1
|
Xu K, Li X, Yan M, Wang T, Yu T, Zhao X, Zhang Y, Zhang L. Simultaneous bilateral and staged total knee arthroplasty combined with unicompartmental knee arthroplasty in the treatment of bilateral knee osteoarthritis: comparison of early clinical outcomes, complications, and prosthesis survival. J Orthop Surg Res 2024; 19:661. [PMID: 39407264 PMCID: PMC11481757 DOI: 10.1186/s13018-024-05173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 10/13/2024] [Indexed: 10/19/2024] Open
Abstract
OBJECTIVE Knee osteoarthritis (KOA) is usually bilateral. In many patients, the degree of bilateral knee degeneration varies, with one side involving multiple compartments and the other a single compartment degeneration. Therefore, the objective of this study was to compare the early clinical efficacy of simultaneous bilateral and staged total knee arthroplasty (TKA) combined with unicompartmental knee arthroplasty (UKA) in the treatment of bilateral KOA with different degrees. METHODS We compared clinical data from 71 simultaneous bilateral TKA/UKA (SB-TKA/UKA) patients with 52 Staged TKA/UKA (Staged-TKA/UKA) patients. Staged-TKA/UKA is defined as TKA on one knee followed by UKA on the other knee. The comparison included Hospital for Special Surgery (HSS) score, range of motion(ROM), complication rate and prosthetic survival rate at the last follow-up between the two groups. RESULTS The follow-up time of SB-TKA/UKA group was (69.08 ± 14.35) months, and that of Staged-TKA/UKA group was (73.25 ± 18.39) months. Staged-KA/UKA group had a shorter hospital stays, less hospitalization costs and shorter operating time (p < 0.001 for hospital stay, p < 0.001 for hospitalization costs and p < 0.001 for operating time). There were no significant differences in HSS and ROM between the two groups at the last follow-up (p > 0.05). There was no significant difference in complication rate between the two groups (χ2 = 0.56, p = 0.454). For the TKA-side knee joint, there was no significant difference in the prosthetic survival rate (χ2 = 0.05, p = 0.824) and the prosthetic survival curve (χ2 = 0.052, p = 0.82) between the two groups. For UKA-side knee joint, there was no significant difference in prosthetic survival rate (χ2 = 0.08, p = 0.777) and prosthetic survival curve (χ2 = 0.074, p = 0.786) between the two groups. CONCLUSIONS Compared to Staged-TKA/UKA, SB-TKA/UKA has the same early clinical efficacy, shorter operating time and hospital stays, less hospitalization costs, and no increased postoperative complications and prosthesis revision rates. Therefore, SB-TKA/UKA may be recommended for patients who can tolerate simultaneous bilateral surgery as assessed before surgery.
Collapse
Affiliation(s)
- Kuishuai Xu
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China
| | - Xiang Li
- Department of Orthopedic Oncology, the Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China
| | - Mingyue Yan
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China
| | - Tianrui Wang
- Department of Traumatology, the Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China
| | - Tengbo Yu
- Department of Orthopedic Surgery, Qingdao Municipal Hospital, Shandong Qingdao, 266000, China
| | - Xia Zhao
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China
| | - Yingze Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China.
| | - Liang Zhang
- Department of Abdominal ultrasound, Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, China.
| |
Collapse
|
2
|
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.
Collapse
Affiliation(s)
- Bashar Reda
- Orthopedic Surgery, College of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Raed Sharaf
- College of Medicine, King Abdulaziz University, Jeddah, SAU
| |
Collapse
|
3
|
Alshaikh AM, Alshaeri NM, Jamal R, Almaghthawi OF, Al Eid MM, Alfageeh ZS, Alturkistani AM, Ali AMB. Mortality Following Simultaneous Versus Staged Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e50823. [PMID: 38125692 PMCID: PMC10732000 DOI: 10.7759/cureus.50823] [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: 12/20/2023] [Indexed: 12/23/2023] Open
Abstract
Bilateral total knee arthroplasty (BTKA) is a common intervention for bilateral knee osteoarthritis, and the choice between simultaneous (SimBTKA) and staged (StaBTKA) procedures remains a critical decision. This meta-analysis systematically reviews and analyzes the existing literature to compare mortality outcomes associated with SimBTKA and StaBTKA. A comprehensive search was conducted across major databases for studies reporting mortality outcomes in SimBTKA and StaBTKA. Inclusion criteria encompassed studies published up to the cutoff date of January 2023, and a total of 37 studies were included in the quantitative synthesis. Meta-analysis was performed using a random-effects model to calculate odds ratios (ORs) with 95% confidence intervals (CIs) using the Review Manage 5.4 software. The meta-analysis included 86,333 SimBTKA cases and 115,146 StaBTKA cases. The overall mortality rate in SimBTKA was 0.66%, while StaBTKA's was 0.43%. The pooled OR for mortality in SimBTKA versus StaBTKA was 1.55 [1.16, 2.08], indicating a statistically significant higher mortality risk in SimBTKA. Our findings suggest that SimBTKA is associated with an increased risk of mortality compared to StaBTKA. This meta-analysis provides valuable insights into the comparative mortality outcomes of SimBTKA and StaBTKA. While SimBTKA may offer potential advantages, including a single anesthesia event and shorter recovery time, clinicians should consider the increased mortality risk associated with this approach. Future research should focus on prospective studies with standardized reporting to further elucidate the nuanced factors influencing mortality outcomes in bilateral knee arthroplasty.
Collapse
Affiliation(s)
| | - Naif M Alshaeri
- Orthopaedics, South Al-Qunfudhah General Hospital, Al Qunfudhah, SAU
| | - Rawaa Jamal
- Medicine, Umm Al-Qura University, Jeddah, SAU
| | | | | | | | | | | |
Collapse
|
4
|
Şahin A, Çepni Ş, Veizi E, Erdoğan Y, Fırat A, Kılıçarslan K. Advantages of Simultaneous Cementless Bilateral Unicondylar Knee Arthroplasty Compared to Staged Surgery. Clin Orthop Surg 2023; 15:752-759. [PMID: 37811517 PMCID: PMC10551677 DOI: 10.4055/cios22178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 10/10/2023] Open
Abstract
Background Unicondylar knee arthroplasty (UKA) is an effective procedure, which reduces pain, increases range of motion, and improves function. UKA could be performed simultaneously or in staged sessions. This study aimed to compare bilateral cementless UKA performed simultaneously and in staged sessions in terms of complications, hemoglobin levels, transfusions, and functional outcomes. Methods Patients undergoing bilateral UKA for symptomatic medial compartment osteoarthritis were retrospectively analyzed. Of the 73 patients who met the inclusion criteria, 40 underwent surgery simultaneously and 33 underwent surgery in separate sessions. Operative time, length of hospital stay, change in hemoglobin, need for blood transfusion, complications, and functional outcomes were assessed. Results There was no statistically significant difference between the two groups in demographic data. Simultaneously operated patients had a significantly shorter hospital stay and shorter operative time. Statistically significant improvements in clinical scores were noted in both groups. The degree of improvement in functional scores did not differ between the groups. There was no difference between the two groups in terms of complication rates, but the number of periprosthetic tibial fractures was higher in the simultaneous group. Conclusions Simultaneous bilateral cementless UKA was more advantageous in terms of cumulative hospital stay and total operation time with similar clinical results when compared to a staged procedure. While the overall complication rate was similar, the rate of periprosthetic fractures was 5% in the simultaneous group.
Collapse
Affiliation(s)
- Ali Şahin
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| | - Şahin Çepni
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| | - Enejd Veizi
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| | - Yasin Erdoğan
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| | - Ahmet Fırat
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| | - Kasım Kılıçarslan
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye
| |
Collapse
|
5
|
Kazubski K, Tomczyk Ł, Bobiński A, Morasiewicz P. Prognostic Factors in Staged Bilateral Total Knee Arthroplasty-A Retrospective Case Series Analysis. J Clin Med 2023; 12:jcm12103547. [PMID: 37240651 DOI: 10.3390/jcm12103547] [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: 04/23/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Bilateral osteoarthritis of the knee is an indication for a bilateral total knee replacement (TKR) procedure. The goal of our study was to assess the sizes of the implants used during the first and second stages of TKR procedures in order to compare their size and identify the prognostic factors for the second procedure. METHODS We evaluated 44 patients who underwent staged bilateral TKR procedures. We assess the following prognostic factors from the first and second surgery: duration of anesthesia, femoral component size, tibial component size, duration of hospital stay, tibial polyethylene insert size, and the number of complications. RESULTS All assessed prognostic factors did not differ statistically between the first and second TKR. A strong correlation was found between the size of femoral components and the size of tibial components used during the first and second total knee arthroplasty. The mean duration of the hospital stay associated with the first TKR surgery was 6.43 days, whereas the mean duration of the second hospital stay was 5.5 days (p = 0.211). The mean sizes of the femoral components used during the first and second procedures were 5.43 and 5.2, respectively (p = 0.54). The mean sizes of the tibial components used during the first and second TKR procedures were 5.36 and 5.25, respectively (p = 0.382). The mean sizes of the tibial polyethylene inserts used during the first and second procedures were 9.45 and 9.34 (p = 0.422), respectively. The mean duration of anesthesia during the first and second knee arthroplasty was 117.04 min and 118.06 min, respectively (p = 0.457). The mean rates of recorded complications associated with the first and second TKR procedures were 0.13 and 0.06 per patient (p = 0.371). CONCLUSIONS We observed no differences between the two stages of treatment in terms of all analyzed parameters. We observed a strong correlation between the size of femoral components used during the first and second total knee arthroplasty. We noted a strong correlation between the size of tibial components used during the first and second procedure. Slightly weaker prognostic factors include the number of complications, duration of anesthesia and tibial polyethylene insert size.
Collapse
Affiliation(s)
- Krystian Kazubski
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Witosa 26, 45-401 Opole, Poland
| | - Łukasz Tomczyk
- Department of Food Safety and Quality Management, Poznan University of Life Sciences, Wojska Polskiego 28, 60-637 Poznan, Poland
| | - Andrzej Bobiński
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Witosa 26, 45-401 Opole, Poland
| | - Piotr Morasiewicz
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Witosa 26, 45-401 Opole, Poland
| |
Collapse
|
6
|
Tamashiro KK, Morikawa L, Andrews S, Nakasone CK. Can single-stage bilateral unicompartmental knee arthroplasty be safely performed in patients over 70? J Orthop 2023; 37:41-45. [PMID: 36974100 PMCID: PMC10039116 DOI: 10.1016/j.jor.2023.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
Background For patients with bilateral, symptomatic unicompartmental knee arthritis, single-stage bilateral unicompartmental knee arthroplasty (ssBUKA) presents an attractive option. However, most studies have examined younger patient cohorts and the safety of ssBUKA remains controversial for older individuals. Therefore, the purpose of this study was to compare complication rates following ssBUKA for patients ≤70 and > 70 years old. Methods A retrospective chart review of 238 patients having undergone ssBUKA was performed, including 134 patients ≤70 and 104 patients >70. Post-operative complications were recorded at the six-week post-operative visit, along with emergency room visits and hospital readmissions within 90 days. Results Compared to patients ≤70, patients >70 were more frequently female (43.3% and 55.8%, respectively) (p = 0.037) and had significantly lower body mass index (30.41 ± 4.64 and 27.30 ± 3.68, respectively) (p < 0.001). Patients >70 were discharged home (50%) less commonly than patients ≤70 (73.1%) (p < 0.001). Two patients ≤70 (1.5%) and two patients >70 (1.9%) sought emergency room treatment (p = 0.589), with respiratory complications most common. There were no differences regarding any postoperative complications between patients ≤70 and > 70 years old. Conclusion These results suggest that patients >70 can safely undergo ssBUKA, as it does not appear to increase the incidence of early post-operative complications compared to patients ≤70. However, 50% of patients >70 were not able to discharge directly home following surgery.
Collapse
Affiliation(s)
| | - Landon Morikawa
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96814, USA
| | - Samantha Andrews
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96814, USA
- University of Hawai'i, John A Burns School of Medicine, Department of Surgery, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| | - Cass K. Nakasone
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96814, USA
- University of Hawai'i, John A Burns School of Medicine, Department of Surgery, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| |
Collapse
|
7
|
Fletcher AN, Johnson LG, Easley ME, Nunley JA, DeOrio JK. Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle Arthroplasty: A Single-Center Comparative Cohort Study. J Bone Joint Surg Am 2022; 104:1712-1721. [PMID: 36005388 DOI: 10.2106/jbjs.22.00072] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The risk-benefit profiles of simultaneous total ankle arthroplasty (TAA) compared with sequential TAA continue to be debated. There are limited case series reporting outcomes after bilateral TAA, with no previous comparison of simultaneous TAA with sequential TAA. Patients with bilateral pathology represent a unique population with an overall more debilitating condition. Thus, we aimed to compare bilateral simultaneous and sequential TAAs, including perioperative complications and patient-reported outcome measures. METHODS We performed a comparative cohort study of patients who underwent primary bilateral TAA, performed in a simultaneous or sequential fashion, from 2007 to 2019 at a single academic center. Data on patient demographic characteristics, comorbidities, perioperative complications, reoperations, and implant failures were collected. Patient-reported outcome measures included preoperative and postoperative visual analog scale (VAS) scores for pain, Short Form-36 Health Survey (SF-36) scores, and Short Musculoskeletal Function Assessment (SMFA) scores. RESULTS A total of 50 patients (100 ankles) were included, with 25 patients (50 ankles) each in the bilateral simultaneous and sequential cohorts. The mean follow-up was 52.2 ± 27.3 months (range, 24 to 109 months). The mean time between sequential TAAs was 17.5 ± 20.1 months (range, 3 to 74 months). The mean patient age was 64.3 ± 10.6 years (range, 21 to 76 years), and 32 (64.0%) were men. The majority of patients (28 patients [56.0%]) had primary osteoarthritis. Both cohorts had equivalent preoperative patient-reported outcome measures and experienced improvements in all measures, which were maintained at the final follow-up with no significant between-group differences (all p > 0.05). There were no differences between the simultaneous TAA group and the sequential TAA group in perioperative complication rates (22.0% compared with 24.0%; p = 0.7788), reoperations (12.0% compared with 10.0%; p = 0.7354), 5-year reoperation-free survival (88.0% compared with 90.0%; p = 0.4612), or failure-free survival (100%). One patient in the simultaneous TAA cohort required metal component revision at 8 years postoperatively. CONCLUSIONS The patient-reported outcome measures, complications, and prosthesis survival of patients who underwent bilateral simultaneous TAA were comparable with those of patients who underwent bilateral sequential TAA. We advocate that simultaneous bilateral TAA is a safe and effective method for the treatment of bilateral end-stage ankle osteoarthritis. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Amanda N Fletcher
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Lindsey G Johnson
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina.,Campbell University School of Osteopathic Medicine, Lillington, North Carolina
| | - Mark E Easley
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - James A Nunley
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - James K DeOrio
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | | |
Collapse
|
8
|
Feltri P, Mondini Trissino da Lodi C, Grassi A, Zaffagnini S, Candrian C, Filardo G. One-stage bilateral unicompartmental knee arthroplasty is a suitable option vs. the two-stage approach: a meta-analysis. EFORT Open Rev 2021; 6:1063-1072. [PMID: 34909225 PMCID: PMC8631243 DOI: 10.1302/2058-5241.6.210047] [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] [Indexed: 12/04/2022] Open
Abstract
To compare one-stage vs. two-stage bilateral unicondylar knee arthroplasty (UKA) in terms of complications, mortality, reinterventions, transfusion rate, days to discharge, and outcomes for the treatment of bilateral mono-compartmental knee osteoarthritis. A systematic review was performed in the PubMed, Web of Science, and Cochrane databases up to February 2021. Randomized controlled trials, case-control studies, and case series describing the use of bilateral UKA were retrieved. A meta-analysis was performed on complications, mortality, reinterventions, transfusion rate, and days to discharge comparing one-stage vs. two-stage replacement, and outcomes were also reported. Assessment of risk of bias and quality of evidence was performed with the Newcastle-Ottawa Scale. Fifteen articles were included on 1451 patients who underwent bilateral UKA (44.9% men, 55.1% women, mean age 66 years). The systematic review documented, for bilateral one-stage UKA: 2.6% major and 5.4% minor complication rates, 0.5% mortality, 1.9% reintervention, 4.1% transfusion rates, and 4.5 mean days to discharge. No studies reported functional differences. The meta-analysis did not find differences for major complications, minor complications, mortality, reintervention, transfusion rates, or days to discharge versus two-stage bilateral procedures. The operative time was 112.3 vs. 125.4 minutes for one-stage and two-stage surgeries, respectively. The overall quality of the retrieved studies was high. Bilateral single-stage UKA is a safe procedure, with a few complications, and overall positive clinical results. No differences were found in terms of complications, mortality, reinterventions, transfusion rate, and days to discharge in comparison with the two-stage approach.
Cite this article: EFORT Open Rev 2021;6:1063-1072. DOI: 10.1302/2058-5241.6.210047
Collapse
Affiliation(s)
- Pietro Feltri
- Orthopaedics and Traumatology Clinic, EOC, Lugano, Switzerland
| | | | - Alberto Grassi
- II Clinica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Christian Candrian
- Orthopaedics and Traumatology Clinic, EOC, Lugano, Switzerland.,Facoltà di Scienze Biomediche, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giuseppe Filardo
- Orthopaedics and Traumatology Clinic, EOC, Lugano, Switzerland.,Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Facoltà di Scienze Biomediche, Università della Svizzera Italiana, Lugano, Switzerland
| |
Collapse
|
9
|
Clavé A, Ros F, Letissier H, Flecher X, Argenson JN, Dubrana F. A Case-Control Comparison of Single-Stage Bilateral vs Unilateral Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2021; 36:1926-1932. [PMID: 33610411 DOI: 10.1016/j.arth.2021.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/22/2020] [Accepted: 01/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We aimed to compare postoperative pain, functional recovery, and patient satisfaction among patients receiving one-stage medial bilateral or medial unilateral UKA (unicompartmental knee arthroplasty). Our main hypothesis was that during the first 72 postoperative hours, patients who underwent medial bilateral UKA did not consume more analgesics than those who underwent medial unilateral UKA. METHODS A prospective case-control study was undertaken involving 148 patients (74 one-stage medial bilateral vs 74 medial unilateral Oxford UKA). The primary outcome was evaluation of the postoperative total consumption of analgesics from 0 to 72 hours. Next, the postoperative evolution of pain scores and functional recovery were assessed. Oxford Knee Scores were assessed preoperatively at 6 and 12 months with the occurrence of clinical or radiological complications. Finally, patient satisfaction was evaluated at the final follow-up. RESULTS The cumulative sums of analgesic consumption (0-72 hours) calculated in the morphine equivalent dose were 21.61 ± 3.70 and 19.11 ± 3.12 mg in the patient and control groups, respectively (P = .30). Moreover, there were no significant differences in terms of pain scores (P = .45), functional recovery (P = .59, .34), length of stay (P = .18), Oxford Knee Scores (P = .68, .60), complications (P = .50), patient satisfaction (P = .66), or recommendations for intervention (P = .64). CONCLUSION Patients who undergo one-stage medial bilateral UKA do not experience more pain and do not consume more analgesics than those who undergo medial unilateral UKA. A bilateral procedure is not associated with a lower recovery or a higher rate of complications, as functional outcomes at 6 and 12 months are similar to those of unilateral management.
Collapse
Affiliation(s)
- Arnaud Clavé
- Department of Orthopaedics asnd Traumatology, Saint-George Private Hospital, Nice, France; Laboratoire de Traitement de l'Information Médicale, LaTIM, UMR 1101 INSERM-UBO, Brest, France
| | - Fabien Ros
- Department of Orthopaedics and Traumatology, Brest University Hospital, Brest, France
| | - Hoël Letissier
- Laboratoire de Traitement de l'Information Médicale, LaTIM, UMR 1101 INSERM-UBO, Brest, France; Department of Orthopaedics and Traumatology, Brest University Hospital, Brest, France
| | - Xavier Flecher
- Department of Orthopaedics and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
| | - Jean-Noël Argenson
- Department of Orthopaedics and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
| | - Frédéric Dubrana
- Department of Orthopaedics and Traumatology, Brest University Hospital, Brest, France
| |
Collapse
|
10
|
Chen W, Sun J, Zhang Y, Hu Z, Chen XY, Feng S. Staged vs simultaneous bilateral unicompartmental knee arthroplasty for clinical outcomes: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25240. [PMID: 33832084 PMCID: PMC8036059 DOI: 10.1097/md.0000000000025240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Bilateral unicompartmental knee arthroplasty (UKA) can be divided into one or two stages clinically. Compared with staged bilateral UKA, whether simultaneous bilateral UKA has better clinical efficacy remains to be verified. METHODS PubMed, EBSCO, and Web of Science were searched by us for meta-analysis. Studies were considered eligible for inclusion if they included simultaneous and staged UKA. We excluded studies unrelated to the research question, studies in non-selected languages, and studies where the full-text was not available. The data were extracted by two independent investigators, and disagreements were resolved through discussions with a third party. If important data or information about the content of the paper were not available, authors were contacted. Publication bias in studies has been assessed. Meta-analysis was done using Review Manager 5.3. RESULTS The systematic review and meta-analysis identified 3370 trials, of which 8 studies (963 patients) compared simultaneous with staged bilateral UKA. The meta-analysis showed that the clinical outcomes of simultaneous bilateral UKA goes down in operating time (weighted mean difference [WMD] = -19.34, 95% confidence interval [CI] -22.44 to -16.25, P < .00001), postoperative hemoglobin (Std. mean difference [SMD] = -0.46, 95% CI -0.71 to -0.20, P = .0004), length of stay (LOS) (WMD = -4.73, 95% CI -6.39 to -3.06, P < .00001), hospital cost (SMD = -5.42, 95% CI -6.54 to -4.30, P < .00001). There were no significant difference in blood transfusion, venous thrombosis, infection, cardiac complications, pulmonary complications, Oxford Knee Score (OKS) between simultaneous and staged bilateral UKA. CONCLUSION Simultaneous bilateral UKA can effectively reduce the operating time, LOS, and hospital cost without increasing postoperative complications compared to stage bilateral UKA. REGISTRATION NUMBER CRD42020160056 (www.crd.york.ac.uk/prospero/).
Collapse
|
11
|
Malahias MA, Manolopoulos PP, Mancino F, Jang SJ, Gu A, Giotis D, Denti M, Nikolaou VS, Sculco PK. Safety and outcome of simultaneous bilateral unicompartmental knee arthroplasty: A systematic review. J Orthop 2021; 24:58-64. [PMID: 33679029 DOI: 10.1016/j.jor.2021.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/14/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Simultaneous bilateral unicompartmentsl knee arthroplasty (BUKA) is considered safe and effective. We performed a systematic review to assess the postoperative outcomes. Methods The US National Library of Medicine (PubMed/MEDLINE), Google Scholar, and the Cochrane Database of Systematic Reviews were queried for publications. Results Ten articles were included with 765 simultaneous BUKA. Overall complication rate was 7.0%, survivorship was 97.6% at mean 17 months follow-up. No differences were reported between simultaneous and staged BUKA. Conclusion Simultaneous BUKA is as safe as staged BUKA, it is associated with decreased length of stay and operative time, although it has an increased rate of blood transfusion.
Collapse
Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Philip P Manolopoulos
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- School of Medicine, European University of Cyprus, Diogenis Str 6 Nicosia CY, 2404, Cyprus
| | - Fabio Mancino
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Seong J Jang
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington, DC, 20037, USA
| | - Dimitrios Giotis
- Department of Orthopaedic Surgery, General Hospital of Grevena, Grevena, Greece
| | - Matteo Denti
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Vasileios S Nikolaou
- 2nd Orthopaedic Department, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| |
Collapse
|
12
|
Kwan H, To K, Bojanic C, Romain K, Khan W. A meta-analysis of clinical and radiological outcomes in simultaneous bilateral unicompartmental knee arthroplasty. J Orthop 2021; 23:128-137. [PMID: 33510553 PMCID: PMC7815461 DOI: 10.1016/j.jor.2020.12.033] [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: 10/19/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The most common pattern seen in bilateral knee osteoarthritis involves only the medial compartment in both knees. In such cases, bilateral Unicompartmental Knee Arthroplasty (UKA) would be a suitable surgery, this can be done simultaneously in one surgery or in stages with a period of time between each UKA. Simultaneous bilateral UKA in appropriately selected patients have the potential advantages of a lower cost, a shorter hospital stay, and a shorter overall recovery process. Despite this, there are concerns that operating on both knees in one surgery may increase the risk of complications, revisions and mortality. METHODS A PRISMA systematic review and meta-analysis was conducted using three databases (MEDLINE, EMBASE, and Scopus) to identify all studies which investigated either clinical or radiological outcomes in simultaneous bilateral UKA. RESULTS All sixteen studies included found that simultaneous bilateral UKA improved clinical and radiological outcomes. Eight studies compared clinical or radiological outcomes between simultaneous and staged bilateral UKA. Simultaneous bilateral UKA was found to have a significantly shorter length of operation, length of hospital stay, and a lower treatment cost (P < 0.001). Our meta-analysis found no statistically significant difference in the all-cause complication rate between simultaneous and staged bilateral UKA (P = 0.36). Only one study compared radiological outcomes between simultaneous and staged bilateral UKA which found no significant difference. CONCLUSION Our review suggests that simultaneous bilateral UKA is comparable to staged bilateral UKA in terms of clinical and radiological outcomes and has the potential to be increasingly adopted in clinical practice due to its superior cost-effectiveness.
Collapse
Affiliation(s)
- Haowen Kwan
- School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
| | - Kendrick To
- Division of Trauma and Orthopaedics, Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK
| | - Christine Bojanic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Karl Romain
- School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
| | - Wasim Khan
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK
| |
Collapse
|
13
|
Tang YHB, Wong HL, Wong TF. One stage bilateral unicompartmental knee replacement: Similar early clinical outcome with shorter rehabilitation and better resources utilization compared with two stage. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491720973673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: There are a lot of debates on the advantages and safety profile of one stage bilateral knee arthroplasty. Most of the studies focus on total knee replacement, and it may not be applied directly to unicompartmental knee replacement (UKR). We would like to compare the early results of one and two stage bilateral UKR in our center. Methods: This is a retrospective review of all the bilateral medial UKR done in our center in 2018–2019. Patients’ demographic data, operative time, postoperative blood, length of stay (LOS) and complications were recorded. The number of admissions, pre-operative assessment sessions (PAS), and weeks of post-operative physiotherapy were analyzed. Clinical outcome was measured by Knee society knee score and range of motion (ROM). Results: Our center performed 97 UKR in 2018–2019, with 50 UKR performed in 25 patients, among which 16 received one stage while 9 received two stage bilateral UKR. Both groups had similar mean age, BMI, sex ratio, ASA grading, pre-operative knee score and ROM. Patient in the one stage group required only 1 PAS/admission/operation to treat both knees with a mean LOS of 7.3 days and 7.8 weeks of physiotherapy, while those in the two stage group required 2 PAS/admissions/operations with a mean cumulative LOS of 9.8 days and 14.1 weeks of physiotherapy. The mean cumulative operative time was similar for both groups but the one stage group only required 1 operative session. There was no difference in blood loss and there was no transfusion or complication. The post-operative knee score and ROM at 3 and 6 months were similar for both groups. Conclusion: In suitable patients with bilateral medial OA knee, one stage bilateral UKR offers simliar early clinical outcome with shorter rehabilitation duration but without increasing complications compared with two stage. Resources can therefore be better utilized.
Collapse
Affiliation(s)
- Yan Ho Bruce Tang
- NTWC Joint Replacement Center, Department of Orthopaedics and Traumatology, Pok Oi Hospital, Hong Kong
| | - Hok Leung Wong
- NTWC Joint Replacement Center, Department of Orthopaedics and Traumatology, Pok Oi Hospital, Hong Kong
| | - Tai Fong Wong
- NTWC Joint Replacement Center, Department of Orthopaedics and Traumatology, Pok Oi Hospital, Hong Kong
| |
Collapse
|
14
|
Sakka BI, Shiinoki A, Morikawa L, Mathews K, Andrews S, Nakasone C. Comparison of early post-operative complications following unilateral or single-stage bilateral unicompartmental knee arthroplasty. Knee 2020; 27:1406-1410. [PMID: 33010754 DOI: 10.1016/j.knee.2020.07.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) demonstrates excellent functional outcomes and patient satisfaction with low complication rates for single compartment knee arthritis. For patients with bilateral symptoms, single-stage bilateral UKA (SSBUKA) provides an alternative to staged procedures but may risk increased blood loss and systemic complications. Therefore, the purpose of this study is to compare 90-day postoperative complications between unilateral UKA and SSBUKA without exclusion for comorbidities. METHODS A retrospective review was completed for 555 consecutive patients having undergone UKA (317 unilateral and 238 bilateral). Data collection included patient demographics and 90-day complications. Independent t-tests (continuous) and Fishers' Exact tests (nominal) were performed to determine differences between unilateral UKA and SSBUKA patients. RESULTS The SSBUKA group had more male patients than the unilateral group (51.3% and 43.8%, respectively). There was no difference in age, body mass index or comorbidity classification. More SSBUKA patients experienced nausea than unilateral patients (17.6% and 11.0%), however, no significant differences were observed in the overall incidence of wound or systemic complications, and no transfusions were required. Significantly more unilateral patients (96.2%) were discharged home compared to SSBUKA (63.0%) (p < 0.001). Two SSBUKA (1.7%) and two unilateral UKA (0.6%) patients required readmission within 90-days with systemic complications. CONCLUSIONS SSBUKA did not increase the risk of early postoperative systemic or wound complications, when performed in all patients with symptomatic disease without exclusion criteria as compared to patients undergoing unilateral UKA. Therefore, SSBUKA can safely be performed on the majority of patients who present to experienced high volume community hospitals.
Collapse
Affiliation(s)
- Brandan I Sakka
- John A. Burns School of Medicine, 651 Ilalo Street, Honolulu, HI 96813, USA
| | - Aaron Shiinoki
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA
| | - Landon Morikawa
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA
| | - Kristin Mathews
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA
| | - Samantha Andrews
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA; University of Hawai'i, Department of Surgery, 1356 Lusitana Street, Honolulu, HI 96813, USA.
| | - Cass Nakasone
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA; University of Hawai'i, Department of Surgery, 1356 Lusitana Street, Honolulu, HI 96813, USA
| |
Collapse
|
15
|
Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
16
|
Pujol N, Okazaki Y, Furumatsu T. Simultaneous bilateral unicompartmental knee arthroplasty surgery has benefits in low complication rate and cost-effectiveness: a systematic review. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
17
|
Biazzo A, Masia F, Verde F. Bilateral unicompartmental knee arthroplasty: one stage or two stages? Musculoskelet Surg 2019; 103:231-236. [PMID: 30511239 DOI: 10.1007/s12306-018-0579-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 11/30/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Bilateral unicompartmental knee arthroplasty (UKA) may be performed as one- or two-stage procedure. Previous reports suggest that UKA provides a more rapid functional recovery than total knee arthroplasty. However, little data exist on whether bilateral UKA can be performed without increasing the perioperative risk compared with unilateral cases. METHODS We retrospectively compared 51 patients treated between January 2014 and March 2017 with single-stage UKA (group A) with 51 patients who underwent unilateral procedure (group B) to evaluate perioperative complications. We noted no statistically significant difference between the two groups in terms of gender, age and body mass index. RESULTS Patients who underwent single-stage bilateral UKA had longer operating room time with respect to single procedure (93.2 min vs. 50.7 min). However, the bilateral group had a shorter cumulative operating room time (93.2 min) compared to the unilateral group (101.5 min) with a statistically significant difference (p < 0.05). Average hemoglobin loss at discharge was 3.1 points for group A and 2.4 for group B, with a statistically significant difference (p < 0.05). CONCLUSION Our results demonstrated that bilateral simultaneous UKA does not increase the risk for perioperative complications. Total blood loss at discharge is statistically higher in bilateral UKA rather than unilateral UKA; however, cumulative hemoglobin loss is statistically lower in bilateral group. Patients can benefit from a single hospital admission and anesthetic time, while the shorter total inpatient stay and lower blood loss can reduce hospital costs in cases of bilateral surgery. LEVEL OF EVIDENCE IV Retrospective study.
Collapse
Affiliation(s)
- A Biazzo
- Orthopaedic Department, Humanitas Gavazzeni, Via M. Gavazzeni 21, Bergamo, Italy.
| | - F Masia
- Orthopaedic Department, Humanitas Gavazzeni, Via M. Gavazzeni 21, Bergamo, Italy
| | - F Verde
- Orthopaedic Department, Humanitas Gavazzeni, Via M. Gavazzeni 21, Bergamo, Italy
| |
Collapse
|
18
|
Su Z, Liu J, Deng X, Ao Y, Wei D, Luo Y, Li Z. [Comparison of early effectiveness and safety of simultaneous and staged bilateral unicompartmental knee arthroplasty for bilateral anteromedial compartment osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:854-859. [PMID: 31298003 DOI: 10.7507/1002-1892.201810030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the early effectiveness and safety of simultaneous bilateral and staged bilateral unicompartmental knee arthroplasty (UKA) in treatment of anteromedial compartment osteoarthritis. Methods The clinical data of 31 patients with bilateral anteromedial compartment osteoarthritis who underwent bilateral UKAs between January 2015 and January 2017 was retrospectively analyzed. Of them, 17 patients were treated with simultaneous bilateral UKAs (simultaneous group) and 14 patients with staged bilateral UKAs (staged group). There was no significant difference in gender, age, body mass index, osteoarthritis grading, and preoperative hip-knee-ankle angle, knee society score (KSS), visual analogue scale (VAS) score, and range of motion (ROM) of knee between the two groups ( P>0.05). The operation time, blood loss, hospitalization stay, minimum hemoglobin value during 10 days after operation, and hospitalization cost were recorded. The staged group was compared by the sum of two operations. The effectiveness was evaluated by KSS score, VAS score, ROM at 3, 6, 12 months after operation, and patient satisfaction scores were recorded at 12 months after operation. Results The operation time, hospitalization stay, and hospitalization cost of the simultaneous group were significantly lower than those of the staged group ( P<0.05). There was no significant difference in blood loss and the minimum hemoglobin value during 10 days after operation between the two groups ( P>0.05). Superficial infection occurred in 1 side of 1 case (7.1%) in staged group. Postoperative delirium occurred in 1 case (5.9%) in simultaneous group. There was no significant difference in incidence of postoperative complications between the two groups ( P=1.000). Patients in both groups were followed up 12-32 months (mean, 24.7 months). There was no significant difference in KSS score between the two groups at 3 months after operation ( t=0.896, P=0.392). KSS scores were significanly higher in simultaneous group than in staged group at 6 and 12 months after operation ( P<0.05). There was no significant difference in ROM and VAS scores between the two groups at 3, 6, and 12 months after operation ( P>0.05). At 12 months after operation, the patient satisfaction scores were significantly higher in simultaneous group than in staged group ( P<0.05). X-ray films showed no loosening of the prosthesis in the two groups. Conclusion Simultaneous bilateral UKAs has the same security as staged bilateral UKAs. Meanwhile knee function recovery was better, hospitalization stay and hospitalization cost reduced, and patient satisfaction was higher in simultaneous bilateral UKAs.
Collapse
Affiliation(s)
- Zhiyuan Su
- Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Juncai Liu
- Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Xiangtian Deng
- Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Yunong Ao
- Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Daiqing Wei
- Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Yun Luo
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu Sichaun, 610072, P.R.China
| | - Zhong Li
- Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000,
| |
Collapse
|
19
|
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.
Collapse
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.
| |
Collapse
|
20
|
Clavé A, Gauthier E, Nagra NS, Fazilleau F, Le Sant A, Dubrana F. Single-stage bilateral medial Oxford Unicompartmental Knee Arthroplasty: A case-control study of perioperative blood loss, complications and functional results. Orthop Traumatol Surg Res 2018; 104:943-947. [PMID: 29729936 DOI: 10.1016/j.otsr.2018.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The benefits and risks of a single-stage medial UKA remains a subject of debate because of the theoretically higher risk of complications and specifically blood loss. The aim of this study was to evaluate the perioperative blood loss, risks and the functional results of single-stage bilateral medial Oxford Unicompartmental Knee Arthroplasty (OUKA) compared to a standard unilateral medial OUKA procedure (control group). HYPOTHESIS The blood loss observed during bilateral single-stage medial Oxford UKA is not different from that of the control group. METHODS In this case-control prospective study, fifty patients (100 knees) who underwent single-stage bilateral medial OUKA (study group) were compared to a hundred patients (100 knees) with unilateral medial OUKA (control group), performed by the same surgeon. The real blood loss (in mL of hematocrit at 100%), incidence of blood transfusions, and complication rates were compared. Clinical results were assessed at 6 month and at a two-year minimum follow-up (FU) using IKS, KOOS and OKS scores, in addition to a satisfaction questionnaire. RESULTS Groups were deemed comparable. Concerning blood loss, no significant difference was observed compared to the control group (465mL±225 vs. 396±190; p=0.07). No difference was found, either, between groups regarding the complication rates (p=0.36), nor the clinical results (p=0.61) and patient satisfaction (p=0.23) at last FU. CONCLUSION Single-stage bilateral procedure does not cause increased blood loss compared with controls. Moreover, clinical results were deemed good and excellent in spite of a slightly greater complication rate than those found in the literature but similar to controls. LEVEL OF EVIDENCE Case-control study, level III.
Collapse
Affiliation(s)
- Arnaud Clavé
- Faculté de médecine, université de Bretagne Occidentale, 29200 Brest, France; Service d'orthopédie, CHU de la Cavale-Blanche, 29200 Brest, France; Oxford Orthopaedic Engineering Centre, NDORMS, University of Oxford, Oxford, UK.
| | - Emeline Gauthier
- Faculté de médecine, université de Bretagne Occidentale, 29200 Brest, France; Service d'orthopédie, CHU de la Cavale-Blanche, 29200 Brest, France
| | - Navraj S Nagra
- Oxford University Clinical Academic Graduate School (OUCAGS), Medical Sciences Division, John Radcliffe Hospital, Oxford, UK
| | - François Fazilleau
- Faculté de médecine, université de Bretagne Occidentale, 29200 Brest, France; Service d'orthopédie, CHU de la Cavale-Blanche, 29200 Brest, France
| | - Anthony Le Sant
- Faculté de médecine, université de Bretagne Occidentale, 29200 Brest, France; Service d'orthopédie, hôpital de Morlaix, 29600 Morlaix, France
| | - Frédéric Dubrana
- Faculté de médecine, université de Bretagne Occidentale, 29200 Brest, France; Service d'orthopédie, CHU de la Cavale-Blanche, 29200 Brest, France
| |
Collapse
|
21
|
Siedlecki C, Beaufils P, Lemaire B, Pujol N. Complications and cost of single-stage vs. two-stage bilateral unicompartmental knee arthroplasty: A case-control study. Orthop Traumatol Surg Res 2018; 104:949-953. [PMID: 29626655 DOI: 10.1016/j.otsr.2018.01.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/09/2017] [Accepted: 01/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Single-stage bilateral knee arthroplasty, even when unicompartmental, remains controversial, chiefly due to the risk of peri-operative complications. The primary objective of this study was to compare the short-term complication rate and cost of single- vs. two-stage bilateral unicompartmental knee arthroplasty (UCA). The secondary objective was to compare total hospital stay lengths and motion-range recovery. HYPOTHESIS Single-stage bilateral UCA is a cost-saving alternative that is not associated with higher complication rates compared to two-stage bilateral UCA. MATERIAL AND METHOD This single-centre retrospective comparative study included 70 patients of any age managed between 2010 and 2016. Among them, 44 (88 UKAs) had single-stage surgery (1S group) and 26 (52 UCAs) two-stage surgery (2S group). The two groups were comparable for age, body mass index, gender distribution, compartment replaced, ASA score, and Charlson comorbidity index. The following were evaluated: operative time, haemoglobin level before and after surgery, major and minor complication rates, motion-range recovery, and the radiographic hip-knee-ankle (HKA) angle. Costs were estimated based on the standard codes assigned to the procedures by the national statutory health insurance system (GHM 08C24 for knee arthroplasty to treat knee osteoarthritis and NFKA006 for unicompartmental tibio-femoral or femoro-patellar arthroplasty), modulated according to the concomitant diagnoses. RESULTS No differences were found for the haemoglobin level change, time to motion-range recovery, or HKA angle. The complication rates per patient were not significantly different between the groups: major complications, 9.1% (n=4) in the 1S group and 15.4% (n=4) in the 2S group (p=1.00); minor complications, 4.5% (n=2) in the 1S group and 3.8% (n=1) in the 2S group (p=1.00). Cost of the total hospital stay was significantly higher in the 2S group than in the 1S group (11,766.7€) and 5626.4€, respectively; p<0.001). Mean total hospital stay duration per patient was 6.7 days with single-stage surgery and 13.4 days with two-stage surgery. DISCUSSION Single-stage bilateral UCA is not associated with a higher rate of peri-operative complications compared to the two-stage alternative and is substantially less costly. Financial incentives from the healthcare authorities are warranted to increase the use of the single-stage procedure. LEVEL OF EVIDENCE III, case-control study.
Collapse
Affiliation(s)
- C Siedlecki
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, 78150 Le Chesnay, France; Service d'Orthopédie Traumatologie, CHU Charles Nicolle, 76000 Rouen, France
| | - P Beaufils
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, 78150 Le Chesnay, France
| | - B Lemaire
- Département d'Information Médicale, Centre Hospitalier de Versailles, Hôpital André Mignot, 78150 Le Chesnay, France
| | - N Pujol
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, 78150 Le Chesnay, France.
| |
Collapse
|
22
|
Unicompartmental knee arthroplasty: Is a reappraisal in order? Orthop Traumatol Surg Res 2018; 104:941-942. [PMID: 30253988 DOI: 10.1016/j.otsr.2018.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/03/2018] [Indexed: 02/02/2023]
|
23
|
Ahn JH, Kang DM, Choi KJ. Bilateral simultaneous unicompartmental knee arthroplasty versus unilateral total knee arthroplasty: A comparison of the amount of blood loss and transfusion, perioperative complications, hospital stay, and functional recovery. Orthop Traumatol Surg Res 2017; 103:1041-1045. [PMID: 28827053 DOI: 10.1016/j.otsr.2017.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/25/2017] [Accepted: 06/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is a good alternative treatment option to total knee arthroplasty (TKA) for single compartment knee osteoarthritis. Several recent reports suggest that UKA results in more rapid functional recovery than TKA, together with fewer complications. Few performed a comparison of bilateral simultaneous UKA and unilateral TKA. HYPOTHESIS Bilateral simultaneous UKA would result in fewer perioperative complications, less blood loss, less transfusion and faster recovery of short-term clinical outcomes, compared with unilateral TKA patients. MATERIAL AND METHODS In a retrospective trial, the bilateral simultaneous UKA (bUKA) cases were matched one to one with a cohort of unilateral TKA (uTKA) cases according to age, body mass index, gender, Kellgren-Lawrence grade of knee osteoarthritis and American Society of Anesthesiologists score. In bilateral simultaneous UKA group, patients had KL grade 4 of bilateral knee osteoarthritis, and in unilateral TKA group, patients had KL grade 4 of unilateral knee osteoarthritis. The transfusion requirements, estimated blood loss (EBL), duration of hospital stay, incidence of complications, and knee clinical scores of the bUKA and uTKA groups were compared at the 6-month short-term follow-up. RESULTS Patients were categorized into the bUKA group (n=52) and uTKA group (n=52). The number of patients requiring transfusion and the amount of EBL was smaller in the bUKA group (P<0.001 for transfusion and P=0.043 for EBL). The duration of hospital stay was shorter and the number of complications was smaller in the bUKA group (P<0.001 for hospital stay and P=0.028 for complications). The clinical outcomes were also superior in the bUKA group (P<0.001). CONCLUSIONS Bilateral simultaneous UKA shows fewer perioperative complications, less blood loss, less transfusion, and better functional outcomes at 6 months postoperatively than unilateral TKA. The data suggest that bilateral simultaneous UKA can be performed safely, and results in acceptable clinical outcomes. LEVEL OF EVIDENCE III, case-control study.
Collapse
Affiliation(s)
- J H Ahn
- Department of orthopedic surgery, Dongguk university, Ilsan hospital, 814 Siksadong, Ilsandonggu, Goyangsi, Gyeonggido, Korea.
| | - D M Kang
- Department of orthopedic surgery, Dongguk university, Ilsan hospital, 814 Siksadong, Ilsandonggu, Goyangsi, Gyeonggido, Korea
| | - K J Choi
- Department of orthopedic surgery, Dongguk university, Ilsan hospital, 814 Siksadong, Ilsandonggu, Goyangsi, Gyeonggido, Korea
| |
Collapse
|
24
|
Lange T, Rataj E, Kopkow C, Lützner J, Günther KP, Schmitt J. Outcome Assessment in Total Knee Arthroplasty: A Systematic Review and Critical Appraisal. J Arthroplasty 2017; 32:653-665.e1. [PMID: 28341034 DOI: 10.1016/j.arth.2016.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/05/2016] [Accepted: 09/13/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Outcome Measures in Rheumatology (OMERACT) initiative developed a core outcome set (COS) of domains to assess effectiveness of interventions for knee osteoarthritis. These domains (pain, physical function, patient global assessment, imaging at 1 year) should be assessed in every trial to make research evidence meaningful and comparable. We systematically evaluated and critically appraised the use of measurement instruments and outcome domains in prospective studies evaluating patients with knee osteoarthritis undergoing total knee arthroplasty (TKA) and assessed their accordance with the OMERACT COS. METHODS Literature search was performed until August 26, 2014, in Medline and Embase. Clinical trials and prospective observational studies with ≥50 participants and a follow-up of ≥1 year were included. We collected general study characteristics, comprehensive information on measurement instruments, and corresponding domains used. RESULTS This systematic review identified low accordance of used outcome domains with the OMERACT COS of domains published in 1997. Only 4 of 100 included studies included all recommended core domains. Pain (85% of studies) and physical function (86%) were assessed frequently, whereas patient global assessment (21%) and joint imaging (≥1 year; 27%) were rarely assessed. There was substantial heterogeneity in the use of measurement instruments (n = 111) investigating TKA. CONCLUSION More efforts are required to implement the existing COS. In addition, a more consistent use of adequate measurement instruments is important to make research evidence on TKA more relevant, better comparable, and thus more useful for guideline developers and clinical decision makers.
Collapse
Affiliation(s)
- Toni Lange
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Elisabeth Rataj
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Christian Kopkow
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| |
Collapse
|
25
|
Woo YL, Chen YQJ, Lai MC, Tay KJD, Chia SL, Lo NN, Yeo SJ. Does obesity influence early outcome of fixed-bearing unicompartmental knee arthroplasty? J Orthop Surg (Hong Kong) 2017; 25:2309499016684297. [PMID: 28366049 DOI: 10.1177/2309499016684297] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Obesity is a known major contributing risk factor for knee osteoarthritis (OA). It is also believed that obese unicompartmental knee arthroplasty (UKA) patients tend to have poorer outcome and possible early failure. The purpose of this study is to investigate the early outcome of obese UKA patients in a single institution. Patients who underwent fixed bearing medial UKA in between year 2005 and 2010 were included in this study. They were divided into four groups based on Body Mass Index (BMI): 25 kg/m2 (Control); 25-29.9 kg/m2 (Overweight); 30-34.9 kg/m2 (Obese); >35 kg/m2 (Severely Obese). Functional outcome was assessed using Knee Society Score (KSS), Oxford Knee Score (OKS) and Short-form 36 (SF-36). One-way ANOVA with Bonferroni post-hoc test was used to compare the four groups for quantitative variables. There were 673 patients in this study, no significant difference between the four BMI groups for gender and side of operated knee ( p > 0.05). The functional outcome of all four groups at 2 years were comparable (all p > 0.05). At a mean follow up of 5.4 (range 2.5, 8.5) years, 9 revision surgeries (1.3%) were identified. The mean duration from initial surgery to revision surgery was 49 months (Range 6, 90). Patients' pre-operative BMI did not influence the early outcome of UKA patients. However, patients with higher BMI had relatively lower functional score prior to the surgery and tended to be younger. This did not translate to early failure and the functional improvement was similar among all four groups.
Collapse
Affiliation(s)
- Yew Lok Woo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Mun Chun Lai
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
26
|
Seol JH, Seon JK, Song EK. Comparison of postoperative complications and clinical outcomes between simultaneous and staged bilateral total knee arthroplasty. J Orthop Sci 2016; 21:766-769. [PMID: 27576110 DOI: 10.1016/j.jos.2016.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 07/11/2016] [Accepted: 07/30/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Controversy exists regarding the safety of simultaneous vs. staged bilateral total knee arthroplasty (TKA). The purpose of this study was to compare postoperative complication rate and clinical outcomes of simultaneous vs. staged bilateral TKA. METHODS A consecutive series of 1074 patients who underwent either simultaneous (759 patients) or staged bilateral (315 patients) TKA from 2004 to 2013 were enrolled in this study. Postoperative complications were categorized as minor or major. Clinical outcome was evaluated at the last follow-up using Knee Society Score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and range of motion (ROM). RESULTS Major complication rate was not statistically different between the two groups. However, minor complication rate was significantly (p < 0.05) higher in the staged TKA group compared to that in the simultaneous TKA group. The median length of stay (LOS) in hospital was 18.0 days after simultaneous TKA vs. cumulated LOS of 34.1 days in the staged group (p < 0.05). Clinical outcome results revealed that there was no significant difference in KSS, WOMAC scores, or ROM between the two groups. CONCLUSIONS Therefore, simultaneous bilateral TKA has some advantage such as less length of stay in hospital compared to staged bilateral TKA. However, this procedure should be conducted very carefully, particularly in high-risk patients.
Collapse
Affiliation(s)
- Jong-Hwan Seol
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Jong-Keun Seon
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Eun-Kyoo Song
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, South Korea.
| |
Collapse
|
27
|
Chen JY, Loh B, Woo YL, Chia SL, Lo NN, Yeo SJ. Fixed Flexion Deformity After Unicompartmental Knee Arthroplasty: How Much Is Too Much. J Arthroplasty 2016; 31:1313-1316. [PMID: 26748406 DOI: 10.1016/j.arth.2015.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/20/2015] [Accepted: 12/08/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The detrimental impact of postoperative fixed flexion deformity (FFD) after unicompartmental knee arthroplasty (UKA) is manifold. This study aims to define the amount of postoperative FFD that is clinically relevant after UKA. METHODS Between 2005 and 2012, 803 patients who underwent a primary UKA at a tertiary hospital were prospectively followed up. They were categorized into 3 groups based on the amount of postoperative FFD: (1) 0° (control); (2) 1°-10° (mild FFD); and (3) >10° (severe FFD). RESULTS There were 26 patients (3%) with severe FFD at 2 years after UKA. The Knee Society Function Score and Knee Score in the severe FFD group were 10 ± 4 and 10 ± 2 points lower than in the control group, respectively (P = .017 and P = .001). Similarly, the Oxford Knee Score and Physical Component Score in the severe FFD group was 5 ± 1 and 7 ± 2 points lower than in the control group, respectively (P = .033 and P < .001). CONCLUSION This study suggests that postoperative FFD of >10° after UKA is associated with significantly poorer functional outcomes.
Collapse
Affiliation(s)
- Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Bryan Loh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Yew Lok Woo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
28
|
Koh IJ, Kim JH, Kim MS, Jang SW, Kim C, In Y. Is Routine Thromboprophylaxis Needed in Korean Patients Undergoing Unicompartmental Knee Arthroplasty? J Korean Med Sci 2016; 31:443-8. [PMID: 26955247 PMCID: PMC4779871 DOI: 10.3346/jkms.2016.31.3.443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/10/2015] [Indexed: 12/25/2022] Open
Abstract
This study was undertaken to determine the prevalence and the natural course of venous thromboembolism (VTE) without thromboprophylaxis to ascertain whether routine thromboprophylaxis is necessary following unicompartmental knee arthroplasty (UKA) in Korean patients. The medical records and multidetector row computed tomography (MDCT) imaging of the consecutive 77 UKAs in 70 patients were reviewed. In all patients, MDCTs were undertaken preoperatively and at 1-week after surgery, and VTE symptoms were evaluated. At postoperative 6-months, follow-up MDCTs were undertaken in all patients in whom VTEs were newly detected after surgery. VTE lesions were newly detected in 18 (26%) of the 70 patients. However, none of the patients complained of VTE-related symptoms and MDCT demonstrated that all VTEs were small and involved limited portion without lower leg edema or pleuroparenchymal complication. At the 6-month follow up MDCT, all types of VTEs were shown to be completely resolved, regardless of their location. All of the VTE lesions maintained an asymptomatic status for 6-month after surgery. VTE following UKA in Korean patients who do not receive thromboprophylaxis seems to occur frequently, but all of the VTEs are clinically insignificant and all VTEs are spontaneously regressed. Routine thromboprophylaxis or thrombolytic treatment in Korean patients undergoing UKA may not be necessary.
Collapse
Affiliation(s)
- In Jun Koh
- Department of Orthopaedic Surgery, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
- Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | | | - Man Soo Kim
- Department of Orthopaedic Surgery, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Sung Won Jang
- Department of Orthopaedic Surgery, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Chulkyu Kim
- Department of Orthopaedic Surgery, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
- Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| |
Collapse
|
29
|
Onsets of complications and revisions are not increased after simultaneous bilateral unicompartmental knee arthroplasty in comparison with unilateral procedures. INTERNATIONAL ORTHOPAEDICS 2014; 39:871-7. [DOI: 10.1007/s00264-014-2545-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
|