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Reda B, Sharaf R. Incidence of Postoperative Infection Following Simultaneous Bilateral Knee Arthroplasty: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54117. [PMID: 38487132 PMCID: PMC10938981 DOI: 10.7759/cureus.54117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
Total knee arthroplasty is one of the most common orthopedic procedures. Simultaneous bilateral knee arthroplasty involves performing total knee arthroplasty on both knees in a single anesthetic session. This systematic review and meta-analysis followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. A primary search was performed using PubMed, EBSCO, Scopus, Web of Science, Clarivate, and Google Scholar databases. Quantitative data synthesis was performed using MedCalc® Statistical Software version 20.115 to determine the pooled prevalence of the infection among patients who underwent simultaneous bilateral knee arthroplasty. The Newcastle-Ottawa Scale was used to assess study quality. We included 30 studies in our quantitative data synthesis, with a total population of 118,502 patients (237,004 knees). The pooled prevalence of superficial infection, deep infection, and unspecified surgical site infection was estimated to be 0.86% (95% confidence interval: 0.62-1.13%), 0.84% (95% confidence interval: 0.64-1.05%), and 1.18% (95% confidence interval: 0.45-2.27%), respectively. There was significant heterogeneity (I2 >50%) in all analyses, and inspection of funnel plots revealed a symmetrical distribution of plotted data. We found that the infection rates following simultaneous bilateral knee arthroplasty were relatively low but heterogeneous, as the data showed marked variability. Superficial infections were more common than deep infections; however, there was a small difference in their prevalence. Furthermore, the reliability of our findings was limited owing to significant heterogeneity.
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Affiliation(s)
- Bashar Reda
- Orthopedic Surgery, College of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Raed Sharaf
- College of Medicine, King Abdulaziz University, Jeddah, SAU
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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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Qadir I, Khan L, Mazari J, Ahmed U, Zaman AU, Aziz A. Comparison of functional outcome of simultaneous and staged bilateral total knee arthroplasty : systematic review of literature. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Safety of simultaneous bilateral TKA (simBTKA) and staged BTKA (staBTKA) have been compared in previous systematic reviews but functional outcome remains neglected aspect of the debate. We performed a systematic review of contemporary literature to compare the functional outcome of simBTKA and staBTKA.
We searched PubMed/MEDLINE, EMBASE and Cochrane Central Database to identify all articles published between 2000 and July 2020 that evaluated the outcome of patients undergoing BTKA either in simultaneous or staged manner.
Ten articles were identified which met the inclusion criteria. Functional outcome was reported in terms of Knee Society score (KSS), range of motion (ROM), Oxford Knee Score (OKS) and Western Ontario and McMaster University score (WOMAC) in seven, five, four and two studies respectively. KSS gained on average 66.6 points (47.5-95.3) for simBTKA and 65.1 points (44.4-97.2) for staBTKA without significant difference between two groups. There was no difference in post-operative ROM (maximum post-operative flexion being 124.4 and 125.1 for simBTKA and staBTKA groups respectively). Mean improvement in OKS ranged from 20 to 32.6 for simBTKA and 21.6 to 33.1 for staBTKA.
There was moderate evidence to suggest that both simultaneous BTKA and staged BTKA produce equivalent improvement in functional scores.
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Li K, Zhu Y. Comment on Goyal et al.: Simultaneous single-stage versus two-staged bilateral total knee arthroplasty: a prospective comparative study. INTERNATIONAL ORTHOPAEDICS 2020; 44:2815-2816. [PMID: 33033855 DOI: 10.1007/s00264-020-04846-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kaihu Li
- Department of Orthopaedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Yong Zhu
- Department of Orthopaedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
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One-Surgeon vs Two-Surgeon Single-Anesthetic Bilateral Total Knee Arthroplasty: Revision and Mortality Rates From the Australian Orthopedic Association National Joint Replacement Registry. J Arthroplasty 2020; 35:1852-1856. [PMID: 32234328 DOI: 10.1016/j.arth.2020.02.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/19/2020] [Accepted: 02/28/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Outcomes following 1-surgeon single-anesthetic sequential bilateral total knee arthroplasty (seq-BTKA) compared to 2-surgeon single-anesthetic simultaneous bilateral total knee arthroplasty (sim-BTKA) are largely unknown. The current study compared revision rates and all-cause mortality following seq-BTKA vs sim-BTKA using data from the Australian Orthopedic Association National Joint Replacement Registry. METHODS Seq-BTKA and sim-BTKA procedures recorded within the registry between September 1, 1999 and December 31, 2018 were analyzed for subsequent revision and patient mortality. Cumulative percent revision and cumulative percent survival were determined using the Kaplan-Meier method. Revision and mortality rates for sim-BTKA and seq-BTKA were compared using Cox proportional hazards models, adjusting for age and gender. RESULTS Included in the analysis were 27,480 seq-BTKAs and 471 sim-BTKAs. There was no difference in the cumulative percent revision between the 2 groups (hazard ratio 1.23, 95% confidence interval 0.82-1.85). Cumulative percent patient survival was not significantly different between the 2 groups (hazard ratio 1.20, 95% confidence interval 0.93-1.54). CONCLUSION Revision rates and mortality were similar for seq-BTKA and sim-BTKA. Investigation of additional outcomes such as complications not requiring revision, pain, function, and cost is required to comprehensively understand the relative merits of each procedure.
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Simultaneous single-stage versus two-staged bilateral total knee arthroplasty: a prospective comparative study. INTERNATIONAL ORTHOPAEDICS 2020; 44:1305-1310. [PMID: 32458035 DOI: 10.1007/s00264-020-04642-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The study aims to prospectively compare peri-operative morbidity and mortality of simultaneous single-stage bilateral total knee arthroplasty (SS BLTKA) with two-staged bilateral total knee arthroplasty (TS BLTKA) performed within 12 months of the first surgery. We hypothesized that SS BLTKA is as safe as TS BLTKA. METHODS Patients with a minimum follow-up of 12 months were included in this study. Oxford knee score and quality of life index SF12 was compared between the 2 groups at six weeks and six month follow-up. RESULTS SS BLTKA included 250 patients and TS BLTKA included 210 patients. The minimum time interval between two operations was three weeks (mean 1.6 months, range 3 weeks-12 months). There was no significant difference between the 2 groups in peri-operative mortality, surgical site infection, major peri-operative complications. There was no difference between the 2 groups in the Oxford knee score and quality of life index SF12 at 6-month follow-up. There was no difference in the range of knee flexion between the 2 groups at six months. Post-operative haemoglobin drop was significantly more in SS BLTKA patients and consequently, blood transfusion requirement was significantly higher in SS BLTKA. There was a significantly higher length of hospital stay and duration of surgery in TS BLTKA group. CONCLUSION There does not appear to be a difference in complication rates between the 2 groups. SS BLTKA seems to be a logical choice if both knees have severe osteoarthritis. Patients with severe cardiopulmonary compromise were excluded, and a unilateral procedure may be preferred in them.
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Malahias MA, Gu A, Adriani M, Addona JL, Alexiades MM, Sculco PK. Comparing the Safety and Outcome of Simultaneous and Staged Bilateral Total Knee Arthroplasty in Contemporary Practice: A Systematic Review of the Literature. J Arthroplasty 2019; 34:1531-1537. [PMID: 31031158 DOI: 10.1016/j.arth.2019.03.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although a variety of studies have assessed the outcomes of simultaneous bilateral total knee arthroplasty (BTKA) and staged BTKA, there remains no definitive conclusion regarding the superiority of one technique in terms of safety. METHODS The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried utilizing keywords pertinent to BTKA, simultaneous and staged, and clinical or functional outcomes. In order to examine the contemporary relevant literature, studies published prior to 2009 were excluded from our search. RESULTS In total, 19 articles met the inclusion criteria and were included in this analysis. The overall quality of the studies included in this review was rated as moderate. Seven of the 19 studies reported no significant differences between the 2 groups in regards to baseline clinical and demographic characteristics (comorbidity index, American Society of Anesthesiologists grade, preoperative clinical subjective scores). Nearly all from these 7 studies with comparable initial characteristics documented no significant differences in the overall complication rates between the 2 groups in addition to no difference in mortality rate, cardiac complications, revision rate, thromboembolic events, and functional outcomes. CONCLUSION In contemporary studies involving comparable baseline demographics (including comorbidity index, American Society of Anesthesiologists grade), there was moderate evidence to show that simultaneous BTKA is as safe as the staged BTKA.
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Affiliation(s)
- Michael-Alexander Malahias
- Department of Orthopaedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Alex Gu
- Department of Orthopaedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Marco Adriani
- Department of Orthopaedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Jacqueline L Addona
- Department of Orthopaedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Michael M Alexiades
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Orthopaedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
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Unilateral versus bilateral total knee arthroplasty: A registry study on survival and risk factors. Orthop Traumatol Surg Res 2019; 105:627-631. [PMID: 31027978 DOI: 10.1016/j.otsr.2019.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/30/2018] [Accepted: 01/31/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bilateral cases, representing at least 25% of total knee arthroplasties (TKA), could convey a statistical bias linked to dependency. Registries allow exploring this issue, susceptible to question surgeon validated protocols. Do bilateral total knee arthroplasties behave differently than unilateral knees in terms of implant survival? HYPOTHESIS Bilateral TKA have a better survival than unilateral TKA. PATIENTS AND METHODS A number of 14,652 bilateral and 27,440 unilateral TKAs were compared. Influencing factors were tested with hazard ratios applied on bilateral knees. RESULTS Bilateral knees had a better survival (p<0.001). Delay between first and second side surgeries had an influence on survival of the first knee: if below a year, the first knee survival was superior to the second knee; more than three years between both arthroplasties significantly decreased the survival of the first implant. If the first knee was revised, the hazard ratio for revision of the second implant was 3.5. DISCUSSION Series should include separate evaluations of bilateral cases, because they have a better survival than unilateral knees. A long delay between both knee replacements could impact both implant survivals. Level of Evidence III, Cohort Comparative Study.
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Qadir I, Shah B, Waqas M, Ahmad U, Javed S, Aziz A. Component Alignment in Simultaneous Bilateral versus Unilateral Total Knee Arthroplasty. Knee Surg Relat Res 2019; 31:31-36. [PMID: 30871290 PMCID: PMC6425892 DOI: 10.5792/ksrr.18.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/04/2018] [Accepted: 10/31/2018] [Indexed: 01/30/2023] Open
Abstract
Purpose The purpose of this study was to investigate differences in component alignment between first and second knees in simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral TKA (UTKA). Materials and Methods 274 SBTKAs and 198 UTKAs were included in study. Patients were divided into three groups as SBTKA on the right knee (group A), SBTKA on the left knee (group B) and UTKA (group C). Femoral and tibial component alignment was checked in both coronal plane (alpha [α] and beta [β] angles) and sagittal plane (gamma [γ] and delta [δ] angles) radiographs. Results There were no statistically significant differences among groups in the preoperative anatomical varus angle and Kellgren–Lawrence gonarthrosis classification grade (p=0.139 and p=0.329, respectively). In the coronal plane, the alignment of femoral component (α angle) and tibial component (β angle) was similar in all three groups (α angle, 95.01 vs. 95.14 vs. 94.9, p=0.945; β angle, 90.03 vs. 89.67 vs. 89.98, p=0.483). The sagittal plane alignment of femoral component (γ angle) and tibial component (δ angle) did not show significant differences (γ angle, 7.04 vs. 6.98 vs. 7.00, p=0.132; δ angle, 86.56 vs. 87.41 vs. 86.73, p=0.610). Conclusions The angular alignment of components was similar between SBTKA and UTKA.
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Affiliation(s)
- Irfan Qadir
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Bahar Shah
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Muhammad Waqas
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Umair Ahmad
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Shahzad Javed
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Amer Aziz
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
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Optimizing Intraoperative Blood Management for One-Stage Bilateral Total Knee Arthroplasty. HSS J 2018; 14:202-210. [PMID: 29983664 PMCID: PMC6031535 DOI: 10.1007/s11420-017-9590-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Effective blood management strategies are a major determinant of successful outcomes after one-stage bilateral total knee arthroplasty (BTKA). Proper patient selection with preoperative optimization and intra- and postoperative interventions can reduce transfusion risk and associated morbidity in these patients. QUESTIONS/PURPOSES The purpose of this study was to evaluate intraoperative blood management modalities based on three keystone questions: (1) What is the role of the anesthesiologist?, (2) Which are the surgeon-dependent strategies?, and (3) Is there any place for pharmacologic interventions? METHODS We searched the established electronic literature database MEDLINE. After critical appraisal, 94 studies were deemed eligible from which to draw documented evidence. RESULTS A number of blood-conserving methods are currently implemented in patients undergoing one-stage BTKA. Among them, regional anesthesia, tourniquet use, and tourniquet deflation after wound closure, femoral canal sparing or femoral canal plugging, avoidance of drains, and tranexamic acid use were the intraoperative strategies with documented efficacy in blood conservation. CONCLUSION Combined proper intraoperative anesthesiologic, surgical, and pharmacologic interventions reduce blood loss and need for transfusion in BTKA patients. However, contemporary relevant literature is lacking evidence-based guidelines.
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Nielsen KA, Thomsen MG, Latifi R, Kallemose T, Husted H, Troelsen A. Does post-operative knee awareness differ between knees in bilateral simultaneous total knee arthroplasty? Predictors of high or low knee awareness. Knee Surg Sports Traumatol Arthrosc 2016; 24:3352-3358. [PMID: 26860099 DOI: 10.1007/s00167-016-4013-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 01/20/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the difference in post-operative knee awareness between knees in patients undergoing bilateral simultaneous total knee arthroplasty (TKA) and to assess factors predicting high or low knee awareness. METHODS This study was conducted on 99 bilateral simultaneous TKAs performed at our institution from 2008 to 2012. All patients received one set of questionnaires [Forgotten Joint Score (FJS) and Oxford Knee Score (OKS)] for each knee. Based on the FJS, the patients' knees were divided into two groups: "best" and "worst" knees. The median of the absolute difference in FJS and OKS within each patient was calculated. Multivariate linear regression was performed to identify factors affecting FJS. RESULTS The difference between knees was 1 point (CI 0-5) for the FJS and 1 point (CI 0-2) for the OKS. The FJS for females increased (decreasing awareness) with increasing age. Males had the highest FJS (lowest awareness) at the age of 67. An increase in the FJS (lower knee awareness) of 12.0 points was found for Kellgren-Lawrence (K-L) grades 3 + 4 compared with K-L grades 1 + 2. A preoperative anatomical alignment of 3° valgus resulted in the lowest FJS (highest knee awareness) with decreasing knee awareness for decreasing tibio-femoral angles. Post-operative alignment did not significantly affect FJS. CONCLUSION Knee awareness did not differ significantly between the "best" and the "worst" knee. Bilateral simultaneous TKA can be performed without compromising the result in one of the knees. Knee awareness after primary TKA was influenced by age, gender, preoperative knee alignment, and severity of OA. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Morten Grove Thomsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Roshan Latifi
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Henrik Husted
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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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 two-surgeon bilateral total knee arthroplasty. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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