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Hummel A, Matsumoto M, Shimoda B, Au DLMT, Andrews SN, Nakasone CK. Complications following single-stage bilateral total knee arthroplasty and unilateral procedures: experience of a high-volume community hospital. Arch Orthop Trauma Surg 2024; 144:315-322. [PMID: 37632532 DOI: 10.1007/s00402-023-05026-2] [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: 09/20/2022] [Accepted: 08/09/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION The safety of single-stage bilateral total knee arthroplasty (SSBTKA) compared to unilateral total knee arthroplasty (TKA) remains controversial. The present study compares the 90-day postoperative complications encountered following SSBTKA and unilateral TKA in an unselected cohort of patients performed at a high-volume community hospital. MATERIALS AND METHODS The perioperative electronic medical records of an unselected consecutive cohort of 1032 patients (1345 knees) having undergone unilateral or SSBTKA were reviewed. Ninety-day postoperative complications or need for additional procedures were compared between unilateral and SSBTKA groups. RESULTS A total of 719 and 313 patients underwent unilateral and SSBTKA, respectively. There were no significant differences in age or BMI between groups. Patients undergoing SSBTKA were more likely to be male (p = 0.019), have longer lengths of stay (p < 0.001) and were less likely to discharge directly home (13.1%) compared to unilateral patients (80.9%) (p < 0.001). Patients undergoing SSBTKA were more likely to require a transfusion (14.7%) compared to unilateral patients (2.2%) (p < 0.001). Interestingly, mortality rate following unilateral TKA (1.7%) was significantly higher than SSBTKA (0.0%) (p = 0.013). There were no significant differences regarding other complications or need for additional procedures within 90 days following surgery. CONCLUSION SSBTKA did not result in greater complications when compared to unilateral TKA in this particular cohort. As expected, transfusion rates will likely be higher and there will be a greater need for acute inpatient care following surgery for SSBTKA patients.
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Affiliation(s)
- Amelia Hummel
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Maya Matsumoto
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Brent Shimoda
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Donna L M T Au
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Samantha N Andrews
- Department of Surgery, John A Burns School of Medicine, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Cass K Nakasone
- Department of Surgery, John A Burns School of Medicine, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA.
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Esteves TA, Buljubasich M, Holc F, Costantini J, Nicolino TI, Carbo L. Complications in simultaneous bilateral total knee arthroplasty, is it a safe procedure? J ISAKOS 2023; 8:451-455. [PMID: 37619961 DOI: 10.1016/j.jisako.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND There is controversy regarding various aspects of simultaneous bilateral total knee replacement (SBTKR). We found disparity in the postoperative outcomes and complications associated with the procedure in the literature linked with the topic. OBJECTIVE To retrospectively analyze the need for blood transfusion after surgery and complications associated with total knee replacement according to the type of procedure (SBTKR or unilateral). METHODS Retrospective cohort analytical study. We included 251 patients with severe knee osteoarthritis that were divided into two groups. 124 (49%) who underwent SBTKR and 127 upon whom unilateral total knee replacement (UTKR) was performed. Demographic data, days of hospitalization, complications within the first 90 days after surgery (thromboembolic events, superficial and deep infection, stiffness, death); and percentages of patients transfused with blood products during hospitalization were evaluated. RESULTS There were no statistical differences in the analysis of postoperative complications in the first 90 days after surgery. In the SBTKR group, 8 patients (6.5%) presented some thromboembolic complication during the postoperative period, while this event was observed in only 2 patients (1.5%) from the other group. The analysis showed a statistically significant drop in postoperative hemoglobin, on average that of 0.8 g/dl, in the SBTKR patient group compared to the UTKR group (95% CI 0.44-1.13; p < 0.001). A higher proportion of patients who required transfusion were observed in the SBTKR group (40%) (OR = 7.12; 95% CI 3.3-16; p < 0.001). We analyzed the cause of postoperative transfusion in the patients who required transfusion taking into account two parameters: hemoglobin less than 8 g/dl and the clinical needs of the patients (symptoms of hypotension, decay, difficulty to rehabilitate without pain, dyspnea). 59 patients received transfusion (50 in the SBTKR group and 9 in the other group). Of these, 19 patients (32.2%) did not meet any transfusion criteria. CONCLUSION We consider SBTKR a safe procedure, which does not increase postoperative complications compared to UTKR. Although there is an increase in blood loss in SBTKR, it does not generate clinical symptoms of relevance. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Tomás Alfredo Esteves
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina.
| | - Martín Buljubasich
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina
| | - Fernando Holc
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina
| | - Julián Costantini
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina
| | - Tomás Ignacio Nicolino
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina
| | - Lisandro Carbo
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina
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Yakkanti RR, Ovadia JE, Reddy GB, Browne JA, D'Apuzzo MR. Inhospital Complications and Costs of Simultaneous Bilateral Total Knee Arthroplasty: The Case for Selection and Potential Cost Savings. J Arthroplasty 2022; 37:1273-1277. [PMID: 35240286 DOI: 10.1016/j.arth.2022.02.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Published comparisons between bilateral and unilateral total knee arthroplasties (TKAs) remain biased, as most patients undergoing bilateral TKA are prescreened and healthier than average patients having unilateral procedures. Our objectives were to compare postoperative complications and resource utilization of patients having simultaneous bilateral TKAs with similar patients having unilateral procedures. METHODS The Nationwide Inpatient Sample (NIS) database was used to identify patients undergoing primary elective TKA from 2002 to 2011. A total of 4,445,263 patients were identified. Of these, 190,783 (4%) were having same-day bilateral procedures. Patients with staged bilateral TKA during the same hospitalization were excluded. Complications and costs were compared to a matched cohort of patients having unilateral procedures. This cohort was matched based on age, gender, and 30 comorbid-defined elements in the NIS. RESULTS A total of 172,366 (90%) simultaneous bilateral procedures were matched 1:1 to patients with unilateral procedures for the adjusted analysis. Patients with bilateral procedures were at an increased risk for many complications including postoperative anemia (OR: 2.3; 95% CI: 2.2-2.3, P < .001), cardiac (OR: 2.1; 95% CI: 2.0-2.3, P < .001), and inhospital mortality (OR: 3.3; 95% CI: 2.6-4.3). These patients also incurred in higher hospital costs ($19,343 vs $12,852, P < .001) and were discharged more commonly to a rehabilitation facility (70% vs 32%, P < .001). CONCLUSION Patients undergoing simultaneous bilateral TKA are at an increased risk of developing important postoperative complications and mortality compared with unilateral cases. These data highlight the importance of patient selection and optimization for bilateral TKA and potential cost savings.
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Affiliation(s)
| | - Joshua E Ovadia
- Department of Orthopedic Surgery, University of Miami, Miami, FL
| | - Gireesh B Reddy
- Department of Orthopedic Surgery, University of Miami, Miami, FL
| | - James A Browne
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA
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Abstract
Aims Simultaneous bilateral total knee arthroplasty (TKA) has been used due to its financial advantages, overall resource usage, and convenience for the patient. The training model where a trainee performs the first TKA, followed by the trainer surgeon performing the second TKA, is a unique model to our institution. This study aims to analyze the functional and clinical outcomes of bilateral simultaneous TKA when performed by a trainee or a supervising surgeon, and also to assess these outcomes based on which side was done by the trainee or by the surgeon. Methods This was a retrospective cohort study of all simultaneous bilateral TKAs performed by a single surgeon in an academic institution between May 2003 and November 2017. Exclusion criteria were the use of partial knee arthroplasty procedures, staged bilateral procedures, and procedures not performed by the senior author on one side and the trainee on another. Primary clinical outcomes of interest included revision and re-revision. Primary functional outcomes included the Oxford Knee Score (OKS) and patient satisfaction scores. Results In total, 315 patients (630 knees) were included for analysis. Of these, functional scores were available for 189 patients (378 knees). There was a 1.9% (n = 12) all-cause revision rate for all knees. Overall, 12 knees in ten patients were revised, and both right and left knees were revised in two patients. The OKS and patient satisfaction scores were comparable for trainees and supervising surgeons. A majority of patients (88%, n = 166) were either highly likely (67%, n = 127) or likely (21%, n = 39) to recommend bilateral TKAs to a friend. Conclusion Simultaneous bilateral TKA can be used as an effective teaching model for trainees without any significant impact on patient clinical or functional outcomes. Excellent functional and clinical outcomes in both knees, regardless of whether the performing surgeon is a trainee or supervising surgeon, can be achieved with simultaneous bilateral TKA. Cite this article: Bone Jt Open 2022;3(1):29–34.
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Affiliation(s)
- Gerard A Sheridan
- Division of Lower Limb Reconstruction and Oncology, The University of British Columbia, Vancouver, Canada
| | - Rotem Moshkovitz
- Division of Lower Limb Reconstruction and Oncology, The University of British Columbia, Vancouver, Canada
| | - Bassam A Masri
- Division of Lower Limb Reconstruction and Oncology, The University of British Columbia, Vancouver, Canada
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Chen SH, Chen JY, Wong TH, Buechel F, Wu MH. Simultaneous Bilateral Total Knee Arthroplasty Becomes Safer after Institution of Optimal Perioperative Management: A Longitudinal Cohort Study. J Knee Surg 2021; 34:941-951. [PMID: 31952092 DOI: 10.1055/s-0039-1700979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Simultaneous bilateral total knee arthroplasty (SBTKA) increases the rates of procedure-related complications and mortality compared with unilateral TKA. There are no well-defined guidelines for selecting patients to avoid mortality and proposing an upgrade treatment to decrease complication rates. This study aimed to evaluate whether optimal perioperative management could improve the safety of SBTKA. From 2005 to 2017, 1,166 cases of SBTKA were identified from 14,209 TKA procedures. We retrospectively examined the SBTKA patients' demographics, comorbidity profiles, procedure-related complications, and perioperative management during two time periods. Optimal perioperative workup for managing SBTKA significantly decreased the incidences of major complication from 6.2 to 2.4% (p = 0.001) and minor complications from 28.9 to 21.5% (p = 0.004) during period I and period II, respectively. The efficiency of less tourniquet use along with intraarticular tranexamic acid injection was demonstrated by the decreases of hemoglobin (Hb) change in the first 2 days after surgery (p = 0.005) and blood transfusion requirement (p = 0.035) during the SBTKA. Furthermore, the less tourniquet use group had less thigh pain (visual analog scale decreased from 6.0 to 4.2, p = 0.003), shorter duration of hospital stay (decreased from 7.8 to 7.1, p < 0.001), and lower coagulation time (decrease from 3.5 to 2.9, p < 0.001) than the routine tourniquet use group. Patient's screening must be performed carefully for cardiopulmonary compromise in patients aged >80 years and with an American Society of Anesthesiologists score of 3. Additionally, hospitalists should consider developing methods for the eligibility, testing, and perioperative monitoring of patients who undergo SBTKA with the aim of avoiding complications and improving outcomes.
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Affiliation(s)
- Shih-Hao Chen
- Department of Orthopaedic Surgery, Buddhist Tzu-Chi Hospital at Taichung, Taiwan.,Department of Orthopaedics, Tzu-Chi University, Hualien, Taiwan
| | - Jen-Yuh Chen
- Postal Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tze-Hong Wong
- Department of Orthopedics, National Taiwan University Hospital, Hsin Chu Branch, HsinChu, Taiwan
| | - Frederick Buechel
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Orthopaedic Surgery, Lenox Hill Hospital, New York.,Robotic Joint Center, New York
| | - Meng-Huang Wu
- Postal Hospital, Taipei, Taiwan.,Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
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Simultaneous single-stage versus two-staged bilateral total knee arthroplasty: a prospective comparative study. INTERNATIONAL ORTHOPAEDICS 2020; 44:1305-1310. [PMID: 32458035 DOI: 10.1007/s00264-020-04642-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The study aims to prospectively compare peri-operative morbidity and mortality of simultaneous single-stage bilateral total knee arthroplasty (SS BLTKA) with two-staged bilateral total knee arthroplasty (TS BLTKA) performed within 12 months of the first surgery. We hypothesized that SS BLTKA is as safe as TS BLTKA. METHODS Patients with a minimum follow-up of 12 months were included in this study. Oxford knee score and quality of life index SF12 was compared between the 2 groups at six weeks and six month follow-up. RESULTS SS BLTKA included 250 patients and TS BLTKA included 210 patients. The minimum time interval between two operations was three weeks (mean 1.6 months, range 3 weeks-12 months). There was no significant difference between the 2 groups in peri-operative mortality, surgical site infection, major peri-operative complications. There was no difference between the 2 groups in the Oxford knee score and quality of life index SF12 at 6-month follow-up. There was no difference in the range of knee flexion between the 2 groups at six months. Post-operative haemoglobin drop was significantly more in SS BLTKA patients and consequently, blood transfusion requirement was significantly higher in SS BLTKA. There was a significantly higher length of hospital stay and duration of surgery in TS BLTKA group. CONCLUSION There does not appear to be a difference in complication rates between the 2 groups. SS BLTKA seems to be a logical choice if both knees have severe osteoarthritis. Patients with severe cardiopulmonary compromise were excluded, and a unilateral procedure may be preferred in them.
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Alghadir AH, Iqbal ZA, Anwer S, Anwar D. Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery. BMC Musculoskelet Disord 2020; 21:246. [PMID: 32293398 PMCID: PMC7161292 DOI: 10.1186/s12891-020-03269-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/03/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Total knee replacement is a common operative procedure to improve pain, function, and quality of life in patients with end stage knee osteoarthritis. The current study aimed to compare simultaneous bilateral versus unilateral total knee replacement on pain intensity and recovery of function. METHODS A total of 80 patients (bilateral 50, unilateral 30) aged 63.28 (9.4) years undergone total knee replacement participated in the current study. The participants were admitted for 5-7 days in the hospital. Participants in both the group received similar inpatient and outpatient physiotherapy sessions. Pain intensity and function capacity were assessed at baseline, day 7, and day 30 postoperatively using visual analogue scale and lower extremity functional scale, respectively. Repeated measures analysis of variance was used to analyze the data. RESULTS Both groups showed a significant reduction of pain intensity (Day 0, mean 8.9, SD 1.0; Day 30, mean 2.2, SD 1.3 in bilateral total knee replacement; Day 0, mean 8.8, SD 1.1; Day 30, mean 2.0, SD 1.5 in unilateral total knee replacement; p < 0.001) and improvement in the functional capacity (Day 0, mean 16.2, SD 10.1; Day 30, mean 55.6, SD 14.6 in bilateral total knee replacement; Day 0, mean 19.1, SD 9.1; Day 30, mean 56.7, SD 15.8 in unilateral total knee replacement; p < 0.001) following total knee replacement at 30 days post-operatively. However, there was a non-significant difference noted between bilateral versus unilateral total knee replacement on the reduction of pain intensity (mean changes, 6.9 versus 6.8) and improvement in the functional capacity (mean changes, 39.4 versus 37.6) at 30 days post-operatively (p > 0.05). CONCLUSION Simultaneous bilateral total knee replacement was associated with a similar reduction of pain intensity and recovery of function compared to unilateral total knee replacement, suggesting the use of simultaneous bilateral total knee replacement in patients with bilateral knee osteoarthritis since its costs and rehabilitation process could be reduced compared to staged bilateral total knee replacement.
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Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O.Box-10219, -11433, Riyadh, Saudi Arabia
| | - Zaheen A Iqbal
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O.Box-10219, -11433, Riyadh, Saudi Arabia
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O.Box-10219, -11433, Riyadh, Saudi Arabia. .,Department of Building and Real Estate, Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region, Hong Kong.
| | - Dilshad Anwar
- Bone Joint and Trauma Clinic, Darbhanga, India.,Royal Hospital and Trauma Center, Darbhanga, India
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Malahias MA, Gu A, Adriani M, Addona JL, Alexiades MM, Sculco PK. Comparing the Safety and Outcome of Simultaneous and Staged Bilateral Total Knee Arthroplasty in Contemporary Practice: A Systematic Review of the Literature. J Arthroplasty 2019; 34:1531-1537. [PMID: 31031158 DOI: 10.1016/j.arth.2019.03.046] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although a variety of studies have assessed the outcomes of simultaneous bilateral total knee arthroplasty (BTKA) and staged BTKA, there remains no definitive conclusion regarding the superiority of one technique in terms of safety. METHODS The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried utilizing keywords pertinent to BTKA, simultaneous and staged, and clinical or functional outcomes. In order to examine the contemporary relevant literature, studies published prior to 2009 were excluded from our search. RESULTS In total, 19 articles met the inclusion criteria and were included in this analysis. The overall quality of the studies included in this review was rated as moderate. Seven of the 19 studies reported no significant differences between the 2 groups in regards to baseline clinical and demographic characteristics (comorbidity index, American Society of Anesthesiologists grade, preoperative clinical subjective scores). Nearly all from these 7 studies with comparable initial characteristics documented no significant differences in the overall complication rates between the 2 groups in addition to no difference in mortality rate, cardiac complications, revision rate, thromboembolic events, and functional outcomes. CONCLUSION In contemporary studies involving comparable baseline demographics (including comorbidity index, American Society of Anesthesiologists grade), there was moderate evidence to show that simultaneous BTKA is as safe as the staged BTKA.
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Affiliation(s)
- Michael-Alexander Malahias
- Department of Orthopaedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Alex Gu
- Department of Orthopaedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Marco Adriani
- Department of Orthopaedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Jacqueline L Addona
- Department of Orthopaedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Michael M Alexiades
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Orthopaedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
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Wyatt MC, Hozack J, Frampton C, Hooper GJ. Safety of single-anaesthetic versus staged bilateral primary total knee replacement: experience from the New Zealand National Joint Registry. ANZ J Surg 2019; 89:567-572. [PMID: 30968551 DOI: 10.1111/ans.15160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical management options for bilateral knee osteoarthritis comprise staged or single-anaesthetic bilateral total knee replacements (SABTKRs). We examined the New Zealand Joint Registry hypothesizing there would be no difference between these practices compared to unilateral total knee replacement (TKR) examining 30-day mortality, all-cause revision rate and function. METHODS For this study, 84 946 primary TKRs were identified. We compared three groups: unilateral TKRs, all SABTKRs and all staged bilateral TKRs with intervals of 1 to 90 days, 91 days to 1 year and >1 year. Cumulative revision rates were calculated (Kaplan-Meier method). Mortality risks were compared to unilateral TKR and hazard ratios (HRs) calculated. Six-month Oxford scores were compared using analysis of variance. RESULTS Thirty-day mortality for SABTKR was 0.219%: unilateral TKR 0.236% (HR 0.43; 95% confidence interval (CI) 0.38-0.48; P < 001). Staged TKR had lower mortality than unilateral TKR at three time interval groups unless performed within 90 days (adjusting for age and American Society of Anesthesiologists grade) TKR (<90 days HR 0.92; 95% CI 0.703-1.371; P = 0.915; 91-365 days HR 0.783; 95% CI 0.687-0.891; P < 0.001; >365 days HR 0.394; 95% CI 0.344-0.451; P < 0.001). Revision risk with SABTKR was lower at 0.43/100 component years (95% CI 0.37-0.49/100 component years) compared to unilateral 0.56/100 component years (95% CI 0.53-0.59; P < 0.05). Six-month Oxford scores were superior in SABTKR versus unilateral TKR (38.6 (95% CI 38.2-39) versus 36.9 (95% CI 36.8-37.1); P < 0.001). CONCLUSIONS SABTKR is at least as safe as unilateral TKR or staged bilateral TKR in appropriately selected cases. Surgeons should wait at least 90 days before the second procedure.
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Affiliation(s)
- Michael C Wyatt
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch Public Hospital, Christchurch, New Zealand.,New Zealand National Joint Registry, Christchurch Public Hospital, Christchurch, New Zealand
| | - Joan Hozack
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch Public Hospital, Christchurch, New Zealand.,New Zealand National Joint Registry, Christchurch Public Hospital, Christchurch, New Zealand
| | - Chris Frampton
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch Public Hospital, Christchurch, New Zealand.,New Zealand National Joint Registry, Christchurch Public Hospital, Christchurch, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch Public Hospital, Christchurch, New Zealand.,New Zealand National Joint Registry, Christchurch Public Hospital, Christchurch, New Zealand
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10
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Simultaneous, same-anaesthetic bilateral total knee arthroplasty has low mortality and complication rates. Knee Surg Sports Traumatol Arthrosc 2018; 26:3395-3402. [PMID: 29574549 DOI: 10.1007/s00167-018-4908-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/20/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE The benefits of simultaneous bilateral total knee arthroplasty (SBTKR) include reduced hospital costs, single anaesthetic exposure and in many cases is also the patient's preference. Despite these potential benefits, risk-adversity with respect to assumed complications and mortality make it difficult for the orthopaedic surgeon and patient to make an informed decision. This study aimed to address the inconsistencies and lack of consensus in previous literature regarding the short-term complications and clinical safety of SBTKR in patients with end-stage knee osteoarthritis (OA). METHODS A cohort of 950 knees (475 patients) undergoing surgery between 2008 and 2013 was extracted from a prospectively collected clinical database and retrospectively linked to the Australian Joint Replacement Registry and hospital records. Patients underwent sequential SBTKR by their treating surgeon under one anaesthetic. Basic demographic data and outcome data including complications and mortality were collected. All data were analyzed using descriptive statistics only. RESULTS A total of 413 patients and 826 knees were included. The average age of the cohort was 70 years with range between 46 and 88 years. 50% of patients were female. The overall mortality rate during the study follow-up period was 1.9%, with an average time to death postoperatively of 23.8 months. There were no cases of acute postoperative mortality (< 6 weeks). Medical complication rates were low. CONCLUSIONS In contrast to the higher mortality and complication rates suggested in previous literature, this study has demonstrated that SBTKR is safe, with low mortality and complication rates under the current surgical protocol. LEVEL OF EVIDENCE IV.
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11
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Davidson IU, Brigati DP, Faour M, UdoInyang IJ, Ibrahim M, Murray TG. Same-Day Bilateral Total Knee Arthroplasty Candidacy Criteria Decrease Length of Stay and Facility Discharge. Orthopedics 2018; 41:293-298. [PMID: 30125039 DOI: 10.3928/01477447-20180815-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 06/21/2018] [Indexed: 02/03/2023]
Abstract
Simultaneous bilateral total knee arthroplasty (SBTKA) may present a higher risk for postoperative complications than unilateral surgery. The authors retrospectively identified 561 patients who underwent SBTKA between 2013 and 2015. The cohort was stratified according to the following appropriateness of care criteria (AOCC): (1) age younger than 70 years; (2) absence of cardiac disease; (3) controlled diabetes; and (4) body mass index less than 30 kg/m2. The authors created an AOCC score, with 0 representing the most ideal candidates and 4 representing the least ideal candidates. The cohort included 140 (25%) ideal candidates with a score of 0; the cohort also included 299 (53%) non-ideal candidates with a score of 1, 105 (19%) with a score of 2, 14 (2%) with a score of 3, and 3 (1%) with a score of 4. Ideal candidates had the shortest mean length of stay at 3.6±1.2 days. Length of stay was longer for patients with an AOCC score of greater than 2 compared with those with an AOCC score of 2 or less (5.2±4.3 vs 3.8±1.6 days, P<.001). Ideal candidates were discharged to home more often than other patients (26% vs 13%, P<.001). Although there was no difference in 90-day all-cause complications between ideal and non-ideal candidates (13% vs 16%, P=.400), medical complications trended strongly (6% vs 11%, P=.086). Appropriateness of care criteria for SBTKA patients were associated with shorter length of stay, higher rates of home discharge, and a trend toward lower complication rates. Simultaneous bilateral total knee arthroplasty can offer better outcomes in a subgroup of patients appropriately selected for surgery. Physicians can use these results to counsel their patients about risks and benefits of undergoing SBTKA. [Orthopedics. 2018; 41(5):293-298.].
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Lizaur-Utrilla A, Serna-Berna R, Vizcaya-Moreno MF, Martinez-Mendez D, Marco-Gomez L, Lopez-Prats FA. Comparison of Functional Outcomes Between the First and Second Knee in Staged Bilateral Total Knee Arthroplasty With Diverse Intervals Between Stages. J Arthroplasty 2018; 33:2863-2867. [PMID: 29776854 DOI: 10.1016/j.arth.2018.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The objective of the study was to analyze if the length of interval time between stages influenced functional and quality of life outcomes in patients with staged bilateral primary total knee arthroplasty (TKA). METHODS This is a retrospective comparative study between 93 patients with an interval between stages of 6-8 months (6-month group), 112 of 12-14 months (1-year group), and 108 of 24-26 months (2-year group). Outcome variables were Knee Society scores, Western Ontario and McMaster Universities, Short Form, and patient satisfaction. RESULTS Overall, the mean follow-up for the first TKA was 8.2 (range, 7-10) years, and for the second TKA, 6.7 (range, 5-10) years. At last follow-up, functional and patient-related outcomes were similar for both knees, regardless of the interval. However, mental score and patient satisfaction were significantly better for the second than for the first TKA in the 2-year group. Age did not correlate significantly with the functional scores but was significantly correlated with the mental score. CONCLUSION The performing staged bilateral TKA with a wide interval between surgeries provided equivalent functional outcomes and quality of life for both knees. Postoperative outcomes were not affected by the length of the time interval between procedures or age. Our results can help the surgeon to inform the patients reliably about what they can expect in the delay of a second knee replaced. Thus, patients could make an informed decision.
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Affiliation(s)
- Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain; Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad, Alicante, Spain
| | - Ricardo Serna-Berna
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain
| | - Maria F Vizcaya-Moreno
- Clinical Research Group, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | | | - Luis Marco-Gomez
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain
| | - Fernando A Lopez-Prats
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad, Alicante, Spain
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Qi Y, Tie K, Wang H, Pan Z, Zhao X, Chen H, Chen L. Perioperative comparison of blood loss and complications between simultaneous bilateral and unilateral total knee arthroplasty for knee osteoarthritis. Knee 2017; 24:1422-1427. [PMID: 28974399 DOI: 10.1016/j.knee.2017.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/16/2016] [Accepted: 06/13/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to compare the blood loss and complications between simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral total knee arthroplasty (UTKA). METHODS This study included 54 SBTKAs and 70 UTKAs performed between 2013 and 2014. Groups were compared with respect to blood loss, hemoglobin, hematocrit, D-dimer, blood transfusion, and complications. RESULTS Hemoglobin between the groups was not significantly different (P>0.05). In the SBTKA group, the hematocrit on the 3rd postoperative day was lower (P<0.05), and the D-dimer on the 1st postoperative day was higher (P<0.05) than in the UTKA group. The total drain output of the UTKA group was not significantly different from any unilateral side of the SBTKA group (P<0.05). The mean autologous red blood cell (RBC) transfusion requirements were not significantly different between the two groups. However, the mean allogeneic RBC transfusion requirement was higher in the SBTKA group than in the UTKA group (P<0.001). The total drainage of the SBTKA group was significantly more than the UTKA group, but the total drain output of the UTKA group was not significantly different from any unilateral side of the SBTKA group (P>0.05). Also, the mean allogeneic RBC transfusion requirement was higher in the SBTKA group than in the UTKA group (P<0.001). CONCLUSION This study demonstrates that the rate of complication between SBTKA and UTKA is similar. The total drainage and transfusion of SBTKA are not twice that of UTKA, and after treatment, hemoglobin could be increased to a similar level. Thus, SBTKA is an effective and safe option.
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Affiliation(s)
- Yongjian Qi
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Kai Tie
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Hua Wang
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zhengqi Pan
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Xinyu Zhao
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Heqiang Chen
- Department of Orthopedic Surgery, Yichang Central People's Hospital, Yichang 443003, China
| | - Liaobin Chen
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
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Seo JG, Kim SM, Shin JM, Kim Y, Lee BH. Safety of simultaneous bilateral total knee arthroplasty using an extramedullary referencing system: results from 2098 consecutive patients. Arch Orthop Trauma Surg 2016; 136:1615-1621. [PMID: 27687177 DOI: 10.1007/s00402-016-2573-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Simultaneous bilateral total knee arthroplasty (TKA) has been associated with a high risk of morbidity and mortality. The orthopedic surgeon must, therefore, decide whether bilateral simultaneous TKA is a safe operation to perform and endeavor to decrease the risk of serious complications or even death. METHODS This retrospective review included 2098 consecutive patients who underwent bilateral simultaneous TKAs by the protocol used in our institution, including the use of extramedullary instruments to minimize medullary canal invasion and overlapping procedures for both knees to decrease operation time. RESULTS The incidence rate of occurred complications was 0.33 % for symptomatic pulmonary embolism, 0.62 % for deep surgical infection requiring revision surgery, 0.05 % for 14-day mortality, 1.14 % for adverse cardiac events, and 0.76 % for postsurgical delirium within the 1-year follow-up. CONCLUSIONS Our protocols, including the use of an extramedullary referencing system and overlapping procedures for both knees, may be considered to decrease the perioperative short-term morbidity and 14-day mortality rates in simultaneous bilateral TKA.
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Affiliation(s)
- Jai Gon Seo
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Kim
- Seoul Medical Center, Sinnae 1-dong, Jungnang-gu, Seoul, Korea
| | - Jung Min Shin
- Hanyang Medical Center, Hanyang University School of Medicine, Seoul, Korea
| | - Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical School, 134-701, Gil-dong, Seoul, Korea.
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Latifi R, Thomsen MG, Kallemose T, Husted H, Troelsen A. Knee awareness and functionality after simultaneous bilateral vs unilateral total knee arthroplasty. World J Orthop 2016; 7:195-201. [PMID: 27004168 PMCID: PMC4794539 DOI: 10.5312/wjo.v7.i3.195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/09/2016] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate knee awareness and functional outcomes in patients treated with simultaneous bilateral vs unilateral total knee arthroplasty (TKA).
METHODS: Through a database search, we identified 210 patients who had undergone unilateral TKA (UTKA) and 65 patients who had undergone simultaneous bilateral TKA (SBTKA) at our institution between 2010 and 2012. All TKAs were cemented and cruciate retaining. The mean follow-up period was 3.2 (2 to 4) years. All the patients had symptomatic and debilitating unilateral or bilateral osteoarthritis for which all conservative and non-surgical treatments were failed, thus preoperatively the patients had poor functionality. All patients were asked to complete Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) questionnaires. The patients were matched according to age, gender, year of surgery, Kellgren-Lawrence score and pre- and postoperative overall knee alignment. The FJS and OKS questionnaire results of the two groups were then compared.
RESULTS: A mixed-effects model was used to analyze differences between SBTKA and UTKA. OKS: The mean difference in the OKS between the patients who had undergone SBTKA and those who had undergone UTKA was 1.5, which was not statistically significant (CI = -0.9:4.0, P-value = 0.228). The mean OKS of the SBTKA patients was 37.6 (SD = 9.0), and the mean OKS of the UTKA patients was 36.1 (SD = 9.9). FJS: The mean difference in the FJS between the patients who had undergone SBTKA and those who had undergone UTKA was 2.3, which was not statistically significant (CI = -6.2:10.8, P-value = 0.593). The mean FJS of the SBTKA patients was 59.9 (SD = 27.5), and the mean FJS of the UTKA patients was 57.5 (SD = 28.8).
CONCLUSION: SBTKA and UTKA patients exhibited similar joint functionality and knee awareness. Our results support the use of SBTKA in selected patients suffering from clinically symptomatic bilateral osteoarthritis.
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Haddad B, Khan W, Mehta V, Mbubaegbu C, Qamar A. Bilateral Simultaneous Total Knee Arthroplasty: A Patient-Matched Retrospective Observational Study. Open Orthop J 2015; 9:499-503. [PMID: 26587069 PMCID: PMC4645832 DOI: 10.2174/1874325001509010499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/23/2015] [Accepted: 01/27/2015] [Indexed: 01/16/2023] Open
Abstract
Bilateral total knee arthroplasty can be performed either as a staged or simultaneous procedure. We conducted a retrospective comparative study to compare the need for transfusion, the length of procedure, the length of stay, and complications of bilateral simultaneous knee arthroplasty with those of unilateral knee arthroplasty. Sixty-nine patients who underwent bilateral simultaneous knee arthroplasty procedures were compared with a matched control group of 69 patients who underwent unilateral knee arthroplasty. Receiver Operating Characteristic (ROC) curve was used to determine optimum cut-off values. Both groups of patients had a similar age and gender distribution, preoperative haemoglobin and ASA scores. Cumulative transfusion episodes were lower in the bilateral group than twice that of the unilateral group. In multivariate analysis the preoperative haemoglobin level and bilateral procedures were independent factors predicting the need for transfusion. The average length of procedure and length of hospital stay in the bilateral group was less than twice than that of the unilateral group. Advanced age and bilateral procedures were independent predictors of prolonged length of stay. A haemoglobin level of 12.5 g/dL and age of 70 were most suitable cut-off points to predict need for transfusion and occurrence of medical complications respectively. We conclude that bilateral simultaneous knee arthroplasties are safe and cost effective in appropriately selected patients. We recommend avoiding bilateral simultaneous procedures in patients over the age of 70 years and with significant comorbidities.
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Affiliation(s)
- Behrooz Haddad
- Homerton University Hospital, Homerton Road, London, E9 6SR, UK ; University College London, Institute of Orthopaedic and Musculoskeletal Sciences, Royal National Orthopaedic Hospital Stanmore Middlesex, HA7 4LP, UK
| | - Wasim Khan
- University College London, Institute of Orthopaedic and Musculoskeletal Sciences, Royal National Orthopaedic Hospital Stanmore Middlesex, HA7 4LP, UK
| | - Vikas Mehta
- Homerton University Hospital, Homerton Road, London, E9 6SR, UK
| | - Chima Mbubaegbu
- Homerton University Hospital, Homerton Road, London, E9 6SR, UK
| | - Arshad Qamar
- Homerton University Hospital, Homerton Road, London, E9 6SR, UK
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Yang Y, Long G, Zhenhu W. Analysis of Interlimb Asymmetry in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty. PLoS One 2015; 10:e0129783. [PMID: 26107692 PMCID: PMC4479550 DOI: 10.1371/journal.pone.0129783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/13/2015] [Indexed: 11/18/2022] Open
Abstract
Simultaneous bilateral TKA (SBTKA) has been a favored surgical solution due to reduced costs and patient suffering. The purpose of the present study was to investigate the risk factors of asymmetric recovery in patients who underwent SBTKA and whether that affected quality of life. A total of 187 patients undergoing SBTKA were included. During this study, patients underwent physical examination (knee swelling, active range of motion (ROM) of knee and quadriceps strength) and completed three surveys (VAS pain rating, Short Form-36 and requisite information lists in this study). Our results reveal interlimb asymmetries existed at least two years postoperatively. Between-limb differences in active ROM, quadriceps strength, and VAS pain scores were significantly detected in our study. Risk factors included being female, being older, and having high BMI and high levels of anxiety and depression; different diagnosis and different component size could be risk factors. Finally, interlimb differences in VAS pain scores and active ROM were negatively associated with SF-36 scores. However, interlimb differences in swelling and quadriceps strength were unrelated to SF-36 scores. Risk factors of asymmetric recovery should be evaluated and appreciated due to their significant impact on patients’ quality of life. Before performing SBTKA, clinicians should consider possible risk factors and inform patients of asymmetric recovery between limbs, which could help decrease the unnecessary consultations and postoperative patient dissatisfaction.
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Affiliation(s)
- Yu Yang
- Department of orthopedic, 252 Hospital of Chinese PLA, Baoding City, Hebei, China
| | - Gong Long
- Department of orthopedic, 252 Hospital of Chinese PLA, Baoding City, Hebei, China
| | - Wang Zhenhu
- Department of orthopedic, 252 Hospital of Chinese PLA, Baoding City, Hebei, China
- * E-mail:
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Koh IJ, Kim GH, Kong CG, Park SW, Park TY, In Y. The Patient's Age and American Society of Anesthesiologists Status Are Reasonable Criteria for Deciding Whether to Perform Same-Day Bilateral TKA. J Arthroplasty 2015; 30:770-5. [PMID: 25512032 DOI: 10.1016/j.arth.2014.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/15/2014] [Accepted: 12/02/2014] [Indexed: 02/01/2023] Open
Abstract
We investigated whether basing a decision to perform same-day bilateral TKA (SD BTKA) on the patient's age and American Society of Anesthesiologists (ASA) status was reasonable. We retrospectively reviewed the records of 1386 patients who underwent 2086 TKAs (686 unilateral TKAs [UTKAs], 1038 SD BTKAs, and 362 one-week staged BTKAs). For the entire cohort, patients undergoing SD BTKA had a higher risk of major complications compared to those undergoing UTKA. However, there was no difference in the incidence of complications for patients aged<75 years with an ASA status of 1 or 2 who underwent UTKA or SD BTKA. If patients are selected based on age and ASA status, SD BTKA may have a risk of postoperative complication similar to UTKA.
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Affiliation(s)
- In Jun Koh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea; Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Geon-Hyeong Kim
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, Uijeongbu-si, Gyeonggi-do, Korea
| | - Chae-Gwan Kong
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, Uijeongbu-si, Gyeonggi-do, Korea; Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Se-Wook Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
| | - Tae Yong Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea; Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
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Zhu M, Chen JY, Tan YR, Yew AKS, Chong HC, Chia SL, Lo NN, Yeo SJ. Effects of anesthetic technique on blood loss and complications after simultaneous bilateral total knee arthroplasty. Arch Orthop Trauma Surg 2015; 135:565-71. [PMID: 25752880 DOI: 10.1007/s00402-015-2188-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Indexed: 11/26/2022]
Abstract
AIMS Anesthetic technique affects perioperative outcomes, but less was known in simultaneous bilateral total knee arthroplasty (BTKA). A single center, retrospective analysis was carried out to prove the hypothesis that utilization of regional anesthesia would result in favorable perioperative outcomes. METHODS Medical records of patients admitted for simultaneous BTKA between 2004 and 2013 were analyzed. Two groups, the general anesthesia (GA) and regional anesthesia (RA) group, were identified. Patient preoperative characteristics were compared. Perioperative outcomes measured included blood loss, transfusion requirement, length of hospitalization, operating time, and 30-day perioperative complications. RESULTS A total of 513 patients were identified, 54.6% were performed under GA, and 45.4% under RA. Patient characteristics were similar between the two groups, except that patients operated under GA were younger than those under RA. RA was associated with significantly less perioperative blood loss (981 vs. 1075 mL, p = 0.017) and 30-day complications (6.4 vs. 13.2%, p = 0.016). Systemic and organ specific infections were particularly lower in the RA group (0.4 vs. 3.9%, p = 0.009). Transfusion requirement, length of hospitalization, and operating time were similar between the two groups. After correcting for covariates, RA offered a 92 mL (p = 0.023) reduction in blood loss and 49% less overall complications (p = 0.047), compared to GA. CONCLUSION Patients who underwent simultaneous BTKA under RA had lesser blood loss and lower complication rate than GA. The impact of RA can be further exploited to improve perioperative outcomes of simultaneous BTKA in addition to various other interventions.
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Affiliation(s)
- Meng Zhu
- Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore,
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Incidence of perioperative events in single setting bilateral direct anterior approach total hip arthroplasty. J Arthroplasty 2015; 30:465-7. [PMID: 25449587 DOI: 10.1016/j.arth.2014.09.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/31/2014] [Accepted: 09/22/2014] [Indexed: 02/01/2023] Open
Abstract
The peri-operative complication rates of a single setting bilateral direct anterior approach (DAA) total hip arthroplasty (THA) are not well known. All single setting (90) bilateral DAA THA patients were reviewed. Blood loss was 632 mL for single setting bilateral DAA procedures. Intra-operative and post-operative complication rates for single setting bilateral DAA THA were low.
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Choi YJ, Lee HI, Ra HJ, Hwang DY, Kim TK, Shim SJ. Perioperative Risk Assessment in Patients Aged 75 Years or Older: Comparison between Bilateral and Unilateral Total Knee Arthroplasty. Knee Surg Relat Res 2014; 26:222-9. [PMID: 25505704 PMCID: PMC4258489 DOI: 10.5792/ksrr.2014.26.4.222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 10/11/2014] [Accepted: 10/14/2014] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the risk of sequential bilateral total knee arthroplasty (TKA) under 1 anesthesia in patients 75 years or older. MATERIALS AND METHODS Patients aged 75 years or older who underwent sequential bilateral TKA (bilateral group, n=159) and unilateral TKA (unilateral group, n=159) between 2002 and 2012 were selected. All patients were evaluated for underlying medical diseases, such as cardiac, pulmonary, and renal problems, and high-risk patients were recommended to postpone the surgery. We compared the underlying diseases, major postoperative complications, and the length of hospital stay between bilateral and unilateral groups. RESULTS The prevalence of underlying diseases of the bilateral group was 74.8% and major complications occurred in 6 patients (3.8%). The prevalence of underlying diseases of the unilateral group was 52.4% and complications were observed in 4 patients (2.4%). Although the complication rate of the bilateral group was slightly higher than that of the unilateral group, the difference was not statistically meaningful (p=0.204). The length of hospital stay was 21.9 days for the bilateral group and 24.9 days for the unilateral group. CONCLUSIONS There was no significant difference in postoperative complications between groups. The result shows that bilateral TKA can be relatively safe compared with unilateral TKA in patients 75 years or older. However, careful selection of low-risk patients is advised.
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Affiliation(s)
- Young-Joon Choi
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Hyun-Il Lee
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Ho Jong Ra
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Do-Yon Hwang
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Tae-Kyung Kim
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Sang-Jun Shim
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
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Disparate postoperative results in the first and second knees on simultaneous bilateral total knee arthroplasty. J Arthroplasty 2014; 29:2331-6. [PMID: 25131798 DOI: 10.1016/j.arth.2014.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/25/2014] [Accepted: 07/19/2014] [Indexed: 02/01/2023] Open
Abstract
We hypothesized that the circumstances of the two consecutive operations of a simultaneous bilateral total knee arthroplasty (TKA) are different, and could lead to different outcomes of overlapping bilateral TKAs. Both knees of 420 subjects were evaluated in the current study. In the second TKA, there were more incidence rates of outlier in mechanical femoro-tibial angle (16.2% vs. 9.0%), more blood loss (735 vs. 656 mL), and longer operation time (61, 58 minutes respectively), as compared to the first TKA, while no significant differences in clinical outcomes. In conclusion, there were no significant differences in the clinical outcomes even though few distinct outcomes due to different circumstances of the surgery. Awareness of these findings can help the continued success of bilateral TKA in an increasing patient population.
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Memtsoudis SG, Hargett M, Russell LA, Parvizi J, Cats-Baril WL, Stundner O, Sculco TP. Consensus statement from the consensus conference on bilateral total knee arthroplasty group. Clin Orthop Relat Res 2013; 471:2649-57. [PMID: 23564364 PMCID: PMC3705037 DOI: 10.1007/s11999-013-2976-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/28/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Controversy exists regarding many aspects of decision making pertaining to same-day versus staged bilateral TKA (BTKAs), including patient selection, perioperative management decisions, and other important choices. QUESTIONS/PURPOSES In the absence of suitable randomized trials, we sought to determine areas of consensus among national experts on the following questions: (1) What are the comparative risks of same-day BTKAs compared with unilateral TKA (UTKA) and staged BTKAs? (2) Who should be considered an appropriate candidate for same-day BTKAs? (3) What constitutes appropriate workup and perioperative management for BTKAs? (4) What is the optimal time between procedures if same-day BTKAs are not deemed appropriate? (5) Are there orthopaedic or rehabilitation considerations for BTKAs that might outweigh medical contraindications? METHODS In the setting of a consensus conference of national experts in orthopaedic surgery, anesthesiology, perioperative medicine, and epidemiology, the major questions surrounding same-day BTKAs were addressed by using an extensive literature review and the modified Delphi process. The process concluded with a meeting of participants and formulation of consensus statements. RESULTS Eighty-one percent of participants agreed that BTKAs are more invasive and complex procedures associated with increased risk for perioperative adverse events compared with UTKA in an unselected group of patients. The consensus group agreed that physicians and hospitals should consider using more restrictive patient selection criteria and exclude those with a modified cardiac risk index greater than 3 to mitigate the potentially increased risk. The majority of the group agreed that perioperative assessment and management should reflect the higher level of acuity of same-day BTKAs. Eighty-one percent of participants agreed that if a patient is not deemed a candidate for same-day BTKAs, a second TKA should be scheduled no sooner than 3 months after the first. The entire group agreed that when there is a conflict between the orthopaedic need and the medical adequacy of same-day BTKAs, the medical concern for the patient's safety should prevail over the orthopaedic need. CONCLUSIONS Experts perceived that same-day BTKAs increase medical risk, and thus a systematic approach to the management of patients should be taken to minimize complications.
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Affiliation(s)
- Stavros G Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
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Bombardieri AM, Memtsoudis SG, Go G, Ma Y, Sculco T, Sharrock N. Pulmonary circulatory changes after bilateral total knee arthroplasty during regional anesthesia. J Clin Anesth 2013; 25:4-8. [PMID: 23391339 DOI: 10.1016/j.jclinane.2012.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 04/20/2012] [Accepted: 05/16/2012] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To monitor the pulmonary hemodynamics of patients undergoing bilateral total knee arthroplasty (BTKA) intraoperatively and up to 24 hours following surgery. DESIGN Prospective observational study. SETTING University-affiliated teaching hospital. PATIENTS 30 ASA physical status 2 and 3 patients scheduled for single-stage, cemented BTKA during epidural anesthesia. INTERVENTIONS Pulmonary artery catheters were in all patients. MEASUREMENTS Systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), the ratio of PVR to SVR at baseline, at the beginning of surgery, and after each knee implantation were recorded and compared with measurements taken one day postoperatively (POD 1). MAIN RESULTS On POD 1, PVR/SVR was increased by 30% compared with baseline (P < 0.0001) and by 20% versus the end of surgery (P < 0.0001). Systemic vascular resistance decreased during surgery and was significantly lower than baseline at 24 hours after surgery (P < 0.0001). No significant change in PVR was noted during surgery. CONCLUSION The PVR/SVR ratio on the day following BTKA was increased. This change may represent the different effects of inflammatory perioperative stresses on the pulmonary and systemic vasculature.
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Simultaneous bilateral total knee arthroplasty. A multicenter feasibility study. Orthop Traumatol Surg Res 2013; 99:191-5. [PMID: 23465514 DOI: 10.1016/j.otsr.2012.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 12/10/2012] [Accepted: 12/17/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The value and risk of simultaneous total knee arthroplasty (TKA) in patients with bilateral knee arthritis is a subject of debate. HYPOTHESES The risk of complications following simultaneous bilateral TKA will be increased compared to the rates published in the literature for unilateral TKA, and the clinical and functional outcomes will be poorer in this particular group. MATERIALS AND METHODS One hundred and twenty-three patients who underwent simultaneous bilateral TKA between 2005 and 2011 in five specialized, high volume centers were evaluated. The files were analyzed retrospectively after a mean 33 months of follow-up. RESULTS The mean hospital stay was 11 days. Mean blood loss was 4.1g/dL. A postoperative transfusion was performed in 68 patients (55%), with a mean 3.1 units of blood. The mean global IKS score increased from 90 to 150 points. Eighty patients would agree to undergo simultaneous bilateral TKA again (65%), and 70 would recommend this procedure to others (57%). DISCUSSION The hypothesis was not confirmed: the risk of complications was not increased compared to the generally accepted risk of a unilateral procedure. The risk of complications in this study was very similar to that published in the literature for the same therapeutic strategy. Therefore, there is no solid medical evidence to prevent recommending this strategy. The results of the participating centers suggest that this therapeutic approach should be continued in selected indications. LEVEL OF EVIDENCE IV, retrospective study.
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Cardiovascular disease predicts complications following bilateral total knee arthroplasty under a single anesthetic. Knee 2012; 19:580-4. [PMID: 22032866 DOI: 10.1016/j.knee.2011.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 09/06/2011] [Accepted: 09/18/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study evaluated the rate of perioperative complications of single anesthetic bilateral total knee arthroplasties (TKA) compared with staged procedures. METHODS The records of all single anesthetic bilateral TKA performed between 1997 and 2007 at one large community hospital and one university hospital were retrospectively reviewed. Complete demographic data, preoperative co-morbidities and complications for 156 patients were compared to a matched staged bilateral TKA (n=78) cohort. RESULTS In the single anesthetic bilateral TKA cohort, cardiovascular disease predicted postoperative myocardial (p<0.01, Odds Ratio - 67.6), need for ICU admission (p<0.01, Odds Ratio - 88.8), and days spent in ICU (p<0.01), while cardiovascular disease did not significantly predict postoperative MI in the staged bilateral (p=0.99, OR - 0). CONCLUSION Patients with cardiovascular disease are at higher risk for perioperative MI after single anesthetic bilateral TKA.
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Interleukin-6 as a marker for surgical trauma in total knee arthroplasty. CURRENT ORTHOPAEDIC PRACTICE 2011. [DOI: 10.1097/bco.0b013e318232d046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mortality and morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 2011; 131:1291-8. [PMID: 21359869 DOI: 10.1007/s00402-011-1287-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To evaluate the mortality and postoperative morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty (TKA). METHODS We identified eligible studies in PubMed (1980-2010), OVID MEDLINE (1980-2010) and the Cochrane library. Data were extracted and evaluated by two reviewers independently. Data analyses were conducted with Stata 10.0. RESULTS Fourteen studies met our inclusion criteria. Combined results showed that the prevalence of mortality [OR = 3.202, 95% CI (1.852-5.537)], mortality at 30 days postoperatively [OR = 5.564, 95% CI (2.392-12.939)] and neurological complications [OR = 2.906, 95% CI (1.200-7.037)] were significantly higher in the population who had undergone simultaneous TKA compared with those who had undergone staged TKA. The prevalence of infection, pulmonary embolism, deep-vein thrombosis, and cardiac complications between the two populations was not significantly different. CONCLUSION Compared with staged bilateral TKA, simultaneous bilateral TKA might carry a higher potential risk of postoperative complications. Patients should be aware of this information when deciding whether to proceed with simultaneous bilateral TKA. The poor quality of the studies calls into question the robustness of the analyses.
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Husted H, Troelsen A, Otte KS, Kristensen BB, Holm G, Kehlet H. Fast-track surgery for bilateral total knee replacement. ACTA ACUST UNITED AC 2011; 93:351-6. [PMID: 21357957 DOI: 10.1302/0301-620x.93b3.25296] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Bilateral simultaneous total knee replacement (TKR) has been considered by some to be associated with increased morbidity and mortality. Our study analysed the outcome of 150 consecutive, but selected, bilateral simultaneous TKRs and compared them with that of 271 unilateral TKRs in a standardised fast-track setting. The procedures were performed between 2003 and 2009. Apart from staying longer in hospital (mean 4.7 days (2 to 16) versus 3.3 days (1 to 25)) and requiring more blood transfusions, the outcome at three months and two years was similar or better in the bilateral simultaneous TKR group in regard to morbidity, mortality, satisfaction, the range of movement, pain, the use of a walking aid and the ability to return to work and to perform activities of daily living. Bilateral simultaneous TKR can therefore be performed as a fast-track procedure with excellent results.
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Affiliation(s)
- H Husted
- Department of Orthopaedics, Hvidovre University Hospital, Copenhagen, Denmark.
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Zmistowski B, Restrepo C, Kahl LK, Parvizi J, Sharkey PF. Incidence and reasons for nonrevision reoperation after total knee arthroplasty. Clin Orthop Relat Res 2011; 469:138-45. [PMID: 20848243 PMCID: PMC3008870 DOI: 10.1007/s11999-010-1558-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A dramatic increase in the demand for TKA is expected. The current burden of revision TKA is well known but the incidence and etiology of nonrevision reoperations after primary TKA is not. QUESTIONS/PURPOSES We determined the rate, reason, timing, and predictors of nonrevision reoperation after TKA. METHODS Using our institutional joint arthroplasty database, we identified 10,188 TKA performed on 7,613 patients between April 2000 and March 2008. A nonrevision reoperation was defined as any procedure requiring anesthetic in which components with bony interfaces were not removed or exchanged. Procedures after revision TKA were excluded. Potential risk factors investigated included age, gender, laterality, and simultaneous bilateral versus staged bilateral versus unilateral TKA. The minimum followup was 1 year (median, 4.1 years; range, 1.1 to 9.1 years). RESULTS Three hundred fifty-three patients of 7,613 (4.6%) underwent 434 nonrevision reoperations on 384 of 10,188 (3.8%) knees. The most common indication for nonrevision reoperation was stiffness (58%; 252 of 434), followed by patellar clunk (12%; 53), infection (12%; 52), wound revision (6%; 26), hematoma (4.4%; 19), among others. The median time to reoperation was 74.5 days (range, 1-3058 days) but varied widely. Younger patients and those with unilateral TKA were more likely to have a nonrevision reoperation. CONCLUSIONS The majority of nonrevision reoperations are performed for stiffness. Patellar clunk and infection also result in a large number of nonrevision reoperations. In weighing the future economic and workforce burden of TKA, nonrevision reoperations need to be acknowledged, and preventive measures need to be implemented. LEVEL OF EVIDENCE Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Benjamin Zmistowski
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Camilo Restrepo
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Lauren K. Kahl
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Javad Parvizi
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Peter F. Sharkey
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
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