all prescriptions following the first and 6 months after the second surgery, whereas for the simBTKA group, total consumption included the 6 months after their two same-day surgeries. The simBTKA group had more MMEs prescribed initially (median = 375) than did the stgBTKA group after second surgery (median = 300; p < 0.007), larger postoperative-refill MMEs in the first 30 days (median = 300) than stgBTKA (median = 0; p = 0.221) and increased total MME consumption 6 months after surgery (median = 675) compared with stgBTKA after second surgery (median = 450; p = 0.077). However, both groups had similar monthly consumptions rates, with medians I MMEs/month of 112 for simBTKA versus 96 for stgBTKA (p = 0.585). Our results suggest there is no significant difference in opioid consumption between simBTKA and stgBTKA. In fact, we found that simBTKA patients received larger opioid amounts in the immediate postoperative period as well as slightly larger amounts at 30 days.
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Affiliation(s)
- Sara J Sustich
- Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ryan Hui
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Cohen JS, Agarwal AR, Gu A, Harris A, Kinnard MJ, Golladay GJ, Thakkar SC. No Difference in 30-day Mortality Between Patients Undergoing Bilateral Simultaneous Total Knee Arthroplasty With Technology Assistance Compared to Conventional Instrumentation. HSS J 2024; 20:230-236. [PMID: 39282001 PMCID: PMC11393621 DOI: 10.1177/15563316231160155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/29/2022] [Indexed: 09/18/2024]
Abstract
Background: Bilateral simultaneous total knee arthroplasty (BSTKA) has decreased in frequency due to concerns about higher rates of early mortality and complications than unilateral or staged surgeries. Purpose: We sought to evaluate whether technology assistance (encompassing robotics and computer assistance) decreases early mortality following BSTKA. Methods: We conducted a retrospective cohort study using a national all-payer claims database. Patients who underwent BSTKA from October 2015 to December 2020 were identified. Univariate and multivariable analyses were conducted to compare outcomes in patients who underwent BSTKA with technology assistance compared to conventional instrumentation. The primary outcome was 30-day postoperative mortality. Secondary outcomes were respiratory failure and fat embolism. A post-hoc analysis was performed to evaluate length of stay, readmission, and other medical complications. Results: A total of 14,870 patients who underwent BSTKA were included in this study. Of these, 860 patients underwent technology-assisted BSTKA, and 14,010 patients underwent BSTKA without technology assistance. After a multivariable analysis, patients who underwent technology-assisted BSTKA had equivalent odds of 30-day mortality compared to those who underwent BSTKA without technology assistance. Technology assistance was not protective against the development of acute respiratory failure or fat embolism. Conclusion: This retrospective cohort study found no differences in the rates of 30-day mortality, respiratory failure, or fat embolism after technology-assisted BSTKA compared to conventional BSTKA. On the post-hoc analysis, technology use was associated with a decreased length of stay, lower readmission risk, and decreased rates of deep vein thrombosis, pulmonary embolism, and blood transfusion.
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Affiliation(s)
- Jordan S. Cohen
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Amil R. Agarwal
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Andrew Harris
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew J. Kinnard
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Gregory J. Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Savyasachi C. Thakkar
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Baltimore, MD, USA
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Franceschetti E, Campi S, Gregori P, Giurazza G, Samuelsson K, Hirschmann MT, Laudisio A, Papalia GF, Zampogna B, Papalia R. No differences in terms of complications, readmissions, reoperations, and patient-reported outcomes in simultaneous bilateral versus staged bilateral total knee arthroplasty in selected patients. Knee 2024; 47:151-159. [PMID: 38394994 DOI: 10.1016/j.knee.2023.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/09/2023] [Accepted: 11/27/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND The safety and the clinical success of simultaneous bilateral total knee arthroplasty (BTKA) is controversial. The aim of this study was to compare complications and patient-reported outcomes following simultaneous BTKA (simBTKA) versus staged BKTA (staBTKA) in patients affected by bilateral symptomatic end-stage knee osteoarthritis (OA). METHODS Data from patients who underwent simBTKA or staBTKA at a single institution from January 2017 to December 2020, with a minimum 1-year follow up period were retrospectively collected. Differences in terms of complications and clinical success were compared among the simBTKA and staBTKA patient groups. Alpha was set at 0.05. RESULTS A total of 173 patients were included in this study. The results revealed no statistically significant differences between the two groups in terms of mortality, revision rate, readmission rate, local and systemic complications and patient-reported outcomes. SimBTKA group had a shorter operating room time (96 (73-119) vs. 195 (159-227); P < 0.0001), and length of hospital stay (4 (3-5) vs. 7 (6-9); P < 0.0001) compared with the staBTKA group. CONCLUSIONS SimBTKA performed in a selected patient population at a high-volume center can be considered comparable to staBTKA in terms of safety, postoperative complications, 30-day readmissions and patient satisfaction. Consequently, reduced operating room time and hospital stay renders simBTKA a cost-effective and advantageous option, not only for patients, but also for healthcare institutes. Furthermore, the current study also highlights the importance of correct patient selection based on clinical preoperative characteristics.
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Affiliation(s)
- Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Stefano Campi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Pietro Gregori
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giancarlo Giurazza
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland; University of Basel, Basel, Switzerland
| | - Alice Laudisio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Khan IA, Kahlon S, Theosmy E, Ciesielka KA, Fillingham YA. Delta hemoglobin cutoffs do not predict readmission in patients undergoing primary simultaneous bilateral total hip or knee arthroplasty: A retrospective cohort study. J Clin Orthop Trauma 2024; 49:102334. [PMID: 38333745 PMCID: PMC10847021 DOI: 10.1016/j.jcot.2024.102334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/26/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Background/aims Primary simultaneous bilateral total joint arthroplasty (simBTJA) can cause postoperative anemia. Clinicians might hesitate to discharge patients who have large changes in hemoglobin [Hgb], despite Hgb levels remaining above transfusion thresholds. This study was conducted to evaluate if delta Hgb or perioperative blood loss correspond with readmission in primary simBTJA patients not transfused perioperatively. Methods From 2015 - 2020, a retrospective chart review of primary simultaneous bilateral total hip/knee arthroplasty cases was conducted. Preoperative and postoperative Hgb levels were obtained from our database or chart review. Exclusion criteria comprised patients who had a preoperative transfusion or transfusion postoperatively during their surgical admission, and patients not discharged home. Outcomes included whether delta Hgb or perioperative blood loss were predictive of 90-day readmission postoperatively, postoperative anemia, and transfusion during readmission. Results The 510 individuals undergoing primary simBTJA possessed an average preoperative Hgb of 14.1 g/dL, starting blood volume of 5012 mL, postoperative Hgb of 10.0 g/dL, delta Hgb of 3.90 g/dL, and perioperative blood loss of 1403 mL. 19 patients (3.73 %) were readmitted, with none requiring transfusion. When constructing receiver operating characteristic (ROC) curves predicting readmission from delta Hgb, a threshold of 4.1 g/dL had an area under the curve (AUC) of 0.454, a sensitivity of 0.473, and a specificity of 0.56. For ROC curves predicting readmission from perioperative blood loss, a threshold of 1144 mL had an AUC of 0.453, a sensitivity of 0.842, and a specificity of 0.297. Similar AUCs, sensitivities, and specificities were obtained when adjusting ROC curves for preoperative Hgb or starting blood volume. Conclusions Delta Hgb and perioperative blood loss do not predict 90-day readmission after primary simBTJA in patients not transfused perioperatively. Patients with a large delta Hgb but stay higher than a 7 g/dL restrictive transfusion threshold may have a strong capacity to overcome postoperative anemia.
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Affiliation(s)
- Irfan A. Khan
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Sundeep Kahlon
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Edwin Theosmy
- Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Kerri-Anne Ciesielka
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Yale A. Fillingham
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Kirschbaum S, Hube R, Perka C, Najfeld M. Bilateral simultaneous knee arthroplasty shows comparable early outcome and complication rate as staged bilateral knee arthroplasty for patients scored ASA 1-3 if performed by a high-volume surgeon: a retrospective cohort study of 127 cases. Arch Orthop Trauma Surg 2024; 144:417-424. [PMID: 37814008 PMCID: PMC10774180 DOI: 10.1007/s00402-023-05078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/17/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND AND PURPOSE The study compares early outcomes after simultaneous and staged knee arthroplasty in patients with bilateral knee osteoarthritis (OA) to evaluate whether simultaneous bilateral TKA shows comparable early outcomes and complication rates to staged bilateral TKA. METHODS A retrospective cohort study including all patients scheduled for primary TKA for bilateral knee OA (n = 127) was conducted. Patients received either simultaneous (n = 53, 41.7%) or staged (n = 74, 58.3%) bilateral TKA by a single, high-volume surgeon-depending on their individual preference. Demographic data, haemoglobin drop (Hb), length of stay (LOS), operation time, 30-day complication rate and achievement of rehabilitation key points were evaluated. RESULTS There was no difference between the groups concerning age, sex, BMI or complication rate. ASA scoring was better in the simultaneous group [2.2, (15.1% ASA 1, 49.1% ASA 2, 35.8% ASA 3) vs. 2.4 (2.7% ASA 1, 51.4% ASA 2, 45.9% ASA 3)]. Average LOS was 7.8 ± 2.1 days for simultaneous TKA, 7.4 ± 1.7 days for single procedure of staged group (p < 0.453) and 14.7 ± 3.1 days if combined (p < 0.001). Cumulative Hb loss was significantly higher in the staged group (3.8 ± 1.2 g/dl vs. 2.4 ± 0.8 g/dl, p < 0.001). Detailed comparison of early outcome parameters between staged and simultaneous procedure depending on ASA score only revealed slightly slower assessment of stairs (p < 0.001) and increased Hb drop per surgery in case of simultaneous procedure (p < 0.011) if ASA score was ≥ 2. Only patients scored ASA 3 demonstrated a significant longer LOS per procedure in simultaneous group (8.5 ± 2.4 vs.7.3 ± 1.6 days, p = 0.034). INTERPRETATION Simultaneous bilateral TKA results in comparable early outcome and complication rate than staged bilateral procedure-even for patients scored ASA 3. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Stephanie Kirschbaum
- Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Robert Hube
- OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Najfeld
- OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
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12
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Alshaikh AM, Alshaeri NM, Jamal R, Almaghthawi OF, Al Eid MM, Alfageeh ZS, Alturkistani AM, Ali AMB. Mortality Following Simultaneous Versus Staged Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e50823. [PMID: 38125692 PMCID: PMC10732000 DOI: 10.7759/cureus.50823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 12/23/2023] Open
Abstract
Bilateral total knee arthroplasty (BTKA) is a common intervention for bilateral knee osteoarthritis, and the choice between simultaneous (SimBTKA) and staged (StaBTKA) procedures remains a critical decision. This meta-analysis systematically reviews and analyzes the existing literature to compare mortality outcomes associated with SimBTKA and StaBTKA. A comprehensive search was conducted across major databases for studies reporting mortality outcomes in SimBTKA and StaBTKA. Inclusion criteria encompassed studies published up to the cutoff date of January 2023, and a total of 37 studies were included in the quantitative synthesis. Meta-analysis was performed using a random-effects model to calculate odds ratios (ORs) with 95% confidence intervals (CIs) using the Review Manage 5.4 software. The meta-analysis included 86,333 SimBTKA cases and 115,146 StaBTKA cases. The overall mortality rate in SimBTKA was 0.66%, while StaBTKA's was 0.43%. The pooled OR for mortality in SimBTKA versus StaBTKA was 1.55 [1.16, 2.08], indicating a statistically significant higher mortality risk in SimBTKA. Our findings suggest that SimBTKA is associated with an increased risk of mortality compared to StaBTKA. This meta-analysis provides valuable insights into the comparative mortality outcomes of SimBTKA and StaBTKA. While SimBTKA may offer potential advantages, including a single anesthesia event and shorter recovery time, clinicians should consider the increased mortality risk associated with this approach. Future research should focus on prospective studies with standardized reporting to further elucidate the nuanced factors influencing mortality outcomes in bilateral knee arthroplasty.
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Affiliation(s)
| | - Naif M Alshaeri
- Orthopaedics, South Al-Qunfudhah General Hospital, Al Qunfudhah, SAU
| | - Rawaa Jamal
- Medicine, Umm Al-Qura University, Jeddah, SAU
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13
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Lee JH, Jung HJ, Choi BS, Ro DH, Kim JI. Effectiveness of Robotic Arm-Assisted Total Knee Arthroplasty on Transfusion Rate in Staged Bilateral Surgery. J Clin Med 2023; 12:4570. [PMID: 37510685 PMCID: PMC10380423 DOI: 10.3390/jcm12144570] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
The transfusion rate in staged bilateral total knee arthroplasty (TKA) remains high despite the application of blood management techniques. The potential of robotic arm-assisted TKA (R-TKA) in reducing the transfusion rate in staged bilateral surgery has not yet been investigated. Therefore, we aimed to evaluate the effectiveness of R-TKA on transfusion reduction compared with conventional TKA (C-TKA) in staged bilateral surgery. This retrospective study involved two groups of patients who underwent 1-week interval staged bilateral TKA-the C-TKA group and the R-TKA group-using MAKO SmartRobotics (Stryker, Kalamazoo, MI, USA). Each group comprised 53 patients after propensity score matching and was compared in terms of nadir hemoglobin (Hb) level and transfusion rate after each stage of surgery. Both groups showed no significant differences in the propensity-matched variables of age, sex, body mass index, American Society of Anesthesiologists physical status score, and preoperative Hb level. The R-TKA group showed a significantly higher nadir Hb level than the C-TKA group after the second TKA (p = 0.002). The transfusion rate was not significantly different between the two groups after the first TKA (p = 0.558). However, the R-TKA group showed a significantly lower transfusion rate in the TKA (p = 0.030) and overall period (p = 0.023) than the C-TKA group. Patients who undergo staged bilateral R-TKA have lower transfusion rate than those who undergo C-TKA. R-TKA may be effective in minimizing unnecessary allogeneic transfusions in staged bilateral surgery.
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Affiliation(s)
- Jong Hwa Lee
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea
| | - Ho Jung Jung
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 24253, Republic of Korea
| | - Byung Sun Choi
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 13620, Republic of Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 13620, Republic of Korea
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea
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Sun K, Pi J, Wu Y, Zeng Y, Xu J, Wu L, Li M, Shen B. The Optimal Period of Staged Bilateral Total Knee Arthroplasty Procedures under Enhanced Recovery: A Retrospective Study. Orthop Surg 2023; 15:1249-1255. [PMID: 36794464 PMCID: PMC10157719 DOI: 10.1111/os.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE The implications of the interval of staged bilateral total knee arthroplasty (TKA) procedures for postoperative complications and costs are not clear. We aimed to determine the optimal time interval between the two stages of bilateral TKA procedures under the enhanced recovery after surgery (ERAS) protocol. METHODS This retrospective study of collected data included bilateral TKA cases under the ERAS protocol performed between 2018 and 2021 at the West China Hospital of Sichuan University. The staged time was subdivided into three groups according to the interval between the first TKA and second contralateral TKA: group 1: 2- to 6-month, group 2: 6- to 12-month, and group 3: >12 months. The primary outcome was the incidence of postoperative complications. The secondary outcomes were the length of hospital stay (LOS), hemoglobin (Hb) decrease, hematocrit (Hct) decrease, and albumin (Alb) decrease. RESULTS We analyzed 281 patients who underwent staged bilateral TKAs between 2018 and 2021 at the West China Hospital of Sichuan University. Regarding postoperative complications, there were no statistically significant differences among the three groups (P = 0.21). For the mean LOS, the 6- to 12-month group had a significantly shorter LOS compared with the 2- to 6-month group (P < 0.01). There was also a significant decrease in Hct of the 2- to 6-month group compared with the 6- to 12-month group and the >12 months group (P = 0.02; P < 0.05, respectively). CONCLUSION Staging the second arthroplasty for more than a half year seems to offer a reduction in the rate of postoperative complications and LOS under ERAS protocol. ERAS shortens the interval of staged bilateral TKA by at least 6 months for patients who might receive their second surgery without the need to wait for an extended period.
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Affiliation(s)
- Kaibo Sun
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jinkui Pi
- Core Facilities of West China Hospital, Sichuan University, Chengdu, China
| | - Yuangang Wu
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zeng
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jiawen Xu
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Limin Wu
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyang Li
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Shen
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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15
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Fletcher AN, Johnson LG, Easley ME, Nunley JA, DeOrio JK. Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle Arthroplasty: A Single-Center Comparative Cohort Study. J Bone Joint Surg Am 2022; 104:1712-1721. [PMID: 36005388 DOI: 10.2106/jbjs.22.00072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The risk-benefit profiles of simultaneous total ankle arthroplasty (TAA) compared with sequential TAA continue to be debated. There are limited case series reporting outcomes after bilateral TAA, with no previous comparison of simultaneous TAA with sequential TAA. Patients with bilateral pathology represent a unique population with an overall more debilitating condition. Thus, we aimed to compare bilateral simultaneous and sequential TAAs, including perioperative complications and patient-reported outcome measures. METHODS We performed a comparative cohort study of patients who underwent primary bilateral TAA, performed in a simultaneous or sequential fashion, from 2007 to 2019 at a single academic center. Data on patient demographic characteristics, comorbidities, perioperative complications, reoperations, and implant failures were collected. Patient-reported outcome measures included preoperative and postoperative visual analog scale (VAS) scores for pain, Short Form-36 Health Survey (SF-36) scores, and Short Musculoskeletal Function Assessment (SMFA) scores. RESULTS A total of 50 patients (100 ankles) were included, with 25 patients (50 ankles) each in the bilateral simultaneous and sequential cohorts. The mean follow-up was 52.2 ± 27.3 months (range, 24 to 109 months). The mean time between sequential TAAs was 17.5 ± 20.1 months (range, 3 to 74 months). The mean patient age was 64.3 ± 10.6 years (range, 21 to 76 years), and 32 (64.0%) were men. The majority of patients (28 patients [56.0%]) had primary osteoarthritis. Both cohorts had equivalent preoperative patient-reported outcome measures and experienced improvements in all measures, which were maintained at the final follow-up with no significant between-group differences (all p > 0.05). There were no differences between the simultaneous TAA group and the sequential TAA group in perioperative complication rates (22.0% compared with 24.0%; p = 0.7788), reoperations (12.0% compared with 10.0%; p = 0.7354), 5-year reoperation-free survival (88.0% compared with 90.0%; p = 0.4612), or failure-free survival (100%). One patient in the simultaneous TAA cohort required metal component revision at 8 years postoperatively. CONCLUSIONS The patient-reported outcome measures, complications, and prosthesis survival of patients who underwent bilateral simultaneous TAA were comparable with those of patients who underwent bilateral sequential TAA. We advocate that simultaneous bilateral TAA is a safe and effective method for the treatment of bilateral end-stage ankle osteoarthritis. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Amanda N Fletcher
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Lindsey G Johnson
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina.,Campbell University School of Osteopathic Medicine, Lillington, North Carolina
| | - Mark E Easley
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - James A Nunley
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - James K DeOrio
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
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