Perioperative Complications in Patients over 70 Years of Age following Simultaneous Bilateral Total Knee Arthroplasty

Complications following single-stage bilateral total knee arthroplasty and unilateral procedures: experience of a high-volume community hospital

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.

Simultaneous Bilateral Total Knee Arthroplasty in Elderly: Are There Factors that Can Influence Safety and Clinical Outcome?

Objective

The aim of this study was to look for preoperative patients' related factors correlating with worse clinical outcomes in a cohort of elderly patients undergoing simultaneous bilateral total knee arthroplasty (SiBTKA) to search for risk factors, which may influence clinical outcomes and safety. Subjects and Methods. The hospital database was mined searching for patients older than 70 years that underwent SiBTKA for severe bilateral knee osteoarthritis (OA) between 2012 and 2016. Preoperative clinical information, Oxford Knee Score (OKS), and Knee Injury and Osteoarthritis Outcome Score (KOOS) prior to surgery were recorded. The OKS and the KOOS were submitted again after a minimum of 5 years of follow-up (FU).

Results

An improvement was observed in all clinical scores at last FU. The major complication rate was 5.4%. No patients' clinical data showed correlation with perioperative complications or need for transfusions. Functional scores at the last FU were negatively affected by age at surgery and positively affected by preoperative clinical scores. Discussion. In the setting of severe symptomatic bilateral knee OA, SiBTKA seems to be effective in improving symptoms at midterm follow-up, with acceptable rates of perioperative complications in patients older than 70. Higher age at surgery and lower preoperative functional scores are associated with worse clinical outcomes at FU. This could assist surgeons in advising patients that delay of surgical treatment could worsen outcomes.