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Longo UG, Papalia R, Mazzola A, Campi S, De Salvatore S, Candela V, Vaiano A, Piergentili I, Denaro V. Bilateral simultaneous hip and knee replacement: an epidemiological nationwide study from 2001 to 2016. BMC Surg 2024; 24:172. [PMID: 38822306 PMCID: PMC11141036 DOI: 10.1186/s12893-024-02450-y] [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: 02/14/2023] [Accepted: 05/09/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Several studies have compared the pros and cons of simultaneous bilateral versus staged bilateral hip and knee replacement but the outcomes of these two surgical options remains a matter of controversy. This study aimed to evaluate demographic features, incidence and hospitalization rates of bilateral one stage total hip and knee arthroplasty in Italy. METHODS The Italian Ministry of Health's National Hospital Discharge Reports (SDO) were used to gather data. This study referred to the adult population (+ 20 years of age) from 2001 to 2015 for hip arthroplasty and from 2001 to 2016 for knee arthroplasty. RESULTS Overall, 1,544 bilateral simultaneous hip replacement were carried out. The incidence rate was 0.21 cases per 100,000 adult Italian residents. Male/female ratio was 1.1. The average days of hospital stay was 11.7 ± 11.8 days. The main primary codified diagnosis was: osteoarthrosis, localized, primary, pelvic region and thigh (ICD code: 715.15). 2,851 bilateral simultaneous knee replacement were carried out. The incidence rate was 0.37 cases per 100,000 adult Italian residents. Male/female ratio was 0.6. The average days of hospital stay was 7.7 ± 5.8 days. The main primary codified diagnosis was: osteoarthrosis, localized, primary, lower leg (ICD code: 715.16). CONCLUSIONS The burden of hip and knee osteoarthrosis as a leading cause of bilateral joint replacement is significant in Italy. The national registers' longitudinal analysis may provide data for establishing international guidelines regarding the appropriate indications for one stage bilateral simultaneous hip or knee replacement versus two stage.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy.
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Alessandro Mazzola
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Stefano Campi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Vincenzo Candela
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Andrea Vaiano
- Department of Statistical Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 5, Roma, 00185, RM, Italy
| | - Ilaria Piergentili
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Vincenzo Denaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
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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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de Geofroy B, Micicoi G, Olmos M, Boileau P, Bronsard N, Gonzalez JF, Gauci MO. Early morbidity and mortality after one-stage bilateral shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2024; 48:505-511. [PMID: 37853140 DOI: 10.1007/s00264-023-06003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE One-stage bilateral shoulder arthroplasty has the advantage of requiring a single hospital stay and a single anaesthesia. The topic has been little reported, unlike one stage bilateral hip and knee arthroplasty, which have demonstrated their interest. The aim of the present study was to determine peri- and early post-operative morbidity and mortality after this procedure. The study hypothesis was that peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty is low in selected patients and that satisfaction is high. METHODS A single-centre retrospective study assessed peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty. Twenty-one patients, aged < 80 years, with ASA score ≤ 3, were consecutively operated on between 1999 and 2020. Indications comprised primary osteoarthritis, aseptic osteonecrosis, inflammatory arthritis, massive rotator cuff tear, and dislocation fracture, involving both shoulders. RESULTS There were no early deaths. The complication rate was 10% (4/21 cases). No prosthesis dislocation or sepsis was reported. Mean blood loss was 145 ± 40 cc, mean surgery time 164 ± 63 min, and mean hospital stay five ± four days. Only one patient required postoperative transfusion. Functional results at six months showed significantly improved range of motion and good patient satisfaction. CONCLUSIONS One-stage bilateral shoulder arthroplasty was feasible in selected patients. Mortality was zero, and morbidity was low. Surgery time was reasonable and required no repositioning. Postoperative home help is indispensable for patient satisfaction during rehabilitation.
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Affiliation(s)
- Bernard de Geofroy
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France
| | - Grégoire Micicoi
- Department of Orthopaedic Surgery and Sport Surgery, University Institute of Locomotion and Sport, University Hospital of Nice, 30 Av Voie Romaine, 06000 Cedex 1, Nice, CS, France
| | - Manuel Olmos
- Department of Orthopaedic Surgery and Sport Surgery, University Institute of Locomotion and Sport, University Hospital of Nice, 30 Av Voie Romaine, 06000 Cedex 1, Nice, CS, France
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice, Groupe Kantys, Locomoteur & Sport, Clinique St Antoine7 Av Durante, 06000, Nice, France
| | - Nicolas Bronsard
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France
| | - Jean-François Gonzalez
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France
| | - Marc Olivier Gauci
- Department of Orthopedic Surgery and Traumatology, Military Teaching Hospital, 34 Boulevard Laveran, 13384, Marseille, France.
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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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Çelen ZE, Özkurt B, Aydin Ö, Akalan T, Gazi O, Utkan A. Comparison of safety and efficiency between sequential simultaneous bilateral and staged bilateral total knee arthroplasty at a high-volume center: a retrospective cohort study. Acta Orthop Belg 2023; 89:455-461. [PMID: 37935229 DOI: 10.52628/89.3.11954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The treatment strategy remains controversial for bilateral end-stage osteoarthritis, particularly with regard to patient safety. The aim of this study was to compare the safety and clinical results of sequential simultaneous bilateral total knee arthroplasty (ssBTKA) and staged bilateral total knee arthroplasty (staBTKA). Patients who underwent either simultaneous (n=168) or staged (n=63) bilateral total knee arthroplasty in a single center between February 2017 and April 2021 were identified retrospectively. Data related to age, gender, body mass index, ASA score, comorbidities, operative time, transfusion rate, length of stay, knee range of motion (ROM), Knee Society Score (KSS), complications, and mortality rates were evaluated. Mean follow-up duration was 39.0±14.7 months. Preoperative characteristics were similar among cohorts. Transfused units were significantly higher in the ssBTKA group (p<0.001). Operative time and length of stay were significantly higher in the staBTKA group (respectively, p<0.001 and p=0.004). Complication rates (except superficial infection rate which was significantly higher in the staBTKA group), revision rates, mortality rates and functional outcomes were statistically similar between the groups (p>0.05). Presence of preoperative coronary artery disease comorbidity was significantly associated with increased postoperative myocardial infarction risk (p=0.001). ssBTKA provided similar functional results, shorter cumulative hospital stay and shorter operative time without increasing complications and mortality rates compared to staBTKA procedure. For patients with pre-existing coronary artery disease, a more cautious approach should be preferred to decrease complications.
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Nagata N, Hiranaka T, Okamoto K, Fujishiro T, Tanaka T, Kensuke A, Kitazawa D, Kotoura K. Is simultaneous bilateral unicompartmental knee arthroplasty and total knee arthroplasty better than simultaneous bilateral total knee arthroplasty? Knee Surg Relat Res 2023; 35:12. [PMID: 37106430 PMCID: PMC10142498 DOI: 10.1186/s43019-023-00183-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/04/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION This retrospective study aims to clarify if there are benefits of performing unicompartmental knee arthroplasty (UKA) on just one indicated side in patients who undergo simultaneous bilateral knee arthroplasty. MATERIALS AND METHODS We compared 33 cases of simultaneous bilateral UKA/total knee arthroplasty (TKA) (S-UT) with 99 cases of simultaneous bilateral TKA (S-TT). Comparison included blood tests [C-reactive protein (CRP), albumin, and D-dimer], the incidence of deep vein thrombosis (DVT), range of motion (ROM), and clinical scores before and 1 year after surgery. RESULTS Clinical scores were not significantly different between the groups. The postoperative flexion angle was significantly better in UKA sides. Blood tests showed that the S-UT had a significantly higher albumin value at 4 and 7 days after surgery. The CRP value at 4 and 7 days, and the D-dimer value at 7 and 14 days after surgery were significantly lower in the S-UT. The S-UT had significantly lower incidence of DVT. CONCLUSIONS In cases of bilateral arthroplasty, if there is an indication on only one side, a better flexion angle can be obtained by UKA on that side, and with less surgical invasion. Moreover, the incidence of DVT is low, which is considered to be a benefit of performing UKA on just one side.
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Affiliation(s)
- Naosuke Nagata
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan.
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan
| | - Toshikazu Tanaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan
| | - Anjiki Kensuke
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan
| | - Daiya Kitazawa
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan
| | - Ken Kotoura
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan
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Lee KH, Chang WL, Tsai SW, Chen CF, Wu PK, Chen WM. The impact of Charlson Comorbidity Index on surgical complications and reoperations following simultaneous bilateral total knee arthroplasty. Sci Rep 2023; 13:6155. [PMID: 37061607 PMCID: PMC10105729 DOI: 10.1038/s41598-023-33196-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/08/2023] [Indexed: 04/17/2023] Open
Abstract
Simultaneous bilateral total knee arthroplasty (TKA) might be associated with higher postoperative morbidity and mortality rates compared with staged bilateral TKA. However, risk factors for surgical complications and reoperations following simultaneous bilateral TKA remain elusive. We conducted this retrospective, single-surgeon case series from 2010 through 2019. A total of 1561 patients who underwent simultaneous bilateral TKA procedures were included. The outcome domains included 30-day and 90-day readmission events for medical or surgical complications and 1-year reoperation events. We performed logistic regression analysis and backward stepwise selection to identify possible risk factors, including age, sex, body mass index, diabetes mellitus (DM), rheumatoid arthritis, American Society of Anesthesiologist (ASA) classification, Charlson Comorbidity Index (CCI), receiving venous thromboembolism (VTE) prophylaxis, or blood transfusion. The overall 30-day, 90-day readmission, and 1-year reoperation rates were 2.11%, 2.88%, and 1.41%, respectively. Higher CCI score (CCI = 4+) was a risk factor for 90-day readmission (aOR: 2.783; 95% CI 0.621-12.465), 90 day readmission for surgical complications (aOR: 10.779; 95% CI 1.444-80.458), and 1 year reoperation (aOR: 4.890; 95% CI 0.846-28.260). Other risk factors included older age, higher ASA level, DM, and receiving VTE prophylaxis. In conclusion, high CCI scores were associated with increased risks of surgical complications and reoperations following simultaneous bilateral TKA procedures.
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Affiliation(s)
- Kun-Han Lee
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Beitou District, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Lin Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Beitou District, 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, Beitou District, 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, Beitou District, 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, Beitou District, 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, Beitou District, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Wang KY, LaVelle MJ, Gazgalis A, Bender JM, Geller JA, Neuwirth AL, Cooper HJ, Shah RP. Bilateral Total Knee Arthroplasty: Current Concepts Review. JBJS Rev 2023; 11:01874474-202301000-00011. [PMID: 36722826 DOI: 10.2106/jbjs.rvw.22.00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
» Bilateral total knee arthroplasty (BTKA) is an effective surgical treatment for bilateral knee arthritis and can be performed as a simultaneous surgery under a single anesthetic setting or as staged surgeries on separate days. » Appropriate patient selection is important for simultaneous BTKA with several factors coming into consideration such as age, comorbidities, work status, and home support, among others. » While simultaneous BTKA is safe when performed on appropriately selected patients, current evidence suggests that the risk of complications after simultaneous BTKA remains higher than for staged BTKA. » When staged surgery is preferred, current evidence indicates that complication risks are minimized if the 2 knees are staged at least 3 months apart. » Simultaneous BTKA is the economically advantageous treatment option relative to staged BTKA, primarily because of shorter total operative time and total hospital stay.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Same-day bilateral total knee replacement versus unilateral total knee replacement: A comparative study. Orthop Traumatol Surg Res 2022; 108:103301. [PMID: 35508293 DOI: 10.1016/j.otsr.2022.103301] [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: 10/15/2020] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Bilateral total knee arthroplasty (TKA) in a single session is rarely done in France, mainly due to the increased risk of perioperative and late complications. The primary objective of this study was to compare the complication rates of same-day bilateral TKA (TKA bilat) with that of unilateral TKA (TKA unilat). The hypothesis was bilateral TKA increases the rate of early and late complications in a group of selected patients (ASA 1 or 2, less than 80 years of age). MATERIAL AND METHODS Retrospective comparative study of 91 bilat TKA and 182 unilat TKA cases operated on between 2009 and 2016 (1 bilat TKA paired with 2 controls). The patients were matched based on age, sex, indication and ASA score. The minimum follow-up was 2 years. Mortality along with early and late complications were documented. The secondary endpoints were implant survival, functional outcomes, and patient satisfaction. RESULTS The early mortality rate was zero in both groups. The early complication rate was lower in the bilat TKA group (9%) than in the unilat TKA group (22%) (p<0.001). The late complications did not differ between groups. Implant survival at 5 years was 99% (95% CI=[95.6-99.7]) in the bilat TKA group and 97% (95% CI=[92.8-98.8]) in the unilat TKA group. The autologous blood transfusion rate was 33% in the bilat TKA group and 2.2% in the unilat TKA group (p<0.001). There was no difference between groups in the satisfaction rate or the KOOS and New IKS scores. A larger share of patients in the unilat TKA group (54%) said they had forgotten about their knee than in the bilat TKA group (43%) (p=0.036). DISCUSSION There were few early complications in the bilat TKA group. There was no significant difference in the number of late complications, survival, functional scores, or patient satisfaction between the two groups. The transfusion rate was higher in the bilat TKA group, while the forgotten knee rate was higher in the unilat TKA group. CONCLUSION Our hypothesis was not confirmed: in the context of this study, in patients who are ASA 1 or 2, and less than 80 years old, same-day bilateral TKA does not increase the complication rate relative to unilateral TKA. LEVEL OF EVIDENCE III, comparative study of continuous paired cases.
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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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Follett MA, Arora P, Maloney WJ, Goodman SB, Huddleston JI, Amanatullah DF. Staging Bilateral Total Knee Arthroplasties Reduces Alignment Outliers. J Arthroplasty 2022; 37:694-698. [PMID: 35017050 PMCID: PMC8934296 DOI: 10.1016/j.arth.2022.01.003] [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: 06/23/2021] [Revised: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients frequently present with bilateral symptomatic knee osteoarthritis and request simultaneous total knee arthroplasties (TKAs). Technical differences between simultaneous and staged TKAs could affect clinical and radiographic outcomes. We hypothesized that staged TKAs would have fewer mechanical alignment outliers than simultaneous TKAs. METHODS We reviewed 87 simultaneous and 72 staged TKAs with at least 2 years of follow-up. Radiographic assessment was done using standing long leg and lateral radiographs of the knee. Coronal and sagittal measurements were performed by 4 blinded observers on 2 separate occasions with an intraobserver agreement of 0.95 and interobserver of 0.92. RESULTS The first simultaneous knee had no difference in the probability of establishing the mechanical axis outside 3° of neutral (45%) compared to the first staged knee (54%, P = .337). However, the second simultaneous knee (49%) was more likely to establish the axis outside mechanical neutral compared to the second staged knee (28%; odds ratio 2.54, confidence interval 1.31-4.94, P = .006). There was an increased risk of deep venous thrombosis with staged TKA (odds ratio 2.96, confidence interval 1.28-6.84, P = .011), but other perioperative complication rates were not significantly different. There were no clinically significant differences in range of motion or Knee Society Score. CONCLUSION There is a significantly increased risk of establishing the second knee outside mechanical neutral during a simultaneous TKA compared to staged bilateral TKAs, possibly related to a number of surgeon-related and system-related factors. The impact on clinical outcomes and radiographic loosening may become significant in long-term follow-up.
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Affiliation(s)
- Matthew A. Follett
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - Prerna Arora
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - William J. Maloney
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - James I. Huddleston
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - Derek F. Amanatullah
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063,Corresponding Author: Department of Orthopaedic Surgery, Stanford Hospital and Clinics, 450 Broadway Street, Redwood City, CA 94063-6342, Phone: 650-723-2257,
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Wan RCW, Fan JCH, Hung YW, Kwok KB, Lo CKM, Chung KY. Cost, safety, and rehabilitation of same-stage, bilateral total knee replacements compared to two-stage total knee replacements. Knee Surg Relat Res 2021; 33:17. [PMID: 34118996 PMCID: PMC8196524 DOI: 10.1186/s43019-021-00098-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/29/2021] [Indexed: 11/27/2022] Open
Abstract
Background Many patients experience bilateral knee osteoarthritis and require bilateral total knee replacement (TKR). Same-stage, bilateral TKR is proposed to be a cost-effective and safe solution compared to two-stage, but conflicting results in the literature are reported. We aim to compare the costs, safety, and rehabilitation performance of patients in same-stage versus two-stage, bilateral TKR with our centre’s perioperative protocol. Materials and methods We retrospectively reviewed 175 patients (95 same-stage, 80 two-stage) who had undergone bilateral TKR in our centre. Patient selection for same-stage, bilateral TKR was strictly protocol-driven and required fulfilment of all criteria, including age < 75 years, American Society of Anesthesiologists (ASA) grade 1 or 2, body mass index (BMI) < 40, and having non-complex arthritis. All patients followed a standardised pre-operative, intra-operative, and post-operative Enhanced Recovery After Surgery (ERAS) protocol. The cost, safety profiles, and rehabilitation outcomes were compared between the same-stage and two-stage groups. Results The same-stage, bilateral TKR reduced the length of hospital stays by 5.71 days per patient, decreased the operation time by 27.4 min, saved 3.34 (18.6%) physiotherapy sessions, and 3.78 (51.5%) occupational therapy sessions. The same-stage group experienced a higher haemoglobin drop but no significant difference in transfusion percentage, transfusion volume, complication rate, and readmission rate. The two-stage subgroup with anaesthetic risk, age, and BMI similar to the same-stage group showed the same results. Same-stage, bilateral TKR patients experienced no significant difference in final post-operative pain levels and rehabilitation outcomes as two-stage TKR patients. Conclusion This study showed that same-stage, bilateral TKR can reduce costs, with similar safety profiles and rehabilitation outcomes compared to the two-stage, bilateral TKR.
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Affiliation(s)
- Raymond C W Wan
- Department of Orthopedics & Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
| | - Jason C H Fan
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China.
| | - Yuk-Wah Hung
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Ka-Bon Kwok
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Carmen K M Lo
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Kwong-Yin Chung
- Department of Orthopedics & Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
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One-session bilateral total knee replacement: Late complications and survivorship. Orthop Traumatol Surg Res 2020; 106:903-906. [PMID: 32631714 DOI: 10.1016/j.otsr.2020.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The early morbidity and mortality of one-session bilateral total knee arthroplasty (1-session BTKA) has been reported in the medical literature. However, there is less information about the long-term clinical impact of this strategy. The aim of this study was to report on the late complications (>90 days), clinical outcomes (KOOS and new KSS) along with the survivorship of 1-session BTKA. We hypothesised that 1-session BTKA will cause few late complications and that the implant survival will meet the criteria of the National Institute for Health and Clinical Excellence (NICE). METHODS This single-centre retrospective study analysed a cohort of ASA-1 and ASA-2 patients who underwent 1-session BTKR over an 8-year period (2009 to 2016). The cohort consisted of 116 patients (66% women, 34% men) with mean age at inclusion of 69 years (32-85 years); 22% of patients were ASA-1 and 78% were ASA-2. The implant-related, infection-related or mechanical complications that occurred more than 90 days after the operation, the clinical outcomes (KOOS and New KSS) and radiological outcomes, along with the survivorship were determined during the scheduled follow-up visits at 3 months, 6 months and 1 year postoperative and during the long-term follow-up or during an intercurrent event. RESULTS No patients were lost to follow-up. Fifteen complications occurred (6.5%): four infections, four patellar problems (three cases of clunk syndrome and one of patellofemoral pain), four cases of stiffness, two of unexplained pain and one femoral periprosthetic fracture. Eight patients were readmitted to the hospital (7%); seven were reoperated (3%) and two implants were revised (1%). The functional outcomes (KOOS and New KSS) were significantly improved and 87% of patients were satisfied or very satisfied with this procedure. At a mean follow-up of 5 years, the survivorship estimated using the Kaplan-Meier method was 98.4% (95% CI: 0.933-0.996). CONCLUSION Performing 1-session BTKA is a reliable strategy as it produces a low rate of late complications, excellent medium-term functional outcomes and survivorship that meets NICE criteria, thus confirming our hypothesis. LEVEL OF EVIDENCE IV, retrospective case series.
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Safety and efficacy of sequential simultaneous bilateral total knee arthroplasty: A single centre retrospective cohort study. J Clin Orthop Trauma 2020; 11:S636-S644. [PMID: 32774041 PMCID: PMC7394781 DOI: 10.1016/j.jcot.2020.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Simultaneous bilateral total knee arthroplasty (TKA) is a promising option for patients with bilateral arthritis of the knee because of the requirement of a single hospitalization and anesthetic regimen, reduced overall hospital stay, lower overall costs, and quicker recovery compared to staged bilateral TKA. However, there are conflicting reports on the safety of the procedure, with little data available in the Indian setting. Herein, we compared the efficacy and safety of sequential simultaneous bilateral TKA (SSBTKA) with those of unilateral TKA (UTKA). METHODS This retrospective analysis included cases of SSBTKA (n = 380, 760 knees) and UTKA (n = 754) performed by the same surgeon and followed up for a minimum duration of 1 year. The functional outcomes (postoperative changes in Oxford Knee Score [OKS] and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), length of hospital stay (LOS), complications, and rates of revision and mortality were compared between the two groups. RESULTS The mean follow-up durations were 40.59 and 36.69 months for the UTKA and SSBTKA groups, respectively. The LOS was significantly longer in the SSBTKA group than in the UTKA group (Median [Interquartile range]: 4[1] vs. 3[0], p < 0.001). The OKS and WOMAC scores increased with time in both groups. The improvements in each of these scores at 3, 6, and 12 months postoperatively were either statistically similar between the two groups or, if statistically different, the differences were too small to be clinically meaningful. Blood transfusions (4% [SSBTKA] vs.0.3% [UTKA], p < 0.001), cardiac complications (1.6% vs. 0.4%, p = 0.034), urine retention (3.7% vs. 1.2%, p = 0.005), and deep infection (0.8% vs. 0%, p = 0.015) were significantly more frequent in the SSBTKA group. None of the patients in the UTKA group had to undergo revision surgery, whereas in the SSBTKA group, 2 (0.6%) patients underwent revision TKA. The overall mortality rates were low in both groups (0.8% [SSBTKA] and 0.3% [UTKA]), with no significant between-group difference (p = 0.209). CONCLUSION The functional outcomes and mortality rates associated with SSBTKA are comparable to those associated with UTKA. The risk of complications and the need for revision, although higher with SSBTKA, the actual numbers are low enough to justify its use. Although the LOS in SSBTKA is longer than that in UTKA, it is likely to be shorter than the cumulative LOS for two UTKA procedures (i.e. a staged bilateral TKA). Thus, SSBTKA appears to be a safe and effective choice for appropriately selected patients.
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Tang A, Yeroushalmi D, Zak S, Lygrisse K, Schwarzkopf R, Meftah M. The effect of implant size difference on patient outcomes and failure after bilateral simultaneous total knee arthroplasty. J Orthop 2020; 22:282-287. [PMID: 32581460 DOI: 10.1016/j.jor.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022] Open
Abstract
Background Proper sizing of femoral and tibial components has been associated with long-term outcomes and survivorship in simultaneous bilateral total knee arthroplasty (SBTKA) and may be a reason for differences in outcomes between knees. The aim of this study compares post-operative outcomes and revision rates in patients undergoing SBTKA with different component sizes. Methods A retrospective review was conducted at a single academic institution identifying patients who underwent SBTKA from 2011 to 2019. Inclusion criteria included: primary osteoarthritis, similar pre-operative deformity, and same implant manufacturer. The primary outcome compares pre- and post-op (delta, Δ) Knee Society Score-Knee Score (KSS-KS) and range of motion (ROM) between knees. Secondary outcome measures were all-cause revisions rates, including manipulations under anesthesia and arthroscopy with or without lysis of adhesions. Results 149 patients were identified who met the inclusion criteria: 128 patients had femoral size difference (FSD) of 0, 138 patients had tibial size difference (TSD) of 0, 21 patients with FSD of 1, and 11 patients with TSD of 1. There was no difference in ΔKSS-KS or ΔROM in patients for any FSD or TSD. Revisions for aseptic loosening were greater for TSD 1 compared to TSD 0 (p < 0.001). No other differences in cause of revision were identified. Conclusion A TSD of 1 may be associated with increased revision rates for aseptic loosening in both smaller and larger sized implants. Surgeons may achieve optimal patient outcomes in SBTKA with proper sized implants through increased awareness of component asymmetry and repeat intraoperative evaluation when asymmetrical measurements occur.
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Affiliation(s)
- Alex Tang
- NYU Langone Health, Department of Orthopedic Surgery - Adult Joint Reconstruction, New York, NY, USA
| | - David Yeroushalmi
- NYU Langone Health, Department of Orthopedic Surgery - Adult Joint Reconstruction, New York, NY, USA
| | - Stephen Zak
- NYU Langone Health, Department of Orthopedic Surgery - Adult Joint Reconstruction, New York, NY, USA
| | - Katherine Lygrisse
- NYU Langone Health, Department of Orthopedic Surgery - Adult Joint Reconstruction, New York, NY, USA
| | - Ran Schwarzkopf
- NYU Langone Health, Department of Orthopedic Surgery - Adult Joint Reconstruction, New York, NY, USA
| | - Morteza Meftah
- NYU Langone Health, Department of Orthopedic Surgery - Adult Joint Reconstruction, New York, NY, USA
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Saini R, Powell J, Sharma R, Puloski S, Mahdavi S, Smith C, Johnston K. One-stage versus 2-stage bilateral total joint arthroplasty: a matched cohort study. Can J Surg 2020; 63:E167-E173. [PMID: 32302083 DOI: 10.1503/cjs.001019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Patients with bilateral end-stage hip or knee arthritis want to know if it is safe to have bilateral surgery under a single anesthetic, to restore their quality of life as quickly as possible. The purpose of this study was to assess if there is an increase in the rate of postoperative medical adverse events, length of stay (LOS), blood transfusion rate and 30-day readmission rate among patients who undergo 1-stage bilateral total hip arthroplasty (BTHA) and 1-stage bilateral total knee arthroplasty (BTKA) compared with patients who undergo 2-stage BTHA and BTKA. Methods Our study cohorts included patients who underwent BTHA and BTKA between Apr. 1, 2009, and Jan. 31, 2016, in Alberta, Canada. To minimize selection bias associated with our retrospective study design, we matched patients who underwent 1-stage BTHA and BTKA with patients with patients who underwent 2-stage BTHA and BTKA, respectively, for age, sex and number of presurgical risk factors using propensity score in a matching ratio of 1:1. Results Our study included 1645 patients who underwent BTHA and 4125 patients who underwent BTKA. We matched 195 patients who underwent 1-stage BTHA and 302 patients who underwent 1-stage BTKA with patients who underwent 2-stage BTHA and BTKA, respectively. There was no significant difference in postoperative medical adverse events between the 1-stage and 2-stage matched cohort groups for both BTHA (adjusted odds ratio [OR] 1.3, 95% confidence interval [CI] 0.3-4.9) and BTKA (adjusted OR 0.9, 95% CI 0.3-2.6). There was no difference in inpatient, 30- or 90-day mortality between the 2 groups for BTHA or BTKA. Patients who underwent 1-stage BTHA and BTKA had a shorter acute length of stay but increased total length of stay (acute care and rehabilitation unit) and were less likely to be discharged home postoperatively. One-stage BTHA and BTKA were associated with higher odds of blood transfusion than 2-stage BTHA and BTKA. The 30-day readmission rate was significantly lower for 1-stage BTHA than for the 2-stage BTHA matched cohort (adjusted OR 0.3, 95% CI 0.1-0.8), whereas there was no difference in the 30-day readmission rate (adjusted OR 0.6, 95% CI 0.2-1.7) between the 1-stage and 2-stage BTKA matched cohorts. Finally, operating room time was significantly lower for 1-stage BTHA (49.6 min less) and 1-stage BTKA (66.7 min less) than for the 2-stage arthroplasty procedures. Conclusion Healthy patients who undergo 1-stage BTHA and BTKA have postoperative medical complication rates comparable to those of patients who undergo 2-stage procedures with the additional benefits of a shorter acute length of stay, but they do have a higher risk of blood transfusion and are less likely to be discharged directly home from the acute care hospital. A multicentre randomized controlled trial on this topic is currently being condcuted by the Canadian Arthroplasty Society.
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Affiliation(s)
- Raghav Saini
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - James Powell
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - Rajrishi Sharma
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - Shannon Puloski
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - Saboura Mahdavi
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - Christopher Smith
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - Kelly Johnston
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
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Vaish A, Belbase RJ, Vaishya R. Is blood transfusion really required in simultaneous bilateral Total Knee Replacement: A retrospective observational study. J Clin Orthop Trauma 2020; 11:S214-S218. [PMID: 32189943 PMCID: PMC7068005 DOI: 10.1016/j.jcot.2020.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022] Open
Abstract
Simultaneous bilateral TKA (SBTKA) in a single sitting is an attractive option for medically fit patients, with end-stage osteoarthritis (OA) of both the knees. It is a cost-effective procedure but is associated with increased blood loss and requirement for blood transfusion. We present a retrospective observational study of 144 patients who had SBTKA, with the mean age of 63.86 ± 7.38 years. We noted that all the cases of SBTKA would not require a blood transfusion, if the preoperative selection and optimization of the patient is done carefully and with the use of clean surgical technique and adequate thermocoagulation of the bleeders and perioperative use of tranexemic acid (TA) is done in these cases. 2/3rd of our patients did not require any blood transfusion, after SBTKA. We found that preexisting Hypertension and Hypothyroidism were associated with increased blood loss. The use of TA was a useful adjunctive measure to reduce perioperative blood loss. According to other studies which were reviewed there was no significant difference in blood loss with or without the use of a tourniquet. However, tourniquet was used in all patients in our study. The pre-operative level of Hemoglobin was an important factor to contribute to the requirement of blood transfusion after SBTKA. We recommend blood transfusion if the post-operative Hemoglobin level is less than 8.0 gm./dl.
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Yong TM, Young EC, Molloy IB, Fisher BM, Keeney BJ, Moschetti WE. Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty. J Arthroplasty 2020; 35:139-144. [PMID: 31500911 PMCID: PMC6910974 DOI: 10.1016/j.arth.2019.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/21/2019] [Accepted: 08/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is limited evidence describing long-term implant survivorship and modes of failure in simultaneous concurrent bilateral total knee arthroplasty (TKA). METHODS We performed a retrospective review of 266 consecutive patients (532 knees) who underwent simultaneous concurrent bilateral TKA. We reviewed medical records for preoperative characteristics, perioperative complications, and revision surgeries. The primary outcome was TKA survivorship. Secondary outcomes included indication and type of revision surgery. We used the Kaplan-Meier method to estimate survivorship and characterize risk of revision up to 20 years post-TKA. RESULTS Our cohort had median follow-up of 9.8 years (interquartile range, 3.9-15.9). Forty-four patients (17%) underwent revision. Revision was more common among younger and male patients. The cumulative incidence of first-time revision per knee (n = 532) was 1.27 per 100 component-years. Implant survival was 99% (confidence interval, 97%-99%) at 5 years, 92% (89%-95%) at 10 years, 83% (77%-87%) at 15 years, and 62% (50%-73%) at 20 years. Five and 10-year survivorship compared favorably to estimates of TKA survivorship in the literature. The cumulative incidence of revision surgery per patient was 1.91 per 100 component-years. Implant survival at 5-, 10-, 15-, and 20-year time points was 96% (CI, 92%-98%), 84% (77%-89%), 71% (62%-79%), and 59% (46%-70%), respectively. Aseptic loosening (40%), polyethylene wear (34%), and infection (11%) were the most common indications for revision. CONCLUSION Simultaneous concurrent bilateral TKA is associated with a higher risk of reoperation for the patient when both knees are evaluated but similar implant survivorship to the literature when each knee was evaluated in isolation.
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Affiliation(s)
- Taylor M. Yong
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH,Reprint requests: Taylor M. Yong, MD, MS, Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756
| | - Emily C. Young
- Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Ilda B. Molloy
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Brian M. Fisher
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH
| | - Benjamin J. Keeney
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH,Berkley Medical Management Solutions, Overland Park, KS
| | - Wayne E. Moschetti
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH
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Feng S, Yang Z, Sun JN, Zhu L, Wang S, Guo KJ, Chen XY, Zha GC. Comparison of the therapeutic effect between the simultaneous and staged unicompartmental knee arthroplasty (UKA) for bilateral knee medial compartment arthritis. BMC Musculoskelet Disord 2019; 20:340. [PMID: 31351465 PMCID: PMC6661101 DOI: 10.1186/s12891-019-2724-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/16/2019] [Indexed: 01/17/2023] Open
Abstract
Background To compare the efficacy and safety of simultaneous vs staged unicompartmental knee arthroplasty (UKA) for bilateral unicompartmental osteoarthritis of the knee. Methods We performed a retrospective analysis of prospectively collected data on 93 patients with bilateral knee medial compartment arthritis underwent simultaneous UKA (Group A, 39) or staged UKA (Group B, 54 cases) from January 2008 to December 2015. Group A: 6 males and 33 females aged 64.9 ± 7.7 years; Group B: 5 males and 49 females aged 64.2 ± 6.4 years. There were no statistically significant differences in pre-operative age, sex ratio, or body weight index between the groups (P > 0.05). Groups were compared in terms of total anesthesia time, volume of drainage, blood transfusion rate, hemoglobin level on post-operative day 3, total post-operative inpatient days, treatment expenses, post-operative therapeutic effect (KSS scores), and complications. Results All patients had follow-up visits post-operatively. The follow-up visit interval was 32–133 months and 41.9 months on average. Total anesthesia time, postoperative length of hospital stay, and hospitalization expenses in Group A were significantly less than those of Group B (P < 0.05). Hemoglobin levels in Group A were significantly lower than those of Group B at post-op day 3 (P < 0.05). However, no significant differences in volume of drainage, the rate of transfusion, complications, and KSS scores were detected between Groups A and B (P > 0.05). Conclusions Both simultaneous and staged UKA achieved the desired therapeutic effect in treatment of bilateral knee medial compartment arthritis. However, simultaneous UKA reduced the cost and the postoperative length of hospital stay without increasing post-operative complications.
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Affiliation(s)
- Shuo Feng
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, Jiangsu, 221002, People's Republic of China
| | - Zhi Yang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, Jiangsu, 221002, People's Republic of China
| | - Jian-Ning Sun
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, Jiangsu, 221002, People's Republic of China
| | - Liang Zhu
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, Jiangsu, 221002, People's Republic of China
| | - Song Wang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, Jiangsu, 221002, People's Republic of China
| | - Kai-Jin Guo
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, Jiangsu, 221002, People's Republic of China
| | - Xiang-Yang Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, Jiangsu, 221002, People's Republic of China.
| | - Guo-Chun Zha
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, Jiangsu, 221002, People's Republic of China.
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Liu L, Liu H, Zhang H, Song J, Zhang L. Bilateral total knee arthroplasty: Simultaneous or staged? A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15931. [PMID: 31145362 PMCID: PMC6708906 DOI: 10.1097/md.0000000000015931] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is one of the most successful orthopedic surgeries performed in recent decades. However, controversies still exist between conducting simultaneous or staged bilateral TKA. The objective of this study is to conduct a systematic review assessing the clinical outcome associated with simultaneous bilateral and staged bilateral total knee arthroplasty (BTKA). METHODS A search was applied to CNKI, Embase, Medline, and Cochrane central database (January 2000-July 2018). All studies that compared simultaneous bilateral TKA (simBTKA) with staged bilateral TKA (staBTKA) without language restriction were reviewed, and qualities of included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled and a meta-analysis completed. RESULTS The 18 studies were identified to be eligible. The 18 comparative studies published from 2001 to 2018, covered 73617 participants in the simBTKA group and 61838 in the staBTKA group, respectively. Results of meta-analyses indicated that simBTKA showed a lower risk of deep infection and respiratory complications, but increased mortality, pulmonary embolism (PE), and deep-vein thrombosis (DVT) compared with staBTKA. There were no significant differences in revision, superficial infection, arthrofibrosis, cardiac complications, neurological complications and urinary complications between procedures. CONCLUSIONS Since there are risks and benefits to both procedures, these potential complications must be interpreted in light of each individual patient's needs and concerns. Further research must be conducted, in the form of a randomized clinical trial, to evaluate the outcomes mentioned in this review.
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Affiliation(s)
- Limin Liu
- Department of Orthopaedic Surgery, The North China Petroleum Administration Bureau General Hospital, Renqiu
| | - Hongtian Liu
- Tuberculosis prevention and control center, Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang, Hebei, P.R. China
| | - Hui Zhang
- Department of Orthopaedic Surgery, The North China Petroleum Administration Bureau General Hospital, Renqiu
| | - Jingtao Song
- Department of Orthopaedic Surgery, The North China Petroleum Administration Bureau General Hospital, Renqiu
| | - Ling Zhang
- Department of Orthopaedic Surgery, The North China Petroleum Administration Bureau General Hospital, Renqiu
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Almaguer AM, Cichos KH, McGwin G, Pearson JM, Wilson B, Ghanem ES. Combined total hip and knee arthroplasty during the same hospital admission: is it safe? Bone Joint J 2019; 101-B:573-581. [PMID: 31038999 DOI: 10.1302/0301-620x.101b5.bjj-2018-1438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this study was to compare outcomes of combined total joint arthroplasty (TJA) (total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed during the same admission) versus bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJAs performed on the same day were compared with those staged within the same admission episode. PATIENTS AND METHODS Data from the National (Nationwide) Inpatient Sample recorded between 2005 and 2014 were used for this retrospective cohort study. Postoperative in-hospital complications, total costs, and discharge destination were reviewed. Logistic and linear regression were used to perform the statistical analyses. p-values less than 0.05 were considered statistically significant. RESULTS Combined TJA was associated with increased risk of deep vein thrombosis, prosthetic joint infection, irrigation and debridement procedures, revision arthroplasty, length of stay (LOS), and in-hospital costs compared with bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJA performed on separate days of the same admission showed no statistically significant differences when compared with same-day combined TJA, but trended towards decreased total costs and total complications despite increased LOS. CONCLUSION Combined TJA is associated with increased in-hospital complications, LOS, and costs. We do not recommend performing combined TJA during the same hospital stay. Cite this article: Bone Joint J 2019;101-B:573-581.
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Affiliation(s)
- A M Almaguer
- Department of Orthopaedic Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA
| | - K H Cichos
- Department of Orthopaedic Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA.,UAB School of Medicine, Birmingham, Alabama, USA
| | - G McGwin
- UAB School of Public Health, Birmingham, Alabama, USA
| | - J M Pearson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA
| | - B Wilson
- UAB School of Medicine, Birmingham, Alabama, USA
| | - E S Ghanem
- Department of Orthopaedic Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA
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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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Abouljoud MM, Alvand A, Boscainos P, Chen AF, Garcia GA, Gehrke T, Granger J, Kheir M, Kinov P, Malo M, Manrique J, Meek D, Meheux C, Middleton R, Montilla F, Reed M, Reisener MJ, van der Rijt A, Rossmann M, Spangehl M, Stocks G, Young P, Young S, Zahar A, Zhang X. Hip and Knee Section, Prevention, Operating Room Environment: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S293-S300. [PMID: 30343970 DOI: 10.1016/j.arth.2018.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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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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Masrouha KZ, Hoballah JJ, Tamim HM, Sagherian BH. Comparing the 30-Day Risk of Venous Thromboembolism and Bleeding in Simultaneous Bilateral vs Unilateral Total Knee Arthroplasty. J Arthroplasty 2018; 33:3273-3280.e1. [PMID: 29970325 DOI: 10.1016/j.arth.2018.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Simultaneous bilateral total knee arthroplasty (SBTKA) may offer certain benefits; however, its overall safety is still disputed. This study aimed at comparing the risk of thromboembolism and bleeding in patients who underwent SBTKA vs unilateral total knee arthroplasty (TKA). METHODS The American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2015 was used to investigate the short-term postoperative complications and their risk factors following SBTKA as compared to unilateral TKA. Demographics, comorbidities, and 30-day outcomes were analyzed. Complications with an increased incidence following SBTKA were stratified to identify subgroups of patients at high risk. RESULTS A total of 155,022 patients were identified, of which 150,581 underwent unilateral TKA and 4441 underwent SBTKA. The SBTKA group was found to be at a higher risk of venous thromboembolism (VTE), bleeding, and composite morbidity. Stratification analysis revealed that SBTKA subgroups at higher risk of VTE include patients of black or Asian origin, obese patients, and those who underwent anesthesia other than general or spinal/epidural. SBTKA subgroups at higher risk of bleeding include patients older than 85 years, those with race other than white, underweight and obese patients, and patients who underwent anesthesia other than spinal/epidural. Although none of the subgroups were protected from bleeding, patients who underwent spinal/epidural anesthesia had a lower risk of bleeding compared to other types of anesthesia. CONCLUSION SBTKA confers an increased risk of postoperative VTE, bleeding, and composite morbidity at 30 days, with no increase in mortality.
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Affiliation(s)
- Karim Z Masrouha
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jamal J Hoballah
- Division of Vascular Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani M Tamim
- Department of Internal Medicine, Biostatistics Unit in the Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bernard H Sagherian
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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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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Bilateral Sequential Total Knee Replacement versus Unilateral Total Knee Replacement in a High Volume Hospital. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2018. [DOI: 10.1016/j.jotr.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background/Purpose Bilateral simultaneous or sequential total knee replacement (TKR) is performed on a portion of patients but the benefits and risks remain controversial. Methods A total of 89 sequential bilateral TKR (BTKR) patients were compared with 89 unilateral TKR (UTKR) patients in our total joint replacement centre from October 2011 to October 2014. The baseline parameters were matched and postoperative results were compared. Results The BTKR group had a shorter length of stay per knee (4.8 days vs. 6.5 days) but with a higher total drain output, higher haemoglobin drop, higher transfusion rate, and more postoperative acute retention of urine. Both groups had similar major complication rates and no 90 days mortality. Conclusion BTKR is a safe surgery in selected patients performed in a high volume hospital with fast-track programme.
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Sobh AH, Siljander MP, Mells AJ, Koueiter DM, Moore DD, Karadsheh MS. Cost Analysis, Complications, and Discharge Disposition Associated With Simultaneous vs Staged Bilateral Total Knee Arthroplasty. J Arthroplasty 2018; 33:320-323. [PMID: 28988612 DOI: 10.1016/j.arth.2017.09.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/24/2017] [Accepted: 09/02/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Simultaneous vs staged bilateral total knee arthroplasty (BTKA) has long been debated. The primary objective of this study was to compare actual hospital costs and complication rates in patients undergoing simultaneous BTKA (simBTKA) and staged BTKA (staBTKA) at a single institution. METHODS A total joint arthroplasty database from a single hospital was used to identify all patients who underwent primary BTKA from 2013 to 2016 and divided into simultaneous and staged groups. StaBTKA patients were included if both procedures were performed within 1 year by the same surgeon. The combined total hospital cost of both procedures was used, and inpatient rehabilitation (IPR) costs were added for all patients discharged to IPR. RESULTS There were 225 simBTKA and 337 staBTKA patients. SimBTKA patients were younger (61 ± 8 vs 66 ± 8 years, P < .001), had lower body mass index (31.3 ± 5.9 vs 34.0 ± 7.2, P < .001), were more predominately male (48% vs 38%, P = .029), and more likely to require IPR as compared with staBTKA patients. There was no difference in total hospital cost for simBTKA as compared with staBTKA ($24,596 ± $5652 vs $24,915 ± $5756, P = .586). Complications were more prevalent in the simBTKA group, including venous thromboembolism (5.4% vs 1.4%, P = .006) and blood transfusions (15.8% vs 6.2%, P < .001). CONCLUSION There were higher complication rates with no significant cost savings in actual hospital costs associated with simBTKA, when accounting for the cost of IPR, as compared with staBTKA. The total cost analysis of simBTKA vs staBTKA, using actual cost data, merits further evaluation.
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Affiliation(s)
- Ali H Sobh
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
| | - Matthew P Siljander
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
| | - Anthony J Mells
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
| | - Denise M Koueiter
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
| | - Drew D Moore
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
| | - Mark S Karadsheh
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
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Springer BD, Mason JB, Odum SM. Systemic Safety of Liposomal Bupivacaine in Simultaneous Bilateral Total Knee Arthroplasty. J Arthroplasty 2018; 33:97-101. [PMID: 28844768 DOI: 10.1016/j.arth.2017.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/18/2017] [Accepted: 07/25/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Intraoperative periarticular injections (PAIs) with local anesthetic are an important component of multimodal pain control in total joint arthroplasty. Liposomal bupivacaine is an extended-release formulation of bupivacaine designed to provide extended pain relief, approved for use in a single surgical site. The systemic safety profile for use in simultaneous bilateral TKA (bTKA) with a full dose in each knee has not been evaluated. The purpose of this study was to determine the safety and pharmacokinetics of bilateral full-dose PAI liposomal bupivacaine in the blood collected in patients undergoing simultaneous bTKA. METHODS In this prospective study, patients had an identical PAI consisting of 20 cc of liposomal bupivacaine (266 mg), 30 cc of 0.25% bupivacaine (75 mg) with epinephrine, and 10 cc of normal saline injected into each knee during bTKA. Blood samples were collected at predefined intervals until patient discharge. No exogenous bupivacaine was administered. Pharmacokinetic evaluations were subsequently performed and compared to bupivacaine toxicity levels. Patients were monitored for adverse events related to anesthetic toxicity (cardiac and neurologic). RESULTS Fifteen patients (mean age, 60.7 years; range, 57-64 years) were enrolled in the study. The mean peak level (Cmax) was 0.8 μg/mL (range, 0.4-1.2 μg/mL). All patients were well below the reported systemic cardiac and toxicity levels reported as 2-4 μg/mL. There were no reported cardiac and neurotoxic events in any patients. CONCLUSION The use of full-dose PAI with liposomal bupivacaine placed into each knee during simultaneous bTKA is safe with systemic bupivacaine levels well below reported cardiac and neurotoxic levels.
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Otero-López A, Beaton-Comulada D. Clinical Considerations for the Use Lower Extremity Arthroplasty in the Elderly. Phys Med Rehabil Clin N Am 2017; 28:795-810. [PMID: 29031344 DOI: 10.1016/j.pmr.2017.06.011] [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] [Indexed: 11/19/2022]
Abstract
There is an increase in the aging population that has led to a surge of reported cases of osteoarthritis and a greater demand for lower extremity arthroplasty. This article aims to review the current treatment options and expectations when considering lower extremity arthroplasty in the elderly patient with an emphasis on the following subjects: (1) updated clinical guidelines for the management of osteoarthritis in the lower extremity, (2) comorbidities and risk factors in the surgical patient, (3) preoperative evaluation and optimization of the surgical patient, (4) surgical approach and implant selection, and (5) rehabilitation and life after lower extremity arthroplasty.
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Affiliation(s)
- Antonio Otero-López
- Department of Orthopaedic Surgery, School of Medicine, University of Puerto Rico, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067, USA.
| | - David Beaton-Comulada
- Department of Orthopaedic Surgery, School of Medicine, University of Puerto Rico, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067, USA
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Huang S, Li X, Tang Y, Stiphan S, Yan B, He P, Xu D. Different patient satisfaction levels between the first and second knee in the early stage after simultaneous bilateral total knee arthroplasty (TKA): a comparison between subjective and objective outcome assessments. J Orthop Surg Res 2017; 12:121. [PMID: 28747231 PMCID: PMC5530562 DOI: 10.1186/s13018-017-0605-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 06/22/2017] [Indexed: 11/21/2022] Open
Abstract
Background Simultaneous bilateral total knee arthroplasty (TKA) is an effective treatment option and safe for properly selected patients. The purpose of this study was to evaluate whether patients have different satisfaction levels between the first and second knee in the early stage after simultaneous bilateral TKA. Methods We retrospectively reviewed 46 patients who underwent simultaneous bilateral TKA by a single surgeon in our department between March 2013 and March 2015. The surgeon typically performed first-side TKA (right knee), followed by TKA on the left knee. Tranexamic acid (TXA) (10 mg/kg) was given intravenously, and the tourniquet was released after wound closure. The preoperative KSS, ROM, and pain visual analog scale (VAS); the objective parameters including drainage volume and swelling evaluated by the circumference of the 10 cm above the patella; and the preoperative and postoperative (1st, 3rd, and 7th days) subjective parameters including pain, satisfaction VAS, and patient satisfaction of the first and second surgeries for each knee were analyzed. Results In simultaneous bilateral TKA, compared with the second-side TKA (left knee), the first-side TKA (right knee) had a lower mean drainage volume (p < 0.05), but the swelling of the knee was higher on the 1st, 3rd, and 7th postoperative days (p < 0.05). Moreover, the first-side TKA was scored lower in satisfaction VAS but higher in pain VAS at the 1st, 3rd, and 7th postoperative days. The patient satisfaction scores indicated 2 (4.4%) of the 46 patients scored first-side TKA higher than second-side TKA, 34 (73.9%) of the 46 patients scored second-side TKA higher than first-side TKA, and 10 (21.7%) of the 46 patients scored their satisfaction as the same for both knees. Conclusions This research study found that there was better patient satisfaction with the second knee in the early stage after simultaneous bilateral TKA, which may provide some considerations for surgeons choosing simultaneous bilateral total knee arthroplasty for patients with osteoarthritis in both knees.
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Affiliation(s)
- Shuai Huang
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China
| | - Xing Li
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China
| | - Yubo Tang
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Sunny Stiphan
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China
| | - Bin Yan
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China
| | - Peiheng He
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China. .,Department of Orthopaedic Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China.
| | - Dongliang Xu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2rd Road, Guangzhou, 510080, Guangdong Province, China.
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Comparison of Staged Bilateral and Simultaneous Bilateral Total Knee Arthroplasty in Deep Vein Thrombosis Occurrence. Trauma Mon 2017. [DOI: 10.5812/traumamon.15178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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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Staged bilateral total shoulder arthroplasty: improved outcomes with less than 6 months between surgeries. J Shoulder Elbow Surg 2016; 25:1774-1779. [PMID: 27288274 DOI: 10.1016/j.jse.2016.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research on optimal timing of bilateral anatomic total shoulder arthroplasty (TSA) is lacking. The purpose of this study was to investigate functional outcomes in patients undergoing bilateral anatomic TSA to understand the ideal timing for the second arthroplasty. METHODS Patients who underwent bilateral TSA for osteoarthritis between 2000 and 2012 with a minimum follow-up of 12 months since their most recent surgery were evaluated. Postoperative patient-reported outcomes (University of California-Los Angeles [UCLA] shoulder rating scale, Constant score, and Simple Shoulder Test [SST]), biometrics (strength and range of motion), and a subjective questionnaire were compared for 4 "interval groups" based on timing between surgeries: <6 months, 6 to 12 months, 12 to 24 months, and >24 months. RESULTS Eighty-two shoulders (41 patients, 70 ± 9 years old) were analyzed. Mean postoperative UCLA, Constant, and SST scores were 29, 72, and 9 points, respectively; 83% of patients reported satisfaction with both shoulders. Patients with <6 months between surgeries demonstrated significantly better UCLA scores than 6- to 12-month interval patients (P = .04), greater Constant scores compared with all other groups (P < .001), and greater SST scores compared with 6- to 12-month and 12- to 24-month interval patients (P = .002), with no differences in length of follow-up between groups. CONCLUSION In the absence of extrinsic factors, such as convenience, changes in social support structure, or changes in health status, patients may be advised that having the second surgery within 6 months of the first might optimize their postoperative functional outcomes and satisfaction compared with waiting a longer interval between surgeries.
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Sheth DS, Cafri G, Paxton EW, Namba RS. Bilateral Simultaneous vs Staged Total Knee Arthroplasty: A Comparison of Complications and Mortality. J Arthroplasty 2016; 31:212-6. [PMID: 27430183 DOI: 10.1016/j.arth.2016.03.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/23/2016] [Accepted: 03/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare the complications and mortality between bilateral simultaneous total knee arthroplasty (BTKA-Simultaneous) and bilateral staged TKA (BTK-Staged) while adjusting for differences in patient, surgeon, and hospital characteristics. METHODS An integrated health care system total joint registry was used to compare patients undergoing BTKA-Simultaneous to BTKA-Staged. For outcomes related to revision and infection, the sample included 11,118 patients, and for outcomes of death, acute myocardial infarction, stroke, and venous thromboembolism, a subsample of 7991 patients with comorbidity data was selected. RESULTS Overall death and complications in both groups were rare. The complication rates for BTKA-Simultaneous and BTKA-Staged were comparable: aseptic revision (1.17% vs 0.9%), septic revision/deep infection (0.8% vs 0.7%), death (0.28% vs 0.1%), and adverse events (2.49% vs 1.97%). In the adjusted models, there were no significant differences in any of the outcomes between the 2 groups. CONCLUSION There is a lack of evidence to support superiority of either BTKA-Simultaneous or BTKA-Staged.
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Affiliation(s)
- Dhiren S Sheth
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Irvine, California
| | - Guy Cafri
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California
| | - Robert S Namba
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Irvine, California
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Bohm ER, Molodianovitsh K, Dragan A, Zhu N, Webster G, Masri B, Schemitsch E, Dunbar M. Outcomes of unilateral and bilateral total knee arthroplasty in 238,373 patients. Acta Orthop 2016; 87 Suppl 1:24-30. [PMID: 27167849 PMCID: PMC4937774 DOI: 10.1080/17453674.2016.1181817] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 01/29/2016] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There is no consensus about the outcome of simultaneous vs. staged bilateral total knee arthroplasty (TKA). We examined this issue by analyzing 238,373 patients. Patients and methods - Demographic, clinical, and outcome data were evaluated for TKA patients (unilateral: 206,771; simultaneous bilateral: 6,349; staged bilateral: 25,253) from the Canadian Hospital Morbidity Database for fiscal years 2006-2007 to 2012-2013. Outcomes were adjusted for age, sex, comorbidities, and hospital TKA volume. Results - Simultaneous bilateral TKA patients were younger than staged bilateral TKA patients (median 64 years vs. 66 years), were more likely to be male (41% vs. 39%), and had a lower frequency of having ≥1 comorbid condition (2.9% vs. 4.2%). They also had a higher frequency of blood transfusions (41% vs. 19%), a shorter median length of stay (6 days vs. 8 days), a higher frequency of transfer to a rehabilitation facility (46% vs. 9%), and a lower frequency of knee infection (0.5% vs. 0.9%) than staged bilateral TKA patients, but they had higher rate of cardiac complications within 90 days (2.0% vs. 1.7%). Simultaneous patients had higher in-hospital mortality compared to the second TKA in staged patients (0.16% vs. 0.06%), but they had similar rates of in-hospital mortality compared to unilateral patients (0.16% vs. 0.14%). The cumulative 3-year revision rate was highest in the unilateral group (2.3%), but it was similar in the staged and simultaneous bilateral groups (1.4%). Interpretation - We found important differences between the outcomes of simultaneous and staged bilateral TKA. Further clarification of outcomes would be best determined in an adequately powered randomized trial, which would remove the selection bias inherent in this retrospective study design.
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Affiliation(s)
- Eric R Bohm
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba
- Canadian Institute for Health Information, Ottawa, Ontario
| | | | - Alina Dragan
- Canadian Institute for Health Information, Ottawa, Ontario
| | - Naisu Zhu
- Canadian Institute for Health Information, Ottawa, Ontario
| | - Greg Webster
- Canadian Institute for Health Information, Ottawa, Ontario
| | - Bas Masri
- Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia
| | - Emil Schemitsch
- Department of Surgery, University of Toronto, Toronto, Ontario
| | - Michael Dunbar
- Canadian Institute for Health Information, Ottawa, Ontario
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Ma T, Tu YH, Xue HM, Wen T, Cai MW. Clinical Outcomes and Risks of Single-stage Bilateral Unicompartmental Knee Arthroplasty via Oxford Phase III. Chin Med J (Engl) 2016; 128:2861-5. [PMID: 26521782 PMCID: PMC4756887 DOI: 10.4103/0366-6999.168042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background: Osteoarthritis often affects the joint bilaterally, and the single-stage (SS) unicompartmental knee arthroplasty (UKA) is advantageous in terms of a single anesthesia administration, a short hospital stay, lower medical costs, and enhanced patient convenience. However, the complication risk of SS UKA continues to be debated. The aim of this article was to evaluate the clinical effectiveness, complications, and functional recovery of SS and two-stage (TS) UKA. Methods: From January 2008 to December 2013, we compared a series of 36 SS UKA with 45 TS UKA for osteoarthritis. The mean age was 65.4 years (range: 55–75 years). The mean body mass index was 25.2 kg/m2 (range: 22–29 kg/m2). The pre- and post-operative Oxford Knee Scores (OKSs), complications, operative times, tourniquet times, the amount of drainage, and hemoglobin (Hb) were evaluated. The Chi-square test, Fisher's exact test, and paired and grouped t-tests were used in this study. Results: The mean follow-up was 50 months. No complications of death, fat embolism, deep vein thrombosis, and prosthetic infection were reported. Patients who underwent SS UKA had a shorter cumulative anesthesia time (113.5 vs. 133.0 min, P < 0.01). There were no significant variations between the values of the mean tourniquet time, the amount of drainage, pre- and post-operative Hb in the different groups. No patient required a blood transfusion. No statistical differences were found in the complications between two groups (P > 0.05). At the final follow-up, the mean OKS improved from 39.48 ± 5.69 to 18.83 ± 3.82 (P < 0.01), with no statistical differences between the two groups (P > 0.05). Patients who underwent SS UKA had a faster recovery. Conclusions: The single-staged UKA offers the benefits of a single anesthesia administration, reduced total anesthetic time, decreased overall rehabilitation time, and absence of an increase in perioperative mortality or complications compared with the TS bilateral UKA.
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Affiliation(s)
| | - Yi-Hui Tu
- Department of Orthopedics, YangPu District Central Hospital Affiliated to Tongji University, Shanghai 200090, China
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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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Simultaneous Bilateral Versus Unilateral Total Knee Arthroplasty: A Comparison of 30-Day Readmission Rates and Major Complications. J Arthroplasty 2016; 31:31-5. [PMID: 26297691 DOI: 10.1016/j.arth.2015.07.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/12/2015] [Accepted: 07/17/2015] [Indexed: 02/01/2023] Open
Abstract
We queried the National Surgical Quality Improvement Program to compare the rate of 30-day readmissions and major complications between simultaneous bilateral and unilateral total knee arthroplasty (TKA). We identified 1771 patients who underwent simultaneous (same-day) bilateral TKA and matched them to a control group of 6790 patients who underwent unilateral TKA. The simultaneous bilateral TKA patients had longer surgery, were more commonly performed under general anesthesia, had a higher rate of postoperative transfusion, and a greater proportion of patients discharged to rehabilitation facilities. Simultaneous bilateral TKA has a low incidence of major complications and was not associated with more readmissions as compared to unilateral TKA (3.6% versus 3.5% respectively). Nonetheless, the odds of major complications was slightly higher following simultaneous bilateral TKA (OR=1.58).
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Tranexamic Acid Decreases Incidence of Blood Transfusion in Simultaneous Bilateral Total Knee Arthroplasty. J Arthroplasty 2015; 30:2106-9. [PMID: 26235522 DOI: 10.1016/j.arth.2015.06.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/24/2015] [Accepted: 06/15/2015] [Indexed: 02/01/2023] Open
Abstract
Blood management for simultaneous bilateral total knee arthroplasty (TKA) patients is more challenging than in unilateral arthroplasty. We examined if administration of tranexamic acid (TXA) to patients undergoing simultaneous bilateral TKA would reduce blood loss and decrease allogeneic blood transfusion requirements. A retrospective review of 103 patients, 57 in the control and 46 in the TXA group, was performed. There was higher postoperative day 1 hemoglobin in patients receiving TXA (2.95±1.33 versus 4.33±1.19, P<0.0001). There was also a decrease in the transfusion incidence with administration of TXA (17.4% versus 57.9%, P<0.0001). In conclusion, we have shown that TXA is an effective tool in reducing the transfusion rates by almost 70% in simultaneous bilateral total knee arthroplasty.
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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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Liu J, Elkassabany N, Poultsides L, Nelson CL, Memtsoudis SG. Staging Bilateral Total Knee Arthroplasty During the Same Hospitalization: The Impact of Timing. J Arthroplasty 2015; 30:1172-6. [PMID: 25724110 DOI: 10.1016/j.arth.2015.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/16/2015] [Accepted: 02/10/2015] [Indexed: 02/01/2023] Open
Abstract
The concept of staging during the same hospitalization for bilateral total knee arthroplasty (BTKA) has emerged as a practice to minimize perioperative risks, although with few data providing an evidence base. A total of 41,664 BTKA patients from Nationwide Inpatient Sample data between 1998 and 2010 were identified, and categorized into three groups, same day, staging 1-3 days, and staging 4-7 days BTKA. Staging BTKA 1-3 days apart was associated with increased rates for complications compared to same day BTKA, while staging 4-7 days BTKA was associated with similar complication profiles compared to same day BTKA. Our study suggests that same day BTKA for selective patient population is preferable, and staging BTKA either 1-3 days or 4-7 days apart should be discouraged.
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Affiliation(s)
- Jiabin Liu
- Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nabil Elkassabany
- Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lazaros Poultsides
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Charles L Nelson
- Department of Orthopaedic Surgery, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Sun J, Li L, Yuan S, Zhou Y. Analysis of Early Postoperative Pain in the First and Second Knee in Staged Bilateral Total Knee Arthroplasty: A Retrospective Controlled Study. PLoS One 2015; 10:e0129973. [PMID: 26068371 PMCID: PMC4465893 DOI: 10.1371/journal.pone.0129973] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 05/14/2015] [Indexed: 12/24/2022] Open
Abstract
Objective A retrospective analysis of early postoperative pain in the first and second knee in staged bilateral total knee arthroplasty (TKA) to provide a clinical evidence for the change of analgesic strategy. Methods From January 2009 to January 2013, 87 cases which meet the inclusion criterion were retrospectively reviewed. In stage TKA, the postoperative pain in the first and second knee at 24h, 48h, 72h after operation were compared using the visual analogue scale (VAS) score in the rest and maximum knee flexion position. The difference in pain scores (ΔVAS) was also compared between the second and first knee at different time intervals (less than 6 months, 6-12 months, more than 12 months). Results The VAS scores in the second knee were significantly higher than those in the first knee at 24h, 48h after surgery, but with no difference at 72h. The ΔVAS in the group of less than 6 months was significantly higher than of those more than 6 months, and there was no difference in ΔVAS between group of 6-12 months and group of more than 12 months. Conclusions Patient receiving staged bilateral TKA experiences greater postoperative pain within 48h after operation in the second knee than in the first knee, which can provide a clinical evidence to enhance the analgesic strategy in the second operation of the staged bilateral TKA. And for the management of postoperative pain in staged bilateral TKA, it’s better to recommend that the interval between two operations should be more than 6 months, which may reduce the postoperative pain in the second knee, improve patient satisfaction, and speed up patient‘s rehabilitation process.
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Affiliation(s)
- Jiuyi Sun
- Department of orthopedics, PLA 455 Hospital, Shanghai, China
| | - Lintao Li
- Department of orthopedics, The Second Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Shuai Yuan
- Department of orthopedics, The Second Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Yiqin Zhou
- Department of orthopedics, The Second Affiliated Hospital of Second Military Medical University, Shanghai, China
- * E-mail:
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Meehan JP, Blumenfeld TJ, White RH, Kim J, Sucher M. Risks and Benefits of Simultaneous Bilateral Total Knee Arthroplasty. JBJS Rev 2015; 3:01874474-201502000-00003. [DOI: 10.2106/jbjs.rvw.n.00019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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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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Zhaohui L, Wanshou G, Qidong Z, Guangduo Z. Topical hemostatic procedures control blood loss in bilateral cemented single-stage total knee arthroplasty. J Orthop Sci 2014; 19:948-53. [PMID: 25158897 DOI: 10.1007/s00776-014-0621-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/27/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Blood management is critical in total knee arthroplasty (TKA). In bilateral, single stage TKA, blood loss seems more prominent. We believe it is important to control all potential bleeding within the wound tissue. PURPOSE The purpose of the study was to evaluate a series of topical procedures used to reduce blood loss and transfusion in single-stage bilateral cemented total knee arthroplasty: antifibrinolysis with tranexamic acid, vasoconstriction with epinephrine, sealing of the bone section intraoperatively, and closure of the drainage tube within the first 4 h postoperatively. MATERIALS AND METHODS Patients with osteoarthritis of the knees were randomly divided into two groups. In group A, 5 ml (25 mg/ml) tranexamic acid (TXA) and 5 ml analgesic containing epinephrine (3 μg/ml) solution were injected at several points into the posterior capsule before installation of the prosthesis. The femoral medullar canal was closed with autograft bone and then sealed compressively with cement. Before the tourniquet was released, 10 ml TXA solution and 10 ml analgesic containing epinephrine were injected at several points into the periosteum, synovium, joint capsule, tendons, and deep fascia tissue (injection of analgesic containing epinephrine into subcutaneous fat and dermis was avoided). The residual nail holes in the bone and the uncovered bone section were covered with bone wax. The tourniquet was then removed, and active bleeding points were stanched. TXA solution (20 ml) was injected into the articular cavity after wound closure. The drainage tube was clamped for 4 h, then opened. In group B, injection of analgesic containing epinephrine into soft tissue, control of active bleeding, and clamping of the drainage tube for 4-h, only, were performed. RESULTS Ninety patients were enrolled in the study. Compared with those in group B, intraoperative blood loss, drainage volume, total postoperative blood loss, and number of patients requiring allogenic blood transfusion were significantly reduced in group A. There was no significant difference between the incidence of complications in the groups. CONCLUSIONS Our topical procedures enable effective and safe reduction of blood loss and the number of patients requiring transfusion in single-stage bilateral osteoarthritic TKA.
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Affiliation(s)
- Liu Zhaohui
- Department of Joint Surgery, China-Japan Friendship Hospital, Yinghua Street, Beijing, 100029, People's Republic of China
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Is bilateral total knee arthroplasty staged at a one-week interval safe? A matched case control study. J Arthroplasty 2014; 29:1946-9. [PMID: 24953946 DOI: 10.1016/j.arth.2014.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/04/2014] [Accepted: 05/10/2014] [Indexed: 02/01/2023] Open
Abstract
Controversy surrounds the safety of bilateral total knee arthroplasty (TKA) and whether staging the procedures one week apart represents a safer option. A consecutive series of 234 patients underwent either a simultaneous (103 patients) or staged bilateral TKA (131 patients) from 2007 to 2012 and were compared to a matched control group of unilateral TKA (131 patients). Staged patients had no difference in one-year complication rate when compared to simultaneous bilateral TKA and the matched unilateral TKA control group (15% vs. 19% vs. 15%, P=0.512). There was also no difference in perioperative complications (10% vs. 14% vs. 7%, P=0.231) or 90-day readmissions (8% vs. 4% vs. 4%, P=0.295). In selected patients with bilateral knee OA, TKA staged at a one-week interval is a safe alternative.
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Odum SM, Springer BD. In-Hospital Complication Rates and Associated Factors After Simultaneous Bilateral Versus Unilateral Total Knee Arthroplasty. J Bone Joint Surg Am 2014; 96:1058-1065. [PMID: 24990970 DOI: 10.2106/jbjs.m.00065] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Data comparing complication rates following simultaneous bilateral total knee arthroplasty with those of unilateral total knee arthroplasty are conflicting. The purpose of this study was to compare in-hospital complication rates following simultaneous bilateral versus unilateral total knee arthroplasty and to determine factors associated with in-hospital complication rates in a large cohort of patients identified from the Nationwide Inpatient Sample (NIS). METHODS The 2004 to 2007 NIS data set was used to identify 407,070 total knee arthroplasties: 24,574 simultaneous bilateral and 382,496 unilateral total knee arthroplasties. Complications, based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, were categorized as none, minor, major, or mortality. Covariates included comorbidities, demographic information, payer type, and hospital total knee arthroplasty volume. Multiple logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Simultaneous bilateral total knee arthroplasty was associated with significantly higher odds of an in-hospital complication compared with unilateral total knee arthroplasty: OR, 1.51 (95% CI, 1.42 to 1.62) for minor complication; OR, 1.30 (95% CI, 1.14 to 1.47) for major complication; and OR, 2.51 (95% CI, 1.66 to 3.80) for mortality. Patients with greater numbers of medical comorbidities were more likely to have an in-hospital complication. Compared with whites, African-American and Asian/Pacific Islander groups had significantly higher odds of a minor complication. Female patients were less likely than male patients to have an in-hospital complication. Patients who were less than sixty-five years old at the time of surgery had significantly reduced odds of a minor complication and mortality compared with patients who were seventy-five years of age or older. Compared with hospitals with a very-high volume of total knee arthroplasty procedures performed (≥850), lower-volume hospitals had significantly increased odds of minor complications and mortality. CONCLUSIONS While complication rates following either unilateral or simultaneous bilateral total knee arthroplasty are low, simultaneous bilateral total knee arthroplasty was associated with higher odds of in-hospital complications, including mortality, compared with unilateral total knee arthroplasty. Patient demographic information, preoperative health status, payer type, and hospital total knee arthroplasty volume were all significant factors in complication rates following bilateral total knee arthroplasty. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Susan M Odum
- OrthoCarolina Research Institute, Inc., 2001 Vail Avenue, Suite 300, Charlotte, NC 28207. E-mail address:
| | - Bryan D Springer
- OrthoCarolina Hip and Knee Center, 2001 Vail Avenue, Suite 200-A, Charlotte, NC 28207. E-mail address:
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Bini SA, Khatod M, Inacio MCS, Paxton EW. Same-day versus staged bilateral total knee arthroplasty poses no increase in complications in 6672 primary procedures. J Arthroplasty 2014; 29:694-7. [PMID: 24360340 DOI: 10.1016/j.arth.2012.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 08/09/2012] [Accepted: 09/17/2012] [Indexed: 02/01/2023] Open
Abstract
We examined the assumption that patients undergoing same-day bilateral total knee arthroplasty (TKA) have a higher incidence of major peri-operative complications than patients who stage their procedures over the course of a year. Between April 2001 and March 2007, prospective data were collected using a total joint registry. Patients undergoing primary, bilateral, same-day, TKAs were compared to patients undergoing primary, staged, bilateral TKAs within 12 months of the index operation. A total of 2441 TKAs were performed on the same day, while 4231 were staged. There were no significant differences in 90-day mortality, thrombotic events and infections between the two groups. Performing same-day bilateral TKA does not predispose patients to increased cumulative incidence of major complications over staged arthroplasty.
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Affiliation(s)
- Stefano A Bini
- Department of Orthopaedic Surgery and Podiatry, Kaiser Permanente Oakland (EBY Medical Center), Oakland, California
| | - Monti Khatod
- Department of Orthopaedic Surgery and Podiatry, Kaiser Permanente Los Angeles, Los Angeles, California
| | - Maria C S Inacio
- Department of Clinical Analysis, Surgical Outcomes & Analysis Unit, San Diego, California
| | - Elizabeth W Paxton
- Department of Clinical Analysis, Surgical Outcomes & Analysis Unit, San Diego, California
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