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Sun K, Pi J, Wu Y, Zeng Y, Xu J, Wu L, Li M, Shen B. The Optimal Period of Staged Bilateral Total Knee Arthroplasty Procedures under Enhanced Recovery: A Retrospective Study. Orthop Surg 2023; 15:1249-1255. [PMID: 36794464 PMCID: PMC10157719 DOI: 10.1111/os.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE The implications of the interval of staged bilateral total knee arthroplasty (TKA) procedures for postoperative complications and costs are not clear. We aimed to determine the optimal time interval between the two stages of bilateral TKA procedures under the enhanced recovery after surgery (ERAS) protocol. METHODS This retrospective study of collected data included bilateral TKA cases under the ERAS protocol performed between 2018 and 2021 at the West China Hospital of Sichuan University. The staged time was subdivided into three groups according to the interval between the first TKA and second contralateral TKA: group 1: 2- to 6-month, group 2: 6- to 12-month, and group 3: >12 months. The primary outcome was the incidence of postoperative complications. The secondary outcomes were the length of hospital stay (LOS), hemoglobin (Hb) decrease, hematocrit (Hct) decrease, and albumin (Alb) decrease. RESULTS We analyzed 281 patients who underwent staged bilateral TKAs between 2018 and 2021 at the West China Hospital of Sichuan University. Regarding postoperative complications, there were no statistically significant differences among the three groups (P = 0.21). For the mean LOS, the 6- to 12-month group had a significantly shorter LOS compared with the 2- to 6-month group (P < 0.01). There was also a significant decrease in Hct of the 2- to 6-month group compared with the 6- to 12-month group and the >12 months group (P = 0.02; P < 0.05, respectively). CONCLUSION Staging the second arthroplasty for more than a half year seems to offer a reduction in the rate of postoperative complications and LOS under ERAS protocol. ERAS shortens the interval of staged bilateral TKA by at least 6 months for patients who might receive their second surgery without the need to wait for an extended period.
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Affiliation(s)
- Kaibo Sun
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jinkui Pi
- Core Facilities of West China Hospital, Sichuan University, Chengdu, China
| | - Yuangang Wu
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zeng
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jiawen Xu
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Limin Wu
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyang Li
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Shen
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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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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Jiang Q, Long H, Xie D, Li X, Wang H, Zeng C, Lei G. A nationwide comparison of staggered and simultaneous bilateral knee arthroplasty during a single hospitalization: Trends, risks and benefits. J Orthop Translat 2022; 36:75-82. [PMID: 35979177 PMCID: PMC9364055 DOI: 10.1016/j.jot.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background We aimed to: (1) perform a nationwide trend analysis of staggered and simultaneous bilateral knee arthroplasty (KA); (2) investigate patient demographics and hospital characteristics in two groups; and (3) compare the outcomes of two groups with a focus on complications, length of stay (LOS) and hospitalization costs. Methods Utilizing the Hospital Quality Monitoring System, we included patients who underwent bilateral KA during a single hospitalization between 2013 and 2019. Patient demographics and hospital characteristics were compared between two groups. Outcomes were compared between propensity-score matched groups using logistic and linear regression. Results During the study period, 6291 staggered bilateral KA and 6284 simultaneous bilateral KA were performed. From 2013 to 2019, the proportion of staggered bilateral KA increased from 32.74% to 59.08%. Patients who were older, were single, had more comorbidities and had a non-osteoarthritis indication for surgery tended to receive staggered bilateral KA. Compared with 3327 propensity-score matched patients undergoing simultaneous bilateral KA, patients undergoing staggered bilateral KA were associated with a significantly lower incidence of wound infection (odds ratio [OR] = 0.22; 95% confidence interval [CI], 0.07–0.65), and readmission within 30 days (OR = 0.73; 95%CI, 0.54–0.99) and 90 days (OR = 0.70; 95%CI, 0.55–0.89). However, staggered bilateral KA had higher odds of blood transfusion (OR = 1.20; 95%CI, 1.02–1.40) and deep venous thrombosis (DVT) (OR = 2.62; 95%CI, 1.82–3.98). Moreover, staggered bilateral KA can lead to higher costs (108,316.21 Chinese yuan [CNY] vs 103,367.60 CNY) and longer LOS (17.29 days vs 12.18 days) than simultaneous bilateral KA. Conclusion Our study indicates that staggered bilateral KA has become more common than simultaneous bilateral KA in China. Compared to simultaneous bilateral KA, staggered bilateral KA was associated with a lower incidence of wound infection and readmission. Staggered bilateral KA may be an alternative for patients who can't tolerate simultaneous surgery. The translational potential of this article: Our study indicates that staggered bilateral KA is a safe and economical option for elderly patients who require bilateral KA but are at high clinical risk. The rising proportion of staggered bilateral KA will be a new trend in bilateral KA.
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Affiliation(s)
- Qiao Jiang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huizhong Long
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
| | - Haibo Wang
- China Standard Medical Information Research Center, Shenzhen, Guangzhou, China.,Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Wang KY, Puvanesarajah V, Raad M, Barry K, Srikumaran U, Thakkar SC. The BTK Safety Score: A Novel Scoring System for Risk Stratifying Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty. J Knee Surg 2022; 36:702-709. [PMID: 34979584 DOI: 10.1055/s-0041-1741000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Selection of appropriate candidates for simultaneous bilateral total knee arthroplasty (si-BTKA) is crucial for minimizing postoperative complications. The aim of this study was to develop a scoring system for identifying patients who may be appropriate for si-BTKA. Patients who underwent si-BTKA were identified in the National Surgical Quality Improvement Program database. Patients who experienced a major 30-day complication were identified as high-risk patients for si-BTKA who potentially would have benefitted from staged bilateral total knee arthroplasty. Major complications included deep wound infection, pneumonia, renal insufficiency or failure, cerebrovascular accident, cardiac arrest, myocardial infarction, pulmonary embolism, sepsis, or death. The predictive model was trained using randomly split 70% of the dataset and validated on the remaining 30%. The scoring system was compared against the American Society of Anesthesiologists (ASA) score, the Charlson Comorbidity Index (CCI), and legacy risk-stratification measures, using area under the curve (AUC) statistic. Total 4,630 patients undergoing si-BTKA were included in our cohort. In our model, patients are assigned points based on the following risk factors: +1 for age ≥ 75, +2 for age ≥ 82, +1 for body mass index (BMI) ≥ 34, +2 for BMI ≥ 42, +1 for hypertension requiring medication, +1 for pulmonary disease (chronic obstructive pulmonary disease or dyspnea), and +3 for end-stage renal disease. The scoring system exhibited an AUC of 0.816, which was significantly higher than the AUC of ASA (0.545; p < 0.001) and CCI (0.599; p < 0.001). The BTK Safety Score developed and validated in our study can be used by surgeons and perioperative teams to risk stratify patients undergoing si-BTKA. Future work is needed to assess this scoring system's ability to predict long-term functional outcomes.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Varun Puvanesarajah
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Micheal Raad
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Kawsu Barry
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Umasuthan Srikumaran
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Savyasachi C Thakkar
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Comparison of the Effect and Complications of Sequential Bilateral Arthroplasty at Different Time Intervals and Simultaneous Bilateral Total Knee Arthroplasty: A Single-Centre Retrospective Cohort Study. Adv Ther 2021; 38:5191-5208. [PMID: 34453702 DOI: 10.1007/s12325-021-01880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION To the authors' knowledge, there is no current consensus regarding the optimal interprocedural interval for patients who have undergone bilateral total knee arthroplasty (BTKA). The purpose of this study is to evaluate complication rates and functional outcome in patients who have undergone BTKA (simultaneous or sequential at different time intervals), and to determine an optimal time frame for the second knee. METHODS Data from 315 patients who were able to tolerate simultaneous BTKA according to the anaesthesiologist's preoperative assessment between 2016 and 2020 were analysed retrospectively. According to the operative time interval, they were divided into simultaneous, ≤ 1-month sequential, 1- to 3-month sequential, and ≥ 3-month sequential BTKA groups. The primary outcomes were revision and readmission rates during the follow-up period, and the secondary outcomes were hospital length of stay (LOS), transfusion and postoperative complications. RESULTS There was no difference in the implant survival or readmission rate between the groups (p > 0.05). Multivariable linear regression showed that interprocedural interval and body mass index (BMI) affected LOS; the LOS of simultaneous BTKA was the shortest (p < 0.05). BMI was associated with an increased LOS of 0.25 days (95% CI 0.02-0.48, p = 0.03). A modified Poisson regression model showed that the odds of blood transfusion were reduced in sequential BTKAs of any interval (p < 0.05), and preoperative haemoglobin (Hb) was also a risk factor (RR 0.96, 95% CI 0.95-0.98, p < 0.001). The interprocedural interval was not a risk factor for postoperative cardiovascular and cerebrovascular complications. CONCLUSION For appropriate patients, simultaneous BTKA is beneficial. However, higher preoperative haemoglobin was required to mitigate the high blood transfusion rate associated with simultaneous surgeries. If suitable patients refuse simultaneous BTKA for other non-medical reasons, sequential BTKA with an interval greater than 1 month is recommended.
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Staggered bilateral total knee arthroplasty during a single hospitalization: is it still an option? a systematic review. Musculoskelet Surg 2021; 106:207-217. [PMID: 33721261 DOI: 10.1007/s12306-021-00696-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bilateral knee osteoarthritis requiring total knee arthroplasty (TKA) can be addressed simultaneously in one surgical setting, staggered a few days apart during a single hospitalization, or staged several weeks to months apart. Several studies have reported on the complications and clinical outcomes of staggered bilateral TKA (BTKA) in a single hospitalization. However, there is no consensus regarding the safety and efficacy of this practice. MATERIALS AND METHODS We performed a systematic review of the literature, utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identifying articles that reported the clinical outcomes and postoperative complications following staggered BTKA. RESULTS Overall, six articles were included for analysis, including 43,892 patients in total. Females (n = 25,931; 59% of all patients) outnumbered males (n = 17,961; 40.1% of all patients), and most patients were middle-aged or elderly (mean age: 68.0 years). The majority of studies (83%) used a 1-week interval as the maximum time for single-hospitalization staggered BTKA. Five studies (83%) reported no difference in mortality rates between staggered, simultaneous, or staged BTKA. Compared to staged BTKA, staggered BTKA conferred an increased rate of blood transfusions. There was no consensus that staggered BTKA led to reduced complications rates, compared to simultaneous or staged BTKA. CONCLUSIONS Single-hospitalization staggered BTKA does not appear to be safer than the well-established simultaneous or staged procedures. Overall, the data suggest that staggered BTKA will continue to decline in utilization, as staggered BTKA does not appear to yield clinical advantage over simultaneous BTKA in a medically appropriate patient. LEVEL OF EVIDENCE III: systematic review (lowest level of studies included).
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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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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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Feng B, Lin J, Jin J, Qian WW, Wang W, Weng XS. Thirty-day Postoperative Complications following Primary Total Knee Arthroplasty: A Retrospective Study of Incidence and Risk Factors at a Single Center in China. Chin Med J (Engl) 2018; 130:2551-2556. [PMID: 28836570 PMCID: PMC5678253 DOI: 10.4103/0366-6999.213071] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) may be associated with serious complications that adversely affect outcomes and increase the likelihood of disability. However, few studies with sufficient sample size have reported postoperative complications following TKA among Chinese patients. This study aimed to evaluate complications of TKA within 30 postoperative days and to identify the related risk factors. METHODS A retrospective complication-based analysis of TKA using the arthroplasty registry between 2008 and 2013 was performed by summarizing complications of TKA within 30 postoperative days. Multivariate logistic regression was used to identify the predicting factors for complications 30 days after operation. RESULTS A total of 1542 patients underwent 2254 primary TKA between January 2008 and December 2013. A total of 137 complications occurred within 30 days after operation with an incidence rate of 6.1%. The incidence rate of major systemic complications within postoperative 30 days was 2.3%, with cardiovascular and respiratory complications as the most common complications. The incidence rates of deep venous thrombosis (DVT) and local complications were 2.4% and 1.0%, respectively. The 30-day postoperative mortality rate was 0.1% (3/2254). Multivariate logistic regression analyses identified body mass index (BMI) of ≥30.0 kg/m2 (odds ratio [OR]: 1.47) and age ≥80 years (OR: 1.87) as significant risk factors for postoperative systemic complications. A BMI of ≥30.0 kg/m2 was a significant risk factor for DVT (OR: 2.86) and other complications (OR: 2.11). The comorbidity of diabetes was a risk factor for postoperative mortality (OR: 19.20). CONCLUSIONS This study highlighted complications with cardiac and respiratory origins as the most common complications within 30 postoperative days following primary TKA. The BMI of ≥30.0 kg/m2 and age ≥80 years were significant risk factors for 30-day postoperative complications.
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Affiliation(s)
- Bin Feng
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
| | - Jin Lin
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
| | - Jin Jin
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
| | - Wen-Wei Qian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
| | - Wei Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
| | - Xi-Sheng Weng
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, 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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Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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