1
|
Hummel A, Matsumoto M, Shimoda B, Au DLMT, Andrews SN, Nakasone CK. Complications following single-stage bilateral total knee arthroplasty and unilateral procedures: experience of a high-volume community hospital. Arch Orthop Trauma Surg 2024; 144:315-322. [PMID: 37632532 DOI: 10.1007/s00402-023-05026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 08/09/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION The safety of single-stage bilateral total knee arthroplasty (SSBTKA) compared to unilateral total knee arthroplasty (TKA) remains controversial. The present study compares the 90-day postoperative complications encountered following SSBTKA and unilateral TKA in an unselected cohort of patients performed at a high-volume community hospital. MATERIALS AND METHODS The perioperative electronic medical records of an unselected consecutive cohort of 1032 patients (1345 knees) having undergone unilateral or SSBTKA were reviewed. Ninety-day postoperative complications or need for additional procedures were compared between unilateral and SSBTKA groups. RESULTS A total of 719 and 313 patients underwent unilateral and SSBTKA, respectively. There were no significant differences in age or BMI between groups. Patients undergoing SSBTKA were more likely to be male (p = 0.019), have longer lengths of stay (p < 0.001) and were less likely to discharge directly home (13.1%) compared to unilateral patients (80.9%) (p < 0.001). Patients undergoing SSBTKA were more likely to require a transfusion (14.7%) compared to unilateral patients (2.2%) (p < 0.001). Interestingly, mortality rate following unilateral TKA (1.7%) was significantly higher than SSBTKA (0.0%) (p = 0.013). There were no significant differences regarding other complications or need for additional procedures within 90 days following surgery. CONCLUSION SSBTKA did not result in greater complications when compared to unilateral TKA in this particular cohort. As expected, transfusion rates will likely be higher and there will be a greater need for acute inpatient care following surgery for SSBTKA patients.
Collapse
Affiliation(s)
- Amelia Hummel
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Maya Matsumoto
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Brent Shimoda
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Donna L M T Au
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Samantha N Andrews
- Department of Surgery, John A Burns School of Medicine, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Cass K Nakasone
- Department of Surgery, John A Burns School of Medicine, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA.
| |
Collapse
|
2
|
Batailler C, Anderson MB, Flecher X, Ollivier M, Parratte S. Is sequential bilateral robotic total knee arthroplasty a safe procedure? A matched comparative pilot study. Arch Orthop Trauma Surg 2023; 143:1599-1609. [PMID: 35536354 DOI: 10.1007/s00402-022-04455-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/15/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION To our knowledge, no papers have reported the results of robotic-assisted surgery for sequential bilateral Total Knee Arthroplasty (TKA). Indeed, sequential bilateral TKA present several benefits, as one single anesthesia, surgical episode, hospitalization, and rehabilitation. The purpose of our study was to evaluate peri-operative outcomes and compare the complication rates, clinical outcomes, and implant positioning of sequential bilateral TKA performed with a robotic-assisted system versus a conventional technique. MATERIALS AND METHODS All patients who underwent a sequential bilateral robotic-assisted primary TKA (raTKA) in our institution between November 2019 and February 2021 were included. Twenty patients met the inclusion criteria and were matched with 20 sequential bilateral TKA performed with a conventional technique. The two groups were comparable for the demographic data and the preoperative parameters, including preoperative anticoagulation and ASA score. The minimum follow-up was 6 months. RESULTS The operative time was significantly longer in the robotic group (< 0.0001), with a mean additional time of 29 min. There was no significant difference between both groups for postoperative blood loss, rate of blood transfusion, or postoperative pain. The average length of stay was 5 days. There was one early complication in the robotic group due to the tibial trackers. The functional outcomes were similar between both groups, except for the functional KSS score, which was better at 6 months in the robotic group (p < 0.0001). The restoration of the knee alignment and the distal femoral anatomy were significantly better in the robotic group than in the conventional group. CONCLUSIONS Despite a longer operative time, the peri-operative parameters of sequential bilateral TKA were similar between robotic and conventional techniques. Further, sequential bilateral raTKA was at least as safe as a conventional technique, without additional risk of medical complications.
Collapse
Affiliation(s)
- Cécile Batailler
- Department of Orthopaedic Surgery, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.
| | | | - Xavier Flecher
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Aix Marseille University, APHM, CNRS, ISM, Marseille, France
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Aix Marseille University, APHM, CNRS, ISM, Marseille, France
| | - Sébastien Parratte
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Aix Marseille University, APHM, CNRS, ISM, Marseille, France.,Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| |
Collapse
|
3
|
Ishii M, Wong K, Shimoda B, Andrews S, Au D, Nakasone CK. Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty? Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04749-y. [PMID: 36604320 PMCID: PMC9815680 DOI: 10.1007/s00402-022-04749-y] [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: 09/23/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The safety and benefits of single stage bilateral total knee arthroplasty (SSBTKA) among older patients as compared to unilateral TKA remains controversial. This study aimed to evaluate the influence of age and comorbidities on complications and early outcomes for unilateral and BTKA in patients over and under 70 years of age. MATERIALS AND METHODS This prospective study compared postoperative complications and early patient-reported outcomes at 6 weeks of 142 unilateral TKA patients (N = 75, ≤ 70; N = 67, > 70) and 89 SSBTKA patients (N = 48, ≤ 70; N = 41, > 70). Patients completed the KOOS JR and PROMIS Global Mental (GMH) and Global Physical Health (GPH) surveys. Knee Society Scores for Knee (KSS-K) and Function (KSS-F) were completed in the clinic. Parametric tests were performed for comparisons of unilateral and BTKA outcomes and complications for patients over and under 70. RESULTS While patient demographics were similar, patients > 70 had more comorbidities than patients ≤ 70 (p < 0.004). There were no significant differences in postoperative complications or readmissions between age groups or procedures. Unilateral TKA patients > 70 had significantly lower pre- (p < 0.001) and post-operative (p = 0.011) KSS-F scores compared to those ≤ 70. SSBTKA patients > 70 had significantly higher preoperative GMH (p = 0.029), postoperative KSS-K (p = 0.027), KOOS JR scores (p = 0.039) and satisfaction (p = 0.048) compared to those ≤ 70. CONCLUSION Age did not influence the risk of early postoperative complications. Additionally, the greater improvements in KOOS JR and higher patient satisfaction for SSBTKA patients > 70 suggests that SSBTKA may meet elderly patient expectations and should not necessarily be discouraged due to safety concerns.
Collapse
Affiliation(s)
- Megan Ishii
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Krystin Wong
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Brent Shimoda
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Samantha Andrews
- Department of Surgery, University of Hawai'i, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| | - Donna Au
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Cass K Nakasone
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA.
- Department of Surgery, University of Hawai'i, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
| |
Collapse
|
4
|
Ariga A, Kohno Y, Nakagawa Y, Watanabe T, Katagiri H, Ohara T, Shioda M, Ozeki N, Amemiya M, Okawa A, Sekiya I, Koga H. Simultaneous bilateral total knee arthroplasty is safe and effective for patients in different ages. J Orthop Sci 2023; 28:173-179. [PMID: 34635383 DOI: 10.1016/j.jos.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 05/25/2021] [Accepted: 08/29/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Simultaneous bilateral total knee arthroplasty is considered beneficial for patients with bilateral end-stage knee osteoarthritis, even though there could be potential postoperative complications. Presently, there is a paucity of evidence of the efficacy and safety of SB-TKA for elderly patients. This study aimed to compare the clinical outcomes of simultaneous bilateral total knee arthroplasty by different age groups. METHODS A total of 216 knees of 108 patients, who underwent simultaneous bilateral total knee arthroplasty for osteoarthritis at our hospital between April 2015 and September 2018, were divided into three groups based on age: 60s (44 knees), 70s (106 knees), and 80s (66 knees). Perioperative data and postoperative clinical outcomes 1 year after surgery were compared between the age groups. RESULTS The patients in the Group 60s were characterized by a higher body mass index (BMI) (P < 0.01), a lower pre-operative knee function score (P < 0.01), longer operation time (P < 0.01), greater intra-operative (P < 0.01), and postoperative bleeding (P = 0.026). No significant difference was found in terms of occurrence of various postoperative complications, although deep vein thrombosis and delirium occurred slightly more frequently in the Group 70s and the Group 80s than in the Group 60s group. The Knee Society Knee Score, a function score, and patient satisfaction scores were significantly improved in all groups 1 year after surgery. Moreover, these indexes of clinical outcomes were similar among the three groups. CONCLUSION Performing simultaneous bilateral total knee arthroplasty in 80s patients was found to be as safe and effective as in the 60s and 70s patients. LEVEL OF EVIDENCE 3 (A retrospective cohort study).
Collapse
Affiliation(s)
- Akane Ariga
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Yuji Kohno
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Yusuke Nakagawa
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Japan; Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Japan.
| | - Toshifumi Watanabe
- Second Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Japan
| | - Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Japan; Second Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Japan
| | - Toshiyuki Ohara
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Mikio Shioda
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Nobutake Ozeki
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Masaki Amemiya
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Japan; Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Japan; Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Japan
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Simultaneous Bilateral Total Knee Arthroplasty in Elderly: Are There Factors that Can Influence Safety and Clinical Outcome? Adv Orthop 2022; 2022:1989822. [PMID: 36046489 PMCID: PMC9420611 DOI: 10.1155/2022/1989822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/25/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022] Open
Abstract
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.
Collapse
|
7
|
Follett MA, Arora P, Maloney WJ, Goodman SB, Huddleston JI, Amanatullah DF. Staging Bilateral Total Knee Arthroplasties Reduces Alignment Outliers. J Arthroplasty 2022; 37:694-698. [PMID: 35017050 PMCID: PMC8934296 DOI: 10.1016/j.arth.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients frequently present with bilateral symptomatic knee osteoarthritis and request simultaneous total knee arthroplasties (TKAs). Technical differences between simultaneous and staged TKAs could affect clinical and radiographic outcomes. We hypothesized that staged TKAs would have fewer mechanical alignment outliers than simultaneous TKAs. METHODS We reviewed 87 simultaneous and 72 staged TKAs with at least 2 years of follow-up. Radiographic assessment was done using standing long leg and lateral radiographs of the knee. Coronal and sagittal measurements were performed by 4 blinded observers on 2 separate occasions with an intraobserver agreement of 0.95 and interobserver of 0.92. RESULTS The first simultaneous knee had no difference in the probability of establishing the mechanical axis outside 3° of neutral (45%) compared to the first staged knee (54%, P = .337). However, the second simultaneous knee (49%) was more likely to establish the axis outside mechanical neutral compared to the second staged knee (28%; odds ratio 2.54, confidence interval 1.31-4.94, P = .006). There was an increased risk of deep venous thrombosis with staged TKA (odds ratio 2.96, confidence interval 1.28-6.84, P = .011), but other perioperative complication rates were not significantly different. There were no clinically significant differences in range of motion or Knee Society Score. CONCLUSION There is a significantly increased risk of establishing the second knee outside mechanical neutral during a simultaneous TKA compared to staged bilateral TKAs, possibly related to a number of surgeon-related and system-related factors. The impact on clinical outcomes and radiographic loosening may become significant in long-term follow-up.
Collapse
Affiliation(s)
- Matthew A. Follett
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - Prerna Arora
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - William J. Maloney
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - James I. Huddleston
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - Derek F. Amanatullah
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063,Corresponding Author: Department of Orthopaedic Surgery, Stanford Hospital and Clinics, 450 Broadway Street, Redwood City, CA 94063-6342, Phone: 650-723-2257,
| |
Collapse
|
8
|
Simultaneous bilateral total knee arthroplasty has higher in-hospital complications than both staged surgeries: a nationwide propensity score matched analysis of 38,764 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1057-1066. [PMID: 35377079 DOI: 10.1007/s00590-022-03248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate (1) healthcare utilization, (2) in-hospital metrics and (3) total in-hospital costs associated with simultaneous versus staged BTKA while evaluating staged BTKA as a single process consisting of two combined episodes. METHODS The national readmissions database was reviewed for simultaneous and staged (two primary unilateral TKAs12 months apart) BTKA patients (2016-2017). A total of 19,382 simultaneous BTKAs were identified, and propensity score matched (1:1) to staged BTKA patients (19,382 patients; 38,764 surgeries) based on demographics, comorbidities, and socioeconomic determinants. Outcomes included healthcare utilization [length of stay (LOS) and discharge disposition], in-hospital periprosthetic fractures, non-mechanical complications, and costs. Staged BTKA was evaluated as one process consisting of two episodes. For each staged patient, continuous outcomes were evaluated via the sum of both episodes. Categorical outcomes were added, and percents were expressed relative to total number of surgeries (n = 38,764). RESULTS Simultaneous BTKA had longer LOS (5.0 days ± 4.7 vs. 4.5 days ± 3.5; p < 0.001), higher non-home discharge [36.9% (n = 7150/19,382) vs. 13.6% (n = 5451/38,764)], in-hospital periprosthetic fractures [0.13% (26/19,382) vs. 0.08% (31/38,764); p = 0.049], any non-mechanical complication [33.76% (6543/19,382) vs.15.93% (6177/38,764); p < 0.0001], hematoma/seroma formation [0.11% (22/19,382) vs. 0.05% (20/38,764); p = 0.0088], wound disruption [0.08% (16/19,382) vs. 0.04% (16/38,764); p = 0.0454], and any infection [1.13% (219/19,382) vs. 0.50% (194/38,764); p < 0.0001]. Average in-hospital costs for the two staged BTKA episodes combined were $5006 higher than those of simultaneous BTKA ($28,196 ± $18,488 vs. $33,202 ± $15,240; p < 0.001). CONCLUSION Simultaneous BTKA had higher healthcare utilization and in-hospital complications than both episodes of staged BTKA combined, with a minimal in-hospital cost savings. Future studies are warranted to further explore patient selection who would benefit from BTKA.
Collapse
|
9
|
Arif MA, Hafeez S. Comparison of Frequency and Morbidity of Unilateral Total Knee Replacement Versus Simultaneous Bilateral Total Knee Replacement. Cureus 2022; 14:e21655. [PMID: 35242458 PMCID: PMC8884456 DOI: 10.7759/cureus.21655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/05/2022] Open
|
10
|
Klasan A, Putnis SE, Yeo WW, Myat D, Fritsch BA, Coolican MR, Parker DA. Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study. J Knee Surg 2021; 34:1579-1586. [PMID: 32450604 DOI: 10.1055/s-0040-1712100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.
Collapse
Affiliation(s)
- Antonio Klasan
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
| | - Sven Edward Putnis
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
| | - Wai Weng Yeo
- Department of Medicine, University of New South Wales, Sydney, Australia
| | - Darli Myat
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
| | | | | | | |
Collapse
|
11
|
Abdelaal MS, Calem D, Sherman MB, Sharkey PF. Short Interval Staged Bilateral Total Knee Arthroplasty: Safety Compared to Simultaneous and Later Staged Bilateral Total Knee Arthroplasty. J Arthroplasty 2021; 36:3901-3908. [PMID: 34580003 DOI: 10.1016/j.arth.2021.08.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Simultaneous bilateral total knee arthroplasty (sim-BTKA) is reported to be safe in a select group of patients. Patients with symptomatic bilateral knee arthritis who are not candidates for sim-BTKA require staged surgery (stag-BTKA). This study aimed to compare the safety and complications associated with sim-BTKA with stag-BTKA performed at 2 time intervals. METHODS This retrospective study of prospectively collected data includes bilateral TKA cases performed between 2001 and 2019. A cohort of sim-BTKA (n = 2728) was compared to a cohort of stag-BTKA (n = 1658). The staged group was subdivided according to the interval between surgeries: ≤90 days (early) and ≥91 days (later). Multivariate logistic regression analyses were used to adjust for confounding variables. RESULTS In-hospital complication rates were lower in both arms of the stag-BTKA groups vs the sim-BTKA. The sim-BTKA group had higher odds ratio of anemia, electrolyte disturbances, pulmonary embolism, and respiratory, urinary, gastrointestinal, and neurological complications. Lower rates of all-cause revision were found in stag-BTKA vs sim-BTKA groups. There was a trend toward revision due to deep infection when increasing the interim before the second stag-BTKA procedure. No differences in complication rates after the second surgery were detected between the early and later stag-BTKA. CONCLUSION This study demonstrates that sim-BTKA is associated with more complications and revisions when compared to stag-BTKA. Performing the second-stage TKA at 90 days or less after the first TKA is not associated with increased risk of complications. Performing sim-BTKA, simply for convenience, is not warranted and should be reserved for a select group of patient matching specific criteria.
Collapse
Affiliation(s)
- Mohammad S Abdelaal
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Daniel Calem
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Matthew B Sherman
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Peter F Sharkey
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
12
|
Chu J, Shieh JS, Wu K, Guan H, Roche S, Held MFG, Yang H, Guo JJ. Simultaneous or Staged Bilateral Arthroscopic Rotator Cuff Repair: An Observational Study of Intraoperative and Postoperative Outcomes. Orthop J Sports Med 2021; 9:23259671211041994. [PMID: 34708140 PMCID: PMC8543723 DOI: 10.1177/23259671211041994] [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: 04/24/2021] [Accepted: 05/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Bilateral arthroscopic rotator cuff repair (ARCR) is frequently performed in
patients with symptomatic bilateral rotator cuff tears. Purpose: To compare patient-reported outcomes and mobility between simultaneous and
staged bilateral ARCR. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 51 patients who underwent simultaneous (anesthetized once) and
42 patients who underwent staged (anesthetized twice) bilateral ARCR between
January 2014 and January 2018; for the staged group, the interval between
procedures was at least 12 months. All operations were performed by the same
surgeon, and all patients had minimum 24-month follow up in both shoulders.
Patient-reported outcomes and range of motion (ROM) were assessed
preoperatively and postoperatively and compared between groups. Outcome
measures included the Constant-Murley score (CMS) and American Shoulder and
Elbow Surgeons (ASES) score as well as measures of psychological status,
health-related quality of life, activities of daily living (ADL), and
patient satisfaction with the state of one’s shoulders. Results: The mean follow-up times for the staged and simultaneous ARCR groups were
44.1 months (range, 36-60 months) and 37.5 months (range, 25-59 months),
respectively. There were no significant differences in age, tear size, or
fatty degeneration of rotator cuff muscles between the groups. The
cumulative length of hospital stay in the staged group was significantly
longer than in the simultaneous group (P < .001). At the
final follow-up, both groups showed significant improvement in ROM, CMS, and
ASES scores (P < .05). No significant differences
between the groups were observed in terms of ROM, CMS, and ASES scores
postoperatively. At 24 months postoperatively, psychological status and
health-related quality of life in both groups improved significantly
(P < .05), and there were no significant
between-group differences. Patients were able to perform most essential ADL.
Both groups had high patient satisfaction, but patient satisfaction for the
second shoulder of the staged group was lower than that of the simultaneous
group (P = .039). Conclusion: Simultaneous bilateral ARCR was shown to be effective, resulting in similar
improvements in clinical outcomes to staged bilateral ARCR at 2-year
follow-up. In addition to higher patient satisfaction, simultaneous
bilateral ARCR also had a shorter treatment cycle.
Collapse
Affiliation(s)
- Jiabao Chu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ju-Sheng Shieh
- Center for Health Policy and Management Studies, Nanjing University, China
| | - Kailun Wu
- Department of Orthopedics, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Huaqing Guan
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Stephen Roche
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Michael F G Held
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiong Jiong Guo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
13
|
Remily EA, Wilkie WA, Mohamed NS, Pastore M, Viola A, Cho AH, Nace J, Delanois RE. Trends of Obese and Morbidly Obese Patients in Same-Day Bilateral Total Knee Arthroplasty from 2009 to 2016. J Knee Surg 2021; 34:1275-1283. [PMID: 32259850 DOI: 10.1055/s-0040-1708038] [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
As obesity in the United States increases, the proportion of obese and morbidly obese patients undergoing same-day bilateral total knee arthroplasty (sd-BTKA) remains unknown. Therefore, this study analyzed: (1) incidence, (2) patient demographics, (3) patient course, and (4) patient outcomes in obese and morbidly obese patients undergoing sd-BTKA in the United States from 2009 to 2016. The National Inpatient Sample was queried for all sd-BTKA patients from 2009 to 2016, yielding 39,901 obese and 20,394 morbidly obese patients. Analyzed variables included overall incidence, age, length of stay (LOS), sex, race, payer, Charlson comorbidity index (CCI) status, disposition, complications, location/teaching status, region of hospital, costs, and charges. Categorical variables were evaluated with chi-square analysis, while continuous variables were analyzed by Student's t-tests. Overall, the number of sd-BTKAs decreased over the study period, although the proportion of both obese and morbidly obese patients increased (p < 0.001 for all). The most common CCI status, 3 + , decreased in proportion for both groups (p < 0.001 for all). Hospital costs decreased and charges increased for both groups (p < 0.001 for all). Mean LOS decreased and patients were most commonly discharged to skilled nursing facilities, although these proportions decreased (p < 0.001 for all). Respiratory failures (p < 0.001 for all) increased for both groups, while proportion of deep vein thromboses and hematomas/seromas (p < 0.001 for all) increased for obese patients and proportion of pulmonary emboli (p < 0.001) increased for morbidly obese patients. The results of this study appear to portray improving optimization and patient selection of higher body mass index (BMI) individuals undergoing this procedure. More information is needed comparing the safety of the sd-BTKA across patients of all BMI groups.
Collapse
Affiliation(s)
- Ethan A Remily
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Wayne A Wilkie
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nequesha S Mohamed
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Mark Pastore
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Anthony Viola
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Abraham H Cho
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| |
Collapse
|
14
|
Kirwan DP, B Imis YP, Harris IA. Increased Early Mortality in Bilateral Simultaneous TKA Using Conventional Instrumentation Compared with Technology-Assisted Surgery: A Study of 34,908 Procedures from a National Registry. J Bone Joint Surg Am 2021; 103:00004623-990000000-00336. [PMID: 34547000 DOI: 10.2106/jbjs.21.00029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Controversy exists regarding the safety of bilateral simultaneous total knee arthroplasty (BSTKA). When conventional instrumentation is used, the increased fat emboli that result from the insertion of intramedullary rods may increase the risk of perioperative complications. We hypothesized that the use of technology-assisted instrumentation (avoiding intramedullary involvement) would be associated with a lower rate of early postoperative death compared with the use of conventional instrumentation. METHODS We compared the 30 and 90-day rates of mortality following BSTKA performed with conventional versus technology-assisted instrumentation from 2003 to 2019, with use of data from a large national registry. Firth logistic regression analysis was utilized, adjusting for age, sex, and procedure year for all BSTKAs performed during the study period. For procedures performed from 2015 to 2019, odds ratios were additionally adjusted for American Society of Anesthesiologists physical status classification and body mass index. RESULTS A total of 34,908 BSTKAs were identified. The proportion of cases utilizing technology-assisted instrumentation increased over the study period. The odds ratio of death within 30 days after technology-assisted BSTKA, adjusted for age, sex, and procedure year, was 0.26 (95% confidence interval [CI], 0.08 to 0.83; p = 0.02). The odds ratio, adjusted for age, sex, procedure year, American Society of Anesthesiologists classification, and body mass index, was 0.26 (95% CI, 0.09 to 0.74; p = 0.01). The corresponding odds ratios for 90-day mortality were 0.25 (95% CI, 0.09 to 0.72; p = 0.01) and 0.26 (95% CI, 0.10 to 0.67; p = 0.005), respectively. CONCLUSIONS Technology-assisted BSTKA was associated with a significant reduction in early mortality compared with the use of conventional instrumentation. This difference may be explained by the reduced fat emboli associated with technology-assisted BSTKA and is likely to be clinically important on a population scale. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- David P Kirwan
- Insight Private Hospital, Albury, New South Wales, Australia
| | - Yi Peng B Imis
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ian A Harris
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, New South Wales, Australia
| |
Collapse
|
15
|
Pritchard KT, Hong I, Goodwin JS, Westra JR, Kuo YF, Ottenbacher KJ. Association of Social Behaviors With Community Discharge in Patients with Total Hip and Knee Replacement. J Am Med Dir Assoc 2021; 22:1735-1743.e3. [PMID: 33041232 PMCID: PMC8026771 DOI: 10.1016/j.jamda.2020.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/07/2020] [Accepted: 08/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Understand the association between social determinants of health and community discharge after elective total joint arthroplasty. DESIGN Retrospective cohort design using Optum de-identified electronic health record dataset. SETTING AND PARTICIPANTS A total of 38 hospital networks and 18 non-network hospitals in the United States; 79,725 patients with total hip arthroplasty and 136,070 patients with total knee arthroplasty between 2011 and 2018. METHODS Logistic regression models were used to examine the association among pain, weight status, smoking status, alcohol use, substance disorder, and postsurgical community discharge, adjusted for patient demographics. RESULTS Mean ages for patients with hip and knee arthroplasty were 64.5 (SD 11.3) and 65.9 (SD 9.6) years; most patients were women (53.6%, 60.2%), respectively. The unadjusted community discharge rate was 82.8% after hip and 81.1% after knee arthroplasty. After adjusting for demographics, clinical factors, and behavioral factors, we found obesity [hip: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76-0.85; knee: OR 0.73, 95% CI 0.69-0.77], current smoking (hip: OR 0.82, 95% CI 0.77-0.88; knee: OR 0.90, 95% CI 0.85-0.95), and history of substance use disorder (hip: OR 0.55, 95% CI 0.50-0.60; knee: OR 0.57, 95% CI 0.53-0.62) were associated with lower odds of community discharge after hip and knee arthroplasty, respectively. CONCLUSIONS AND IMPLICATIONS Social determinants of health are associated with odds of community discharge after total hip and knee joint arthroplasty. Our findings demonstrate the value of using electronic health record data to analyze more granular patient factors associated with patient discharge location after total joint arthroplasty. Although bundled payment is increasing community discharge rates, post-acute care facilities must be prepared to manage more complex patients because odds of community discharge are diminished in those who are obese, smoking, or have a history of substance use disorder.
Collapse
Affiliation(s)
- Kevin T Pritchard
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, Wonju-si, South Korea.
| | - James S Goodwin
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA; Department of Internal Medicine, School of Medicine, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Jordan R Westra
- Department of Preventive Medicine and Population Health, School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Department of Preventive Medicine and Population Health, School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
16
|
Wilson L, Fiasconaro M, Liu J, Poeran J, Poultsides L, Memtsoudis SG. Risk of chronic opioid use after simultaneous versus staged bilateral knee arthroplasty. Reg Anesth Pain Med 2020; 46:405-409. [PMID: 33219103 DOI: 10.1136/rapm-2020-102060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Several studies have identified excess risk associated with undergoing simultaneous (compared with unilateral or staged) bilateral total knee arthroplasty (BTKA). However, few have addressed subsequent chronic opioid use. Given the substantial morbidity and mortality associated with prolonged opioid use, we evaluated the incidence of postoperative chronic opioid use following simultaneous versus staged BTKA, based on the different timing strategies of staged procedures. METHODS In this retrospective cohort study, patients who underwent BTKA procedures (2012-2016; Truven Health MarketScan; n=14 407) were classified as having undergone simultaneous or staged BTKA (<3 months, 3-6 months or 6-12 months apart). Outcomes were postoperative chronic opioid use and oral morphine equivalents prescribed on discharge. Multivariable regression models measured associations between type/timing of BTKA and outcomes. ORs and 95% CIs were reported. RESULTS Unadjusted frequency of chronic opioid use did not differ between groups, (Simultaneous: 11.3%, staged <3 months: 10.7%, staged 3-6 months: 11.7%, staged >6 months: 10.2%; p=0.247). In an adjusted model, there was no significant difference in the odds of becoming chronic opioid users between staged and simultaneous BTKA (staged <3 months OR 1.03, 95% CI 0.88 to 1.21/staged 3-6 months OR 0.94, 95% CI 0.79 to 1.12/staged >6 months OR 0.96, 95% CI 0.82 to 1.13; p=0.755). Patients undergoing staged BTKAs <6 months apart (compared with simultaneous) were prescribed slightly greater oral morphine equivalents on hospital discharge (staged <3 months 6% increase, 95% CI 3% to 10%; staged 3-6 months 4%, 95% CI 1% to 8%; p=0.002). CONCLUSION Although patients undergoing staged BTKA <6 months apart were prescribed greater quantities of opioids on discharge, there was no significant difference in the odds of postoperative chronic opioid use compared with simultaneous BTKA. The timing of BTKA procedures does not appear to influence the likelihood of postoperative chronic opioid dependence.
Collapse
Affiliation(s)
- Lauren Wilson
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York City, New York, USA
| | - Megan Fiasconaro
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York City, New York, USA
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York City, New York, USA.,Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Lazaros Poultsides
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York city, New York, USA
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York City, New York, USA .,Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA.,Department of Health Policy and Research, Weill Cornell Medical College, New York City, New York, USA.,Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
17
|
Safety and efficacy of sequential simultaneous bilateral total knee arthroplasty: A single centre retrospective cohort study. J Clin Orthop Trauma 2020; 11:S636-S644. [PMID: 32774041 PMCID: PMC7394781 DOI: 10.1016/j.jcot.2020.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Simultaneous bilateral total knee arthroplasty (TKA) is a promising option for patients with bilateral arthritis of the knee because of the requirement of a single hospitalization and anesthetic regimen, reduced overall hospital stay, lower overall costs, and quicker recovery compared to staged bilateral TKA. However, there are conflicting reports on the safety of the procedure, with little data available in the Indian setting. Herein, we compared the efficacy and safety of sequential simultaneous bilateral TKA (SSBTKA) with those of unilateral TKA (UTKA). METHODS This retrospective analysis included cases of SSBTKA (n = 380, 760 knees) and UTKA (n = 754) performed by the same surgeon and followed up for a minimum duration of 1 year. The functional outcomes (postoperative changes in Oxford Knee Score [OKS] and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), length of hospital stay (LOS), complications, and rates of revision and mortality were compared between the two groups. RESULTS The mean follow-up durations were 40.59 and 36.69 months for the UTKA and SSBTKA groups, respectively. The LOS was significantly longer in the SSBTKA group than in the UTKA group (Median [Interquartile range]: 4[1] vs. 3[0], p < 0.001). The OKS and WOMAC scores increased with time in both groups. The improvements in each of these scores at 3, 6, and 12 months postoperatively were either statistically similar between the two groups or, if statistically different, the differences were too small to be clinically meaningful. Blood transfusions (4% [SSBTKA] vs.0.3% [UTKA], p < 0.001), cardiac complications (1.6% vs. 0.4%, p = 0.034), urine retention (3.7% vs. 1.2%, p = 0.005), and deep infection (0.8% vs. 0%, p = 0.015) were significantly more frequent in the SSBTKA group. None of the patients in the UTKA group had to undergo revision surgery, whereas in the SSBTKA group, 2 (0.6%) patients underwent revision TKA. The overall mortality rates were low in both groups (0.8% [SSBTKA] and 0.3% [UTKA]), with no significant between-group difference (p = 0.209). CONCLUSION The functional outcomes and mortality rates associated with SSBTKA are comparable to those associated with UTKA. The risk of complications and the need for revision, although higher with SSBTKA, the actual numbers are low enough to justify its use. Although the LOS in SSBTKA is longer than that in UTKA, it is likely to be shorter than the cumulative LOS for two UTKA procedures (i.e. a staged bilateral TKA). Thus, SSBTKA appears to be a safe and effective choice for appropriately selected patients.
Collapse
|
18
|
Alghadir AH, Iqbal ZA, Anwer S, Anwar D. Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery. BMC Musculoskelet Disord 2020; 21:246. [PMID: 32293398 PMCID: PMC7161292 DOI: 10.1186/s12891-020-03269-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/03/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Total knee replacement is a common operative procedure to improve pain, function, and quality of life in patients with end stage knee osteoarthritis. The current study aimed to compare simultaneous bilateral versus unilateral total knee replacement on pain intensity and recovery of function. METHODS A total of 80 patients (bilateral 50, unilateral 30) aged 63.28 (9.4) years undergone total knee replacement participated in the current study. The participants were admitted for 5-7 days in the hospital. Participants in both the group received similar inpatient and outpatient physiotherapy sessions. Pain intensity and function capacity were assessed at baseline, day 7, and day 30 postoperatively using visual analogue scale and lower extremity functional scale, respectively. Repeated measures analysis of variance was used to analyze the data. RESULTS Both groups showed a significant reduction of pain intensity (Day 0, mean 8.9, SD 1.0; Day 30, mean 2.2, SD 1.3 in bilateral total knee replacement; Day 0, mean 8.8, SD 1.1; Day 30, mean 2.0, SD 1.5 in unilateral total knee replacement; p < 0.001) and improvement in the functional capacity (Day 0, mean 16.2, SD 10.1; Day 30, mean 55.6, SD 14.6 in bilateral total knee replacement; Day 0, mean 19.1, SD 9.1; Day 30, mean 56.7, SD 15.8 in unilateral total knee replacement; p < 0.001) following total knee replacement at 30 days post-operatively. However, there was a non-significant difference noted between bilateral versus unilateral total knee replacement on the reduction of pain intensity (mean changes, 6.9 versus 6.8) and improvement in the functional capacity (mean changes, 39.4 versus 37.6) at 30 days post-operatively (p > 0.05). CONCLUSION Simultaneous bilateral total knee replacement was associated with a similar reduction of pain intensity and recovery of function compared to unilateral total knee replacement, suggesting the use of simultaneous bilateral total knee replacement in patients with bilateral knee osteoarthritis since its costs and rehabilitation process could be reduced compared to staged bilateral total knee replacement.
Collapse
Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O.Box-10219, -11433, Riyadh, Saudi Arabia
| | - Zaheen A Iqbal
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O.Box-10219, -11433, Riyadh, Saudi Arabia
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, P.O.Box-10219, -11433, Riyadh, Saudi Arabia. .,Department of Building and Real Estate, Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region, Hong Kong.
| | - Dilshad Anwar
- Bone Joint and Trauma Clinic, Darbhanga, India.,Royal Hospital and Trauma Center, Darbhanga, India
| |
Collapse
|
19
|
One-Stage Sequential Bilateral Total Knee Arthroplasty: An Effective Treatment for Advanced Bilateral Knee Osteoarthritis Providing High Patient Satisfaction. J Arthroplasty 2020; 35:401-406. [PMID: 31635904 DOI: 10.1016/j.arth.2019.09.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/29/2019] [Accepted: 09/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The mortality and risks of bilateral total knee arthroplasty (BTKA) have been reported to be far greater than in unilateral total knee arthroplasty (UTKA). This study aimed to determine whether this remains the case using contemporary anesthetic and surgical techniques for one-stage single anesthetic sequential BTKA. METHODS Two cohorts of 394 patients were created by propensity matching for gender, age, body mass index, American Society of Anesthesiologists grade, and Veterans Rand-12 health survey scores. Primary outcome was morbidity and mortality, with satisfaction measures using patient-reported outcome measures. RESULTS The mortality rate was low with one case after BTKA. Major complications were also low; however, a pulmonary embolism rate of 2% in BTKA patients was significantly higher than 0.3% after UTKA (P < .05), and associated with an American Society of Anesthesiologists grade ≥3. The rate of minor complications between the 2 cohorts was comparable (P = .95). Blood transfusions were uncommon and not significantly different between cohorts (2.5% vs 1.3%, P = .3). BTKA patients stayed in hospital a mean 1.3 days longer with greater rehabilitation requirements. At final follow-up, patient satisfaction was high with all patient-reported outcome measures significantly improved and comparable between cohorts. CONCLUSION BTKA is safe and effective in the majority of patients. Transfusion rates were far lower than historically reported and major complications were rare after both UTKA and BTKA. A significant increase in the rate of pulmonary embolism after BTKA was observed, especially in high risk patients. At minimum 1-year postoperatively, cohorts had the same significant clinical improvement and high level of satisfaction.
Collapse
|
20
|
Yong TM, Young EC, Molloy IB, Fisher BM, Keeney BJ, Moschetti WE. Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty. J Arthroplasty 2020; 35:139-144. [PMID: 31500911 PMCID: PMC6910974 DOI: 10.1016/j.arth.2019.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/21/2019] [Accepted: 08/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is limited evidence describing long-term implant survivorship and modes of failure in simultaneous concurrent bilateral total knee arthroplasty (TKA). METHODS We performed a retrospective review of 266 consecutive patients (532 knees) who underwent simultaneous concurrent bilateral TKA. We reviewed medical records for preoperative characteristics, perioperative complications, and revision surgeries. The primary outcome was TKA survivorship. Secondary outcomes included indication and type of revision surgery. We used the Kaplan-Meier method to estimate survivorship and characterize risk of revision up to 20 years post-TKA. RESULTS Our cohort had median follow-up of 9.8 years (interquartile range, 3.9-15.9). Forty-four patients (17%) underwent revision. Revision was more common among younger and male patients. The cumulative incidence of first-time revision per knee (n = 532) was 1.27 per 100 component-years. Implant survival was 99% (confidence interval, 97%-99%) at 5 years, 92% (89%-95%) at 10 years, 83% (77%-87%) at 15 years, and 62% (50%-73%) at 20 years. Five and 10-year survivorship compared favorably to estimates of TKA survivorship in the literature. The cumulative incidence of revision surgery per patient was 1.91 per 100 component-years. Implant survival at 5-, 10-, 15-, and 20-year time points was 96% (CI, 92%-98%), 84% (77%-89%), 71% (62%-79%), and 59% (46%-70%), respectively. Aseptic loosening (40%), polyethylene wear (34%), and infection (11%) were the most common indications for revision. CONCLUSION Simultaneous concurrent bilateral TKA is associated with a higher risk of reoperation for the patient when both knees are evaluated but similar implant survivorship to the literature when each knee was evaluated in isolation.
Collapse
Affiliation(s)
- Taylor M. Yong
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH,Reprint requests: Taylor M. Yong, MD, MS, Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756
| | - Emily C. Young
- Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Ilda B. Molloy
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Brian M. Fisher
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH
| | - Benjamin J. Keeney
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH,Berkley Medical Management Solutions, Overland Park, KS
| | - Wayne E. Moschetti
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH
| |
Collapse
|
21
|
Borges JHDS, Lobo Júnior P, Dias DM, Silva MFFD, Freitas A, Araújo T. Cost and Safety Evaluation of Simultaneous Bilateral Total Knee Arthroplasty versus Unilateral Knee. Rev Bras Ortop 2019; 54:709-713. [PMID: 31875071 PMCID: PMC6923658 DOI: 10.1055/s-0039-1696682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/21/2018] [Indexed: 12/18/2022] Open
Abstract
Objective
To measure the cost of simultaneous total knee arthroplasty, as well as the costs of total and intensive care unit (ICU) length of stay, perioperative complications and need for blood transfusion compared to the costs of unilateral procedure in a referral hospital, in Federal District, Brazil.
Method
The present article is a retrospective study analyzing the medical records of patients admitted for unilateral or bilateral total knee arthroplasty, performed between June 2011 and March 2017. Seventy-four medical records were included in the study for evaluation of data such as total cost of the procedure, comorbidities, complications, days of hospitalization, and need for blood transfusion.
Results
A significantly higher incidence of deep vein thrombosis (DVT) was found in unilateral procedures. Compared to the other data, no statistically significant differences were found in the relative costs or in the need for blood transfusion.
Conclusion
There was no increase in the cost or in complications when comparing the simultaneous bilateral knee joint replacement procedure with the unilateral procedure, which corroborates most of the literature.
Collapse
Affiliation(s)
| | - Paulo Lobo Júnior
- Instituto de Pesquisa e Ensino (IPE)-Home, Hospital Ortopédico e Medicina Especializada, Brasília, DF, Brasil
| | - Darlan Malba Dias
- Instituto de Pesquisa e Ensino (IPE)-Home, Hospital Ortopédico e Medicina Especializada, Brasília, DF, Brasil
| | | | - Anderson Freitas
- Instituto de Pesquisa e Ensino (IPE)-Home, Hospital Ortopédico e Medicina Especializada, Brasília, DF, Brasil
| | - Thaiane Araújo
- Instituto de Pesquisa e Ensino (IPE)-Home, Hospital Ortopédico e Medicina Especializada, Brasília, DF, Brasil
| |
Collapse
|
22
|
Tsay EL, Grace TR, Vail T, Ward D. Bilateral Simultaneous vs Staged Total Knee Arthroplasty: Minimal Difference in Perioperative Risks. J Arthroplasty 2019; 34:2944-2949.e1. [PMID: 31351855 DOI: 10.1016/j.arth.2019.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/15/2019] [Accepted: 07/01/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND With the rising utilization of total joint arthroplasty, the role of simultaneous-bilateral surgery will have an expanding impact. The purpose of this study is to examine the risks of perioperative complications with this approach in total knee arthroplasty (TKA), to inform shared decision-making. METHODS We reviewed national hospital discharge data from 2005 to 2014 to compare outcomes between simultaneous-bilateral TKAs (sim-BTKAs) and staged-bilateral TKAs (staged-BTKAs). Hierarchical logistic regression analyses were used to adjust for confounders. Outcomes analyzed included mortality, various medical complications, knee infection, and mechanical complications. RESULTS This study analyzed 27,301 sim-BTKAs and 45,419 staged-BTKAs. Patients who underwent simultaneous surgery had a statistically significant higher adjusted odds of mortality, cardiac events, thromboembolic events, and complications involving the urinary and digestive systems, and a lower adjusted odds of deep knee infection and hematoma. Thirteen of the 14 complications had overall incidences less than 2% and 1 outcome had an incidence of 3%. The absolute between-group risk difference for any complication was 1% or less. CONCLUSION Sim-BTKAs have a statistically significant increased odds of multiple complications compared to staged-BTKAs. However, the absolute risk differences between these options are minimal and the occurrence of any complication is low. LEVEL OF EVIDENCE Therapeutic Level III.
Collapse
Affiliation(s)
- Ellen L Tsay
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Trevor R Grace
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Thomas Vail
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Derek Ward
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| |
Collapse
|
23
|
Poultsides LA, Triantafyllopoulos GK, Wanivenhaus F, Pumberger M, Memtsoudis SG, Sculco TP. Same-Day Surgery Does Not Increase the Manipulation Under Anesthesia and Reoperation Rates for Stiffness Following Bilateral Total Knee Arthroplasty. J Arthroplasty 2019; 34:2646-2651. [PMID: 31272825 DOI: 10.1016/j.arth.2019.06.017] [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: 02/05/2019] [Revised: 06/03/2019] [Accepted: 06/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is a paucity of data on the incidence of stiffness and need for subsequent manipulation under anesthesia (MUA) and reoperation following same-day bilateral total knee arthroplasty (BTKA). We compared the rates of at least 1 MUA, bilateral knee involvement, single and multiple MUA rates, and stiffness-related reoperation rates between patients undergoing same-day, same-admission staged, and staged within 1 year BTKA in a tertiary institution. METHODS We analyzed institutional data for 3175 same-day (group A), 153 same-admission staged (group B), and 1226 staged within 1 year BTKA patients (group C) from 1998 to 2009. Several variables, including patient demographics, comorbidity profile, Charlson-Deyo index, and range of motion at different time points, were tabulated. Follow-up was minimum 1 year after first MUA. Univariate analyses were performed using the Wilcoxon rank-sum or Kruskal-Wallis test, and Fisher exact or the chi-square test for continuous and categorical variables, respectively. The Cochran-Armitage trend test was used to check the bilateral knee involvement rate across groups. RESULTS Overall, 2.2% (98/4554) of BTKA patients required MUA. The rate of at least 1 MUA was similar across groups but the percentage of bilateral knee involvement was higher in group A. The single MUA rate was comparable among groups. Both no revision and revision reoperation rates were similar among the manipulated groups. CONCLUSION Same-day BTKA was not associated with increased incidence of single or multiple MUA and stiffness-related reoperation rates. These findings may facilitate preoperative counseling in patients with symptomatic bilateral knee disease, eligible for same-day BTKA.
Collapse
Affiliation(s)
- Lazaros A Poultsides
- Department of Orthopaedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, New York, NY
| | - Georgios K Triantafyllopoulos
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Florian Wanivenhaus
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Matthias Pumberger
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Thomas P Sculco
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| |
Collapse
|
24
|
Richardson SS, Kahlenberg CA, Blevins JL, Goodman SM, Sculco TP, Figgie MP, Sculco PK. Complications associated with staged versus simultaneous bilateral total knee arthroplasty: An analysis of 7747 patients. Knee 2019; 26:1096-1101. [PMID: 31262633 DOI: 10.1016/j.knee.2019.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/13/2019] [Accepted: 06/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Benefits of simultaneous bilateral total knee replacement (TKR) include lower costs, decreased hospital stay, and shorter rehabilitation. This study evaluated complications associated with simultaneous versus staged bilateral TKR within 12 months. We hypothesized that after controlling for comorbidities, the simultaneous group would have the highest rate of complications. METHODS This retrospective study analyzed the Humana subset of the PearlDiver Patient Records Database. CPT 27447 and associated modifiers were used to identify patients who underwent simultaneous or staged bilateral primary TKRs. Staged bilateral TKRs were performed within 12 months and were stratified by the time between procedures. Primary outcomes were the Centers for Medicare & Medicaid Services' publicly reported complications. Risks of complications were compared using multivariate logistic regression controlling for age, gender, and comorbidities. RESULTS Seven thousand seven hundred forty-seven patients underwent simultaneous or staged bilateral TKRs between January 2007 and April 2015. There were lower odds of transfusion and all-cause 90-day readmission but higher odds of mechanical complications and infection for all staged groups compared to the simultaneous. Patients whose staged surgeries were ≪3 months apart had significantly higher odds of undergoing manipulation under anesthesia (MUA). CONCLUSIONS Higher rates of blood transfusion and readmission were associated with simultaneous bilateral TKR, while higher rates of mechanical complications and infection were associated with staged bilateral TKR. MUA risk was highest in patients staged ≪3 months apart. While there are inherent risks to simultaneous bilateral TKR, surgeons and patients should also be aware of risks associated with staging the procedures. LEVEL OF EVIDENCE III.
Collapse
|
25
|
Safety of simultaneous versus staged bilateral opening-wedge high tibial osteotomy with locked plate and immediate weight bearing. INTERNATIONAL ORTHOPAEDICS 2019; 44:109-117. [PMID: 31385014 DOI: 10.1007/s00264-019-04385-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 07/29/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE With advances in technology and particularly locked screws, patients with high tibial osteotomy (HTO) are frequently allowed full weight bearing for a unilateral procedure. We are aware of no reports comparing the safety of a simultaneous bilateral HTO with staged bilateral HTO. The purpose of this study was to retrospectively compare these two strategies. MATERIAL AND METHODS Ninety patients were treated with bilateral HTO surgery for osteoarthritis from 2009 to 2013; they had opening-wedge HTO and fixed with the same plate fixation and locked screws. A comparison of the outcomes after simultaneous bilateral HTO (35 patients) and after sequential staged bilateral HTO (55 patients) was performed. We considered four measures of medical safety: hypotension, serious intra-operative adverse event, heterologous blood transfusion, and thrombophlebitis. We considered also four measures of orthopaedic safety: infection, patient's inability to walk full weight bearing, changes in correction, and nonunion. RESULTS For the same duration of operation, the duration of anaesthesia and the time in the operating room were 35% longer for patients having a staged bilateral HTO. Blood loss was higher in patients undergoing simultaneous bilateral HTO compared with those who underwent a staged bilateral HTO. For patients undergoing simultaneous bilateral HTO, thrombophlebitis frequency and length of anticoagulation were lower than the sum of each event in the staged bilateral HTO. The patients with simultaneous bilateral HTO had a longer total period of time for crutches than patients with staged bilateral HTO. Patients in the simultaneous bilateral cohort did not develop an infection within one year as patients in the planned-stage cohort. The simultaneous bilateral cohort had a lower rate of delayed union than the planned-stage cohort did. CONCLUSION On the basis of this analysis, simultaneous bilateral HTO is a reasonable treatment option. Individuals who undergo staged bilateral HTO face the risk of complications twice, in addition to two hospitalizations. Patients who undergo simultaneous bilateral HTO have a higher risk of blood transfusion.
Collapse
|
26
|
Hashimoto S, Terauchi M, Hatayama K, Saito K, Chikuda H. Younger patients with high varus malalignment of the contralateral knee may be candidates for simultaneous bilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:2173-2180. [PMID: 30887066 DOI: 10.1007/s00167-019-05472-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/04/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Bilateral total knee arthroplasty (TKA) is being performed more frequently. However, a consensus on whether simultaneous or staged procedures should be performed is not available. This study reviewed the clinical course of contralateral knees in patients who underwent unilateral TKA (UTKA) to determine which patients are candidates for simultaneous bilateral TKA (BTKA). METHODS One hundred eighty-six patients with osteoarthritis who underwent UTKA at a single hospital between 2006 and 2009 (follow-up mean, 10.1 years) were retrospectively investigated. Age, sex, obesity, contralateral knee pain, Hospital for Special Surgery score, femorotibial angle (FTA), and Kellgren-Lawrence grades at the time of initial surgery were used to evaluate the risk for requiring contralateral TKA. Survival analysis and receiver-operating characteristic (ROC) analysis were performed. RESULTS Ninety-one patients (48.9%) underwent contralateral TKA. The FTA of the contralateral knee (CFTA) was an independent related factor (hazard ratio, 1.15; p < 0.001), and the CFTA cut-off value for the next surgery was 183° (area under the curve, 0.85; sensitivity, 80.7%; specificity, 76.2%). The 10-year Kaplan-Meier survival rates for the CFTA < 183° group and the CFTA ≥ 183° group were 79.1% and 27.0%, respectively. In the CFTA ≥ 183° group, age was the predictor of future TKA, and elderly patients tended to not require a second procedure. The age cut-off value for the next surgery was 76 years. CONCLUSIONS Varus deformities in the contralateral knee predicted additional contralateral TKA. Patients with CFTA ≥ 183° and aged 75 years or younger are considered reasonable candidates for simultaneous BTKA. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Shogo Hashimoto
- Department of Orthopaedic Surgery, Gunma University, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Masanori Terauchi
- Department of Orthopaedic Surgery, Japan Community Health care Organization, Gunma Central Hospital, Maebashi, Gunma, Japan
| | - Kazuhisa Hatayama
- Department of Orthopaedic Surgery, Japan Community Health care Organization, Gunma Central Hospital, Maebashi, Gunma, Japan
| | - Kenichi Saito
- Department of Orthopaedic Surgery, Gunma University, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| |
Collapse
|
27
|
Lindberg-Larsen M, Pitter FT, Husted H, Kehlet H, Jørgensen CC. Simultaneous vs staged bilateral total knee arthroplasty: a propensity-matched case-control study from nine fast-track centres. Arch Orthop Trauma Surg 2019; 139:709-716. [PMID: 30840128 DOI: 10.1007/s00402-019-03157-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Limited data exist on patient safety after simultaneous vs staged bilateral total knee arthroplasty (TKA) in matched groups. Hence, the aim of this study was to compare length of stay (LOS), in-hospital complications, 30-day readmissions and mortality after simultaneous and staged bilateral TKA in matched patients. PATIENTS AND METHODS A retrospective case-control study of prospectively collected data in nine centres from February 2010 to November 2015. Propensity scores (PS) were used to match simultaneous and staged (1-6 months between stages) bilateral TKA patients with prospectively collected patient characteristics from the Lundbeck Foundation Centre for Fast-track THA and TKA Database. 30-day follow-up was acquired from the Danish Patient Registry and patient records. RESULTS A total of 344 (47.1%) simultaneous and 386 (52.9%) staged bilateral TKA procedures were performed. PS matching was possible in 232 simultaneous and 232 staged bilateral TKA patients. LOS was median 4 days (IQR 3-5) after simultaneous and cumulated 4 days (IQR 4-6) after staged procedures. The in-hospital complication rate was 15.5% after simultaneous vs 7.3% (p = 0.004) after staged procedures. Two cases (0.9%) of venous thromboembolic events were found in each group. Eight patients (3.4%) were re-operated after simultaneous vs one patient (0.4%) after staged bilateral TKA (p = 0.037). The 30-day readmission rate was 8.6% after simultaneous vs 5.6% after staged procedures (p = 0.281). No patients died in either group. CONCLUSIONS We found no significant differences in 30-day readmission rates and mortality between simultaneous and staged bilateral TKA, but the in-hospital complication rate and re-operation rate was higher after the simultaneous procedure calling for further matched investigations in larger cohorts.
Collapse
Affiliation(s)
- M Lindberg-Larsen
- The Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. .,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, J. B. Winsløvsvej 4, 5000, Odense C, Denmark.
| | - F T Pitter
- Section of Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - H Husted
- The Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - H Kehlet
- The Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Section of Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - C C Jørgensen
- The Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Section of Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | | |
Collapse
|
28
|
Wyatt MC, Hozack J, Frampton C, Hooper GJ. Safety of single-anaesthetic versus staged bilateral primary total knee replacement: experience from the New Zealand National Joint Registry. ANZ J Surg 2019; 89:567-572. [PMID: 30968551 DOI: 10.1111/ans.15160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical management options for bilateral knee osteoarthritis comprise staged or single-anaesthetic bilateral total knee replacements (SABTKRs). We examined the New Zealand Joint Registry hypothesizing there would be no difference between these practices compared to unilateral total knee replacement (TKR) examining 30-day mortality, all-cause revision rate and function. METHODS For this study, 84 946 primary TKRs were identified. We compared three groups: unilateral TKRs, all SABTKRs and all staged bilateral TKRs with intervals of 1 to 90 days, 91 days to 1 year and >1 year. Cumulative revision rates were calculated (Kaplan-Meier method). Mortality risks were compared to unilateral TKR and hazard ratios (HRs) calculated. Six-month Oxford scores were compared using analysis of variance. RESULTS Thirty-day mortality for SABTKR was 0.219%: unilateral TKR 0.236% (HR 0.43; 95% confidence interval (CI) 0.38-0.48; P < 001). Staged TKR had lower mortality than unilateral TKR at three time interval groups unless performed within 90 days (adjusting for age and American Society of Anesthesiologists grade) TKR (<90 days HR 0.92; 95% CI 0.703-1.371; P = 0.915; 91-365 days HR 0.783; 95% CI 0.687-0.891; P < 0.001; >365 days HR 0.394; 95% CI 0.344-0.451; P < 0.001). Revision risk with SABTKR was lower at 0.43/100 component years (95% CI 0.37-0.49/100 component years) compared to unilateral 0.56/100 component years (95% CI 0.53-0.59; P < 0.05). Six-month Oxford scores were superior in SABTKR versus unilateral TKR (38.6 (95% CI 38.2-39) versus 36.9 (95% CI 36.8-37.1); P < 0.001). CONCLUSIONS SABTKR is at least as safe as unilateral TKR or staged bilateral TKR in appropriately selected cases. Surgeons should wait at least 90 days before the second procedure.
Collapse
Affiliation(s)
- Michael C Wyatt
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch Public Hospital, Christchurch, New Zealand.,New Zealand National Joint Registry, Christchurch Public Hospital, Christchurch, New Zealand
| | - Joan Hozack
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch Public Hospital, Christchurch, New Zealand.,New Zealand National Joint Registry, Christchurch Public Hospital, Christchurch, New Zealand
| | - Chris Frampton
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch Public Hospital, Christchurch, New Zealand.,New Zealand National Joint Registry, Christchurch Public Hospital, Christchurch, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch Public Hospital, Christchurch, New Zealand.,New Zealand National Joint Registry, Christchurch Public Hospital, Christchurch, New Zealand
| |
Collapse
|
29
|
Wyles CC, Robinson WA, Maradit-Kremers H, Houdek MT, Trousdale RT, Mabry TM. Cost and Patient Outcomes Associated With Bilateral Total Knee Arthroplasty Performed by 2-Surgeon Teams vs a Single Surgeon. J Arthroplasty 2019; 34:671-675. [PMID: 30661905 DOI: 10.1016/j.arth.2018.12.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 12/13/2018] [Accepted: 12/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Bilateral total knee arthroplasty (TKA) can be performed under a single-anesthetic (SA) or staged under a two-anesthetic (TA) technique. Recently, our institution began piloting a 2-surgeon team SA method for bilateral TKA. The purpose of this study was to compare the inpatient costs and clinical outcomes in the first 90 days after surgery between the team SA, single-surgeon SA, and single-surgeon TA approaches for bilateral TKA. METHODS All primary TKAs performed from 2007 to 2017 by the 2 participating surgeons for each of the 3 groups of interest were identified: team SA (N = 42 patients; 84 knees), single-surgeon SA (N = 146 patients; 292 knees), single-surgeon TA (N = 242 patients; 484 knees). No patients were lost to follow-up. RESULTS Median hospital cost (per TKA) for the episode(s) of care was as follows: team SA $20,962, single-surgeon SA $22,057, single-surgeon TA $31,145 (P < .001 overall; P = .0905 team SA vs single-surgeon SA). Rate of 90-day complications was 2.4% for team SA, 11.0% for single-surgeon SA, and 8.3% for single-surgeon TA (P = .2090). Discharge to skilled nursing facilities or rehab was as follows: team SA 31%, single-surgeon SA 53%, and single-surgeon TA after the second operation 34% (P < .001). CONCLUSION This pilot project suggests that team SA bilateral TKA is a potentially cost-effective option with fewer complications compared to single-surgeon SA bilateral TKA. The less frequent disposition to skilled nursing facilities in the team SA group in conjunction with more efficient operating room utilization may further enhance the financial benefits.
Collapse
Affiliation(s)
- Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Tad M Mabry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| |
Collapse
|
30
|
Qadir I, Shah B, Waqas M, Ahmad U, Javed S, Aziz A. Component Alignment in Simultaneous Bilateral versus Unilateral Total Knee Arthroplasty. Knee Surg Relat Res 2019; 31:31-36. [PMID: 30871290 PMCID: PMC6425892 DOI: 10.5792/ksrr.18.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/04/2018] [Accepted: 10/31/2018] [Indexed: 01/30/2023] Open
Abstract
Purpose The purpose of this study was to investigate differences in component alignment between first and second knees in simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral TKA (UTKA). Materials and Methods 274 SBTKAs and 198 UTKAs were included in study. Patients were divided into three groups as SBTKA on the right knee (group A), SBTKA on the left knee (group B) and UTKA (group C). Femoral and tibial component alignment was checked in both coronal plane (alpha [α] and beta [β] angles) and sagittal plane (gamma [γ] and delta [δ] angles) radiographs. Results There were no statistically significant differences among groups in the preoperative anatomical varus angle and Kellgren–Lawrence gonarthrosis classification grade (p=0.139 and p=0.329, respectively). In the coronal plane, the alignment of femoral component (α angle) and tibial component (β angle) was similar in all three groups (α angle, 95.01 vs. 95.14 vs. 94.9, p=0.945; β angle, 90.03 vs. 89.67 vs. 89.98, p=0.483). The sagittal plane alignment of femoral component (γ angle) and tibial component (δ angle) did not show significant differences (γ angle, 7.04 vs. 6.98 vs. 7.00, p=0.132; δ angle, 86.56 vs. 87.41 vs. 86.73, p=0.610). Conclusions The angular alignment of components was similar between SBTKA and UTKA.
Collapse
Affiliation(s)
- Irfan Qadir
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Bahar Shah
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Muhammad Waqas
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Umair Ahmad
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Shahzad Javed
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Amer Aziz
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| |
Collapse
|
31
|
O'Connor A, Asaad P. Unusual presentation of acute pancreatitis following high tibial osteotomy. BMJ Case Rep 2019; 12:12/2/e227438. [PMID: 30765443 PMCID: PMC6381942 DOI: 10.1136/bcr-2018-227438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a case of a 55-year-old man taxi driver admitted electively for high tibial osteotomy for relief of bilateral medial compartment osteoarthritis. He was obese and an ex-smoker but medical history was otherwise unremarkable. Day 1 postoperatively the patient started to suffer vomiting episodes and the abdomen was distended. C Reactive protein and white cell count were both elevated but other bloods were normal. CT abdomen and pelvis was performed which showed acute interstitial pancreatitis. Glasgow score was calculated as 2. He was treated aggressively with analgesia, intravenous fluid and intravenous antibiotics. He has made a good recovery following these conservative measures. To our knowledge, this is the first case in the literature reporting pancreatitis as a complication of high tibial osteotomy. This case highlights the importance of close monitoring for abdominal complications even in the setting of elective orthopaedic surgery where it is a rare phenomenon.
Collapse
Affiliation(s)
- Adam O'Connor
- Department of General Surgery, Royal Albert Edward Infirmary, Wigan, UK
| | - Peter Asaad
- Department of General Surgery, Royal Albert Edward Infirmary, Wigan, UK
| |
Collapse
|
32
|
Early morbidity and mortality after single-stage bilateral total knee replacement. Orthop Traumatol Surg Res 2018; 104:1199-1203. [PMID: 30309768 DOI: 10.1016/j.otsr.2018.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Single-stage bilateral total knee replacement (TKR) has the advantages of requiring only one hospital stay and one anesthesia session, having a shorter rehabilitation period, and reducing the cost of patient care. However, this strategy is controversial because of the perioperative risk. We hypothesized that this strategy did not cause early perioperative mortality and that the early morbidity and readmission rates would be low when patients are selected based on their ASA score. METHODS This single-center retrospective study analyzed a cohort of ASA-1 and ASA-2 patients who underwent single-stage bilateral TKR over an 8-year period (2009 to 2016). The study cohort consisted of 116 patients, mainly women with mean age of 69 years at inclusion; 22.4% of patients were ASA-1 and 77.6% were ASA-2. Death and early complications during the first 90 days postoperative, the early readmission rate and the blood-sparing strategy were analyzed using the clinical and paraclinical data collected during the hospital stay, during the convalescent care center stay, and during the follow-up visits at 6 weeks and 3 months postoperative. The analysis was completed using the intrahospital software Clinicom, which allowed us to trace all the events and episodes for each patient. RESULTS The early mortality rate was 0%. There were five major complications (4.3%) and thirteen minor complications (11%). The early readmission rate was 5.2%. Homologous blood transfusion was performed in 36% of patients. Administration of tranexamic acid reduced this rate to 24.3% versus 44% in patients not taking it (p=0.06). CONCLUSION The perioperative mortality in this selected population is zero and the early morbidity is acceptable. The early readmission rate is also low. Thus proposing single-stage bilateral TKR to patients meeting the criteria defined in this study is a valid strategy. LEVEL OF EVIDENCE IV, retrospective cohort study.
Collapse
|
33
|
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
|
34
|
Simultaneous, same-anaesthetic bilateral total knee arthroplasty has low mortality and complication rates. Knee Surg Sports Traumatol Arthrosc 2018; 26:3395-3402. [PMID: 29574549 DOI: 10.1007/s00167-018-4908-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/20/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE The benefits of simultaneous bilateral total knee arthroplasty (SBTKR) include reduced hospital costs, single anaesthetic exposure and in many cases is also the patient's preference. Despite these potential benefits, risk-adversity with respect to assumed complications and mortality make it difficult for the orthopaedic surgeon and patient to make an informed decision. This study aimed to address the inconsistencies and lack of consensus in previous literature regarding the short-term complications and clinical safety of SBTKR in patients with end-stage knee osteoarthritis (OA). METHODS A cohort of 950 knees (475 patients) undergoing surgery between 2008 and 2013 was extracted from a prospectively collected clinical database and retrospectively linked to the Australian Joint Replacement Registry and hospital records. Patients underwent sequential SBTKR by their treating surgeon under one anaesthetic. Basic demographic data and outcome data including complications and mortality were collected. All data were analyzed using descriptive statistics only. RESULTS A total of 413 patients and 826 knees were included. The average age of the cohort was 70 years with range between 46 and 88 years. 50% of patients were female. The overall mortality rate during the study follow-up period was 1.9%, with an average time to death postoperatively of 23.8 months. There were no cases of acute postoperative mortality (< 6 weeks). Medical complication rates were low. CONCLUSIONS In contrast to the higher mortality and complication rates suggested in previous literature, this study has demonstrated that SBTKR is safe, with low mortality and complication rates under the current surgical protocol. LEVEL OF EVIDENCE IV.
Collapse
|
35
|
Parisi TJ, Levy DL, Dennis DA, Harscher CA, Kim RH, Jennings JM. Radiographic Changes in Nonoperative Contralateral Knee After Unilateral Total Knee Arthroplasty. J Arthroplasty 2018; 33:S116-S120. [PMID: 29548619 DOI: 10.1016/j.arth.2018.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Some patients perceive symptomatic improvement in the contralateral knee after unilateral total knee arthroplasty (TKA). This so-called "splinting effect" has been observed but has not been radiographically evaluated. METHODS A retrospective review of patients with bilateral knee osteoarthritis treated with unilateral TKA was performed. Patients were subcategorized into 2 groups based on whether contralateral TKA was performed within the 2-year period. Contralateral radiographic measurements were performed. RESULTS Forty-four of 203 patients had contralateral TKA performed within 2 years. Preoperative parameters were significantly worse in the bilateral group. By 6 weeks postoperatively, mechanical axis plumbline improved approximately 1°, with more change in those patients with preoperative varus alignment. Larger delta changes were also present in bilateral group preoperative to 1-year radiographs for tibiofemoral angle and joint space widening. CONCLUSION In patients with bilateral knee osteoarthritis who undergo unilateral TKA, a splinting effect may be present and measurable radiographically with improvement of contralateral mechanical axis plumbline. Further research is necessary to determine whether this improvement may delay contralateral TKA implantation.
Collapse
Affiliation(s)
| | - Daniel L Levy
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO
| | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN; Department of Mechanical and Materials Engineering, Denver University, Denver, CO; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO
| | - Cole A Harscher
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO
| | | | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Mechanical and Materials Engineering, Denver University, Denver, CO
| |
Collapse
|
36
|
No difference in the functional improvements between unilateral and bilateral total knee replacements. BMC Musculoskelet Disord 2018; 19:87. [PMID: 29562893 PMCID: PMC5861654 DOI: 10.1186/s12891-018-2006-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 03/12/2018] [Indexed: 12/04/2022] Open
Abstract
Background Differences between staged bilateral total knee replacement (TKR) and simultaneous bilateral TKR have been investigated, but few studies have investigated differences in the functional improvements resulting from these methods. Therefore, this study investigates the different functional improvements between staged bilateral total knee TKR and simultaneous bilateral TKR. Methods Among 144 potential bilateral TKR patients who were included in this study, 93 (64.6%) patients selected unilateral TKR and 51 (35.4%) selected bilateral TKR. Functional improvements were assessed using the Western Ontario and McMaster University osteoarthritis index (WOMAC) and the Medical Outcomes Trust Short Form-36 (SF-36), and patients were interviewed pre-operatively and after 6 months. A generalized equation was used to test for differences in functional improvements. Results After TKR, pain, stiffness, function and total WOMAC scores were significantly reduced in both groups, with mean changes from − 26.6 to − 41.4 and from − 27.5 to − 42.2.The mean health change of SF-36 scores, physical component and mental component scores changed to 45.2 ± 18.2, 74.0 ± 15.4 and 77.0 ± 9.6, respectively, in Group 1 and 47.1 ± 17.1, 74.0 ± 15.2 and 75.5 ± 12.1, respectively, in Group 2. Unilateral and simultaneous bilateral TKR produce similar functional improvements, although current work status may be a novel impact factor. Conclusion No differences in functional improvements were identified between patients who selected unilateral versus bilateral TKR, indicating no recommendation for one procedure over the other. Electronic supplementary material The online version of this article (10.1186/s12891-018-2006-x) contains supplementary material, which is available to authorized users.
Collapse
|
37
|
Bernal-Fortich LD, Aguilar CA, Rivera-Villa AH, Galindo-Avalos J, Aguilera-Martínez P, Torres-González R, Colin-Vázquez A. A prospective randomized trial of total synovectomy versus limited synovectomy in primary total knee arthroplasty: evaluation of bleeding, postoperative pain, and quality of life with SF-12 v2. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:701-706. [PMID: 29383503 DOI: 10.1007/s00590-018-2139-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND During total knee arthroplasty (TKA), total synovectomy (TS) as a part of the surgical technique has been proposed to reduce the inflammatory tissue after the procedure, but there is a controversy about it because of the risk of major postsurgical bleeding. The aim of this study was to compare postoperative bleeding, pain, and health-related quality of life (HRQOL) after a TKA when a TS is performed and when it is not. METHODS The difference in pre and postoperative hemoglobin was measured, as well as postoperative pain using visual analogue scale (VAS) scores at 24 and 48 h post-surgical, HRQOL was measured prior to surgery and at one year using the SF-12V2 questionnaire. RESULTS We assessed a total of 148 patients (73 for TS and 75 for limited synovectomy). We have found a difference of 0.9 mg/dl of pre- and postoperative hemoglobin between both groups, with a higher bleeding amount for the TS group (P = 0.0000647); VAS scores were slightly lower for the TS group at 24 and 48 h after surgery, but not relevant. The TS group required transfusion in 13.3% and the limited synovectomy group in 6.8%. No significant differences in HRQOL were found in both groups at 1 year follow-up. CONCLUSIONS Performing a TS in TKA in patients with osteoarthrosis does not result in a relevant lower postoperative pain, or in an improvement in HRQOL, and it does increase the amount of bleeding after the procedure.
Collapse
Affiliation(s)
- Luis Dario Bernal-Fortich
- UMAE "Dr. Victorio de la Fuente Narváez" IMSS-UNAM, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico.
| | - Carlos Alberto Aguilar
- Joint Replacement Surgery Department, UMAE Traumatology, Orthopedics and Rehabilitation "Dr. Victorio de la Fuente Narváez" IMSS, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
| | - Adrián H Rivera-Villa
- Joint Replacement Surgery Department, UMAE Traumatology, Orthopedics and Rehabilitation "Dr. Victorio de la Fuente Narváez" IMSS, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
| | - Joel Galindo-Avalos
- UMAE "Dr. Victorio de la Fuente Narváez" IMSS-UNAM, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
| | - Pedro Aguilera-Martínez
- Joint Replacement Surgery Department, UMAE Traumatology, Orthopedics and Rehabilitation "Dr. Victorio de la Fuente Narváez" IMSS, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
| | - Rubén Torres-González
- Health Education and Research Department, UMAE Traumatology, Orthopedics and Rehabilitation "Dr. Victorio de la Fuente Narváez" IMSS, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
| | - Avelino Colin-Vázquez
- UMAE "Dr. Victorio de la Fuente Narváez" IMSS-UNAM, Av. Colector 15 s/n Esq. Av. Instituto Politécnico Nacional. Col. Magdalena de las Salinas, Delg. Gustavo A. Madero, C.P. 07760, Mexico, Mexico
| |
Collapse
|
38
|
Sobh AH, Siljander MP, Mells AJ, Koueiter DM, Moore DD, Karadsheh MS. Cost Analysis, Complications, and Discharge Disposition Associated With Simultaneous vs Staged Bilateral Total Knee Arthroplasty. J Arthroplasty 2018; 33:320-323. [PMID: 28988612 DOI: 10.1016/j.arth.2017.09.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/24/2017] [Accepted: 09/02/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Simultaneous vs staged bilateral total knee arthroplasty (BTKA) has long been debated. The primary objective of this study was to compare actual hospital costs and complication rates in patients undergoing simultaneous BTKA (simBTKA) and staged BTKA (staBTKA) at a single institution. METHODS A total joint arthroplasty database from a single hospital was used to identify all patients who underwent primary BTKA from 2013 to 2016 and divided into simultaneous and staged groups. StaBTKA patients were included if both procedures were performed within 1 year by the same surgeon. The combined total hospital cost of both procedures was used, and inpatient rehabilitation (IPR) costs were added for all patients discharged to IPR. RESULTS There were 225 simBTKA and 337 staBTKA patients. SimBTKA patients were younger (61 ± 8 vs 66 ± 8 years, P < .001), had lower body mass index (31.3 ± 5.9 vs 34.0 ± 7.2, P < .001), were more predominately male (48% vs 38%, P = .029), and more likely to require IPR as compared with staBTKA patients. There was no difference in total hospital cost for simBTKA as compared with staBTKA ($24,596 ± $5652 vs $24,915 ± $5756, P = .586). Complications were more prevalent in the simBTKA group, including venous thromboembolism (5.4% vs 1.4%, P = .006) and blood transfusions (15.8% vs 6.2%, P < .001). CONCLUSION There were higher complication rates with no significant cost savings in actual hospital costs associated with simBTKA, when accounting for the cost of IPR, as compared with staBTKA. The total cost analysis of simBTKA vs staBTKA, using actual cost data, merits further evaluation.
Collapse
Affiliation(s)
- Ali H Sobh
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
| | - Matthew P Siljander
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
| | - Anthony J Mells
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
| | - Denise M Koueiter
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
| | - Drew D Moore
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
| | - Mark S Karadsheh
- Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, Michigan
| |
Collapse
|
39
|
Mutsuzaki H, Watanabe A, Komatsuzaki T, Kinugasa T, Ikeda K. Investigation of perioperative safety and clinical results of one-stage bilateral total knee arthroplasty in selected low-risk patients. J Orthop Surg Res 2018; 13:14. [PMID: 29343282 PMCID: PMC5772713 DOI: 10.1186/s13018-018-0720-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 01/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background An increased perioperative complication rate has been a concern with one-stage bilateral total knee arthroplasty (TKA). The purpose of this study was to retrospectively investigate the perioperative safety and clinical results of one-stage bilateral TKA in selected low-risk patients. Methods Sixty-seven patients who received one-stage bilateral TKAs for osteoarthritis who were American Society of Anesthesiology (ASA) class 1 or 2 were included in this study. Perioperative complications, blood loss, transfusion rate, blood laboratory results, and clinical results were evaluated up to 1 year after surgery. Results No major complications (deep infection, pulmonary embolism, cerebrovascular accident, myocardial infarction, death, or removal or revision of the implants) were observed. The average total blood loss was 1139.5 ml. The transfusion rate was 95.5%. Postoperative hemoglobin level and C-reactive protein level gradually improved up to postoperative day 21 (P < 0.01). Bilateral knee extension knee angles and clinical scores improved postoperatively as compared with preoperative values (P < 0.01). Conclusions Although total blood loss and transfusion rate can be high, this preliminary case series suggested that the one-stage bilateral TKA in ASA class 1 or 2 patients can have high perioperative safety levels, and good clinical results can be obtained up to 1 year after surgery. If low-risk patients are selected for bilateral TKA, a one-stage procedure can be beneficial for patients, with a minimal increase in the risk of complications.
Collapse
Affiliation(s)
- Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0394, Japan. .,Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan.
| | - Arata Watanabe
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
| | - Tetsuya Komatsuzaki
- Department of Anesthesiology, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
| | - Tomonori Kinugasa
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
| | - Kotaro Ikeda
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
| |
Collapse
|
40
|
Taheriazam A, Saeidinia A. Concurrent one-stage total knee and hip arthroplasty due to sequel of juvenile rheumatoid arthritis: A case report. Medicine (Baltimore) 2017; 96:e8779. [PMID: 29145334 PMCID: PMC5704879 DOI: 10.1097/md.0000000000008779] [Citation(s) in RCA: 4] [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] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Rheumatoid arthritis is a chronic systemic connective tissue disease. Total hip and knee arthroplasties are common major orthopaedic procedures worldwide. PATIENT CONCERNS To date, no studies have presented 1-stage concurrent total hip arthroplasty (THA) and total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA). We reported a case which is, to our knowledge, the first description of both THA and TKA in a patient with RA simultaneously. DIAGNOSES History of juvenile rheumatoid arthritis (JRA), deterioration of signs and symptoms in history and physical examinations and radiography were lead to making decision for her surgery. INTERVENTIONS Concurrent total hip replacement and total knee arthroplasty were performed for patient. OUTCOMES After more than a 2-year follow-up time, the patient showed excellent clinical function and remained satisfied with the surgical outcome. Multiple simultaneous total joint arthroplasty (TJA) is reviewed in this article. LESSONS Joint arthroplasty surgeries can be performed in a simultaneous procedure to shorten disability and rehabilitation time with one anesthesia.
Collapse
Affiliation(s)
- Afshin Taheriazam
- Department of Orthopedics Surgery, Tehran Medical Sciences Branch, Islamic Azad University, Tehran
| | - Amin Saeidinia
- Mashhad University of Medical Sciences, Mashhad
- Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
41
|
Mufarrih SH, Qureshi NQ, Ali A, Malik AT, Naim H, Noordin S. Total knee Arthroplasty: risk factors for allogeneic blood transfusions in the South Asian population. BMC Musculoskelet Disord 2017; 18:359. [PMID: 28830388 PMCID: PMC5568396 DOI: 10.1186/s12891-017-1728-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is the recommended treatment for end-stage knee osteoarthritis. Considering the various risks associated with intra and postoperative blood transfusions, better understanding is required with respect to the risk factors contributing to a greater possibility of blood transfusion during or after surgery. Although literature highlights several such factors, our study is among the first to identify these risk factors in the South Asian population which differs from other populations in several ways. METHODS The study consists of a review of 658 patients undergoing TKA from 2005 to 2015. Data was obtained from patient medical records and was analysed using logistic regression analysis. The relationship between each predictor and the outcome variable was calculated as an Odds ratio (OR), the threshold of significance for which was p = 0.25 and p = 0.05 for univariate and multivariable analysis respectively. RESULTS The mean age of the patient population was 63 years (78% female), 25% of whom received one or more blood transfusions. Multivariable analysis revealed 5 significant independent predictors for increased risk of blood transfusions including bilateral knee surgery (OR:5.51), preoperative anemia (OR:4.15), higher ASA (American Society of Anaesthesiologists) status (3-4) (OR:1.92), female sex (OR:3.44) and BMI (Body mass index) ≤30 (OR:1.79) while increasing co-morbidities and age (>60) were found to be insignificant. CONCLUSIONS The factors identified for the South Asian population are largely similar to those for other populations. Identification of high risk patients will permit the application of an international multipronged approach which not only targets the modifiable risk factors but also the decision making process and blood management protocols in order to minimize the transfusion associated risks for a patient undergoing a TKA.
Collapse
Affiliation(s)
| | | | - Arif Ali
- Aga Khan University Hospital, Karachi, Pakistan
| | | | - Huda Naim
- Dow International Medical College, Karachi, Pakistan
| | | |
Collapse
|
42
|
Kim C, Park SS, Dhotar HS, Perruccio AV, Zywiel MG, Davey JR. Topical tranexamic acid reduces transfusion rates in simultaneous bilateral total knee arthroplasty: a retrospective case series. Can J Surg 2017; 60:311-315. [PMID: 28742015 DOI: 10.1503/cjs.014716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Topical tranexamic acid (TA) has been reported to be effective in reducing postoperative bleeding and transfusions after total knee arthroplasty (TKA). The main objective of this study was to retrospectively assess the effectiveness and safety of topical TA administration in patients undergoing simultaneous bilateral TKA. METHODS We conducted a retrospective chart review of consecutive cohorts of patients undergoing simultaneous bilateral TKA. We compared the patients who received TA with patients from a similar time frame who did not receive TA. For those who received TA, a topical concentration of 2 g per 30 mL of normal saline was used in each knee. Preoperative and postoperative hemoglobin, transfusions, length of stay (LOS) and postoperative complications were recorded for each patient until discharge. Outcome measures were analyzed using independent t test, χ2 test and logistic regression. RESULTS We included 49 patients in our analysis: 25 who received TA and 24 who did not. There were no statistical differences in demographics between the groups. The rate of transfusion in the TA group was 4% compared with 67% in the non-TA group (p < 0.001). The net hemoglobin loss in the TA group was 4.1 g/dL versus 6.2 g/dL in the non-TA group (p < 0.001). The use of TA was found to be associated with a greater than 99% reduced risk of receiving a transfusion (odds ratio 0.003, 95% confidence interval < 0.001-0.072, p < 0.001). There were no thromboembolic events in patients who received TA, and there was 1 pulmonary embolus in the non-TA group. Postoperative LOS was significantly reduced in the TA group (mean difference 1.1 d, p = 0.005). CONCLUSION Topical administration of TA in patients undergoing simultaneous bilateral TKA significantly reduced transfusions, blood loss and postoperative LOS, with no increased risk of thromboembolic events.
Collapse
Affiliation(s)
- Christopher Kim
- From the Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ont
| | - Sam S Park
- From the Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ont
| | - Herman S Dhotar
- From the Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ont
| | - Anthony V Perruccio
- From the Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ont
| | - Michael G Zywiel
- From the Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ont
| | - J Roderick Davey
- From the Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ont
| |
Collapse
|
43
|
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
|
44
|
Jiang X, Ma XL, Ma JX. Efficiency and Safety of Intravenous Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-analysis. Orthop Surg 2017; 8:285-93. [PMID: 27627710 DOI: 10.1111/os.12256] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/14/2016] [Indexed: 11/30/2022] Open
Abstract
The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of i.v. tranexamic acid (TXA) in simultaneous bilateral total knee arthroplasty (TKA). Potentially relevant published reports were identified from the following electronic databases: Medline, PubMed, Embase, ScienceDirect and Cochrane Library. RevMan v5.3was used to pool data. Two randomized controlled trials and four case-control studies met the inclusion criteria. The current meta-analysis identified significant differences between TXA group and control groups in terms of postoperative hemoglobin concentration (P < 0.01), drainage volume (P < 0.01), transfusion rate (P < 0.01) and units transfused (P = 0.006). There were no significant differences in length of stay (P = 0.66), operation time (P = 0.81) or and incidence of adverse effects such as infection (P = 0.42), deep venous thrombosis (DVT) (P = 0.88) and pulmonary embolism (PE) (P = 0.11). Our results show that i.v. administration of TXA in simultaneous bilateral TKA reduces postoperative drops in hemoglobin concentration, drainage volume, and transfusion requirements and does not prolong length of stay or operation time. Moreover, no adverse effects, such as infection, DVT or PE, were associated with TXA.
Collapse
Affiliation(s)
- Xuan Jiang
- Graduate School of General Hospital, Tianjin Medical University, Tianjin, China.,Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Xin-Long Ma
- Graduate School of General Hospital, Tianjin Medical University, Tianjin, China. .,Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
| | - Jian-Xiong Ma
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| |
Collapse
|
45
|
Seo JG, Kim SM, Shin JM, Kim Y, Lee BH. Safety of simultaneous bilateral total knee arthroplasty using an extramedullary referencing system: results from 2098 consecutive patients. Arch Orthop Trauma Surg 2016; 136:1615-1621. [PMID: 27687177 DOI: 10.1007/s00402-016-2573-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Simultaneous bilateral total knee arthroplasty (TKA) has been associated with a high risk of morbidity and mortality. The orthopedic surgeon must, therefore, decide whether bilateral simultaneous TKA is a safe operation to perform and endeavor to decrease the risk of serious complications or even death. METHODS This retrospective review included 2098 consecutive patients who underwent bilateral simultaneous TKAs by the protocol used in our institution, including the use of extramedullary instruments to minimize medullary canal invasion and overlapping procedures for both knees to decrease operation time. RESULTS The incidence rate of occurred complications was 0.33 % for symptomatic pulmonary embolism, 0.62 % for deep surgical infection requiring revision surgery, 0.05 % for 14-day mortality, 1.14 % for adverse cardiac events, and 0.76 % for postsurgical delirium within the 1-year follow-up. CONCLUSIONS Our protocols, including the use of an extramedullary referencing system and overlapping procedures for both knees, may be considered to decrease the perioperative short-term morbidity and 14-day mortality rates in simultaneous bilateral TKA.
Collapse
Affiliation(s)
- Jai Gon Seo
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Kim
- Seoul Medical Center, Sinnae 1-dong, Jungnang-gu, Seoul, Korea
| | - Jung Min Shin
- Hanyang Medical Center, Hanyang University School of Medicine, Seoul, Korea
| | - Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical School, 134-701, Gil-dong, Seoul, Korea.
| |
Collapse
|
46
|
Bohm ER, Molodianovitsh K, Dragan A, Zhu N, Webster G, Masri B, Schemitsch E, Dunbar M. Outcomes of unilateral and bilateral total knee arthroplasty in 238,373 patients. Acta Orthop 2016; 87 Suppl 1:24-30. [PMID: 27167849 PMCID: PMC4937774 DOI: 10.1080/17453674.2016.1181817] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 01/29/2016] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There is no consensus about the outcome of simultaneous vs. staged bilateral total knee arthroplasty (TKA). We examined this issue by analyzing 238,373 patients. Patients and methods - Demographic, clinical, and outcome data were evaluated for TKA patients (unilateral: 206,771; simultaneous bilateral: 6,349; staged bilateral: 25,253) from the Canadian Hospital Morbidity Database for fiscal years 2006-2007 to 2012-2013. Outcomes were adjusted for age, sex, comorbidities, and hospital TKA volume. Results - Simultaneous bilateral TKA patients were younger than staged bilateral TKA patients (median 64 years vs. 66 years), were more likely to be male (41% vs. 39%), and had a lower frequency of having ≥1 comorbid condition (2.9% vs. 4.2%). They also had a higher frequency of blood transfusions (41% vs. 19%), a shorter median length of stay (6 days vs. 8 days), a higher frequency of transfer to a rehabilitation facility (46% vs. 9%), and a lower frequency of knee infection (0.5% vs. 0.9%) than staged bilateral TKA patients, but they had higher rate of cardiac complications within 90 days (2.0% vs. 1.7%). Simultaneous patients had higher in-hospital mortality compared to the second TKA in staged patients (0.16% vs. 0.06%), but they had similar rates of in-hospital mortality compared to unilateral patients (0.16% vs. 0.14%). The cumulative 3-year revision rate was highest in the unilateral group (2.3%), but it was similar in the staged and simultaneous bilateral groups (1.4%). Interpretation - We found important differences between the outcomes of simultaneous and staged bilateral TKA. Further clarification of outcomes would be best determined in an adequately powered randomized trial, which would remove the selection bias inherent in this retrospective study design.
Collapse
Affiliation(s)
- Eric R Bohm
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba
- Canadian Institute for Health Information, Ottawa, Ontario
| | | | - Alina Dragan
- Canadian Institute for Health Information, Ottawa, Ontario
| | - Naisu Zhu
- Canadian Institute for Health Information, Ottawa, Ontario
| | - Greg Webster
- Canadian Institute for Health Information, Ottawa, Ontario
| | - Bas Masri
- Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia
| | - Emil Schemitsch
- Department of Surgery, University of Toronto, Toronto, Ontario
| | - Michael Dunbar
- Canadian Institute for Health Information, Ottawa, Ontario
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
47
|
Gromov K, Troelsen A, Stahl Otte K, Ørsnes T, Husted H. Morbidity and mortality after bilateral simultaneous total knee arthroplasty in a fast-track setting. Acta Orthop 2016; 87:286-90. [PMID: 26823094 PMCID: PMC4900080 DOI: 10.3109/17453674.2016.1141631] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - The safety aspects of bilateral simultaneous total knee arthroplasty (BSTKA) are still debated. In this retrospective single-center study, we investigated early morbidity and mortality following BSTKA in a modern fast-track setting. We also identified risk factors for re-admission within 90 days and for a length of stay (LOS) of more than 5 days. Patients and methods - 284 patients were selected to receive BSTKA at our institution from 2008 through 2014 in a well-described, standardized fast-track setup (Husted 2012a, b). All re-admissions within 90 days were identified and mortality rates and time until death were recorded. Transfusion rates and numbers of transfusions were also recorded. Logistic regression analysis was used to identify risk factors for re-admission within 90 days, and also for a LOS of more than 5 days. Results - 90-day mortality was 0%. 10% of the patients were re-admitted within 90 days. Median time to re-admission was 18 (3-75) days. 153 patients (54%) received postoperative blood transfusions. An ASA score of 3 was identified as an independent risk factor for re-admission within 90 days (OR = 5, 95% CI: 1.3-19) and for LOS of > 5 days (OR = 6, 95% CI: 1.6-21). Higher BMI was a weak risk factor for re-admission within 90 days. Interpretation - BSTKA in selected patients without cardiopulmonary disease in a fast-track setting appears to be safe with respect to early postoperative morbidity and mortality. Surgeons should be aware that patients with an ASA score of 3 have an increased risk of re-admission and a prolonged length of stay, while patients with higher BMI have an increased risk of re-admission following BSTKA.
Collapse
Affiliation(s)
- Kirill Gromov
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen,,Correspondence:
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen,
| | - Kristian Stahl Otte
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen,
| | - Thue Ørsnes
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen,
| | - Henrik Husted
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen,,The Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement, Copenhagen, Denmark
| |
Collapse
|
48
|
Ma T, Tu YH, Xue HM, Wen T, Cai MW. Clinical Outcomes and Risks of Single-stage Bilateral Unicompartmental Knee Arthroplasty via Oxford Phase III. Chin Med J (Engl) 2016; 128:2861-5. [PMID: 26521782 PMCID: PMC4756887 DOI: 10.4103/0366-6999.168042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background: Osteoarthritis often affects the joint bilaterally, and the single-stage (SS) unicompartmental knee arthroplasty (UKA) is advantageous in terms of a single anesthesia administration, a short hospital stay, lower medical costs, and enhanced patient convenience. However, the complication risk of SS UKA continues to be debated. The aim of this article was to evaluate the clinical effectiveness, complications, and functional recovery of SS and two-stage (TS) UKA. Methods: From January 2008 to December 2013, we compared a series of 36 SS UKA with 45 TS UKA for osteoarthritis. The mean age was 65.4 years (range: 55–75 years). The mean body mass index was 25.2 kg/m2 (range: 22–29 kg/m2). The pre- and post-operative Oxford Knee Scores (OKSs), complications, operative times, tourniquet times, the amount of drainage, and hemoglobin (Hb) were evaluated. The Chi-square test, Fisher's exact test, and paired and grouped t-tests were used in this study. Results: The mean follow-up was 50 months. No complications of death, fat embolism, deep vein thrombosis, and prosthetic infection were reported. Patients who underwent SS UKA had a shorter cumulative anesthesia time (113.5 vs. 133.0 min, P < 0.01). There were no significant variations between the values of the mean tourniquet time, the amount of drainage, pre- and post-operative Hb in the different groups. No patient required a blood transfusion. No statistical differences were found in the complications between two groups (P > 0.05). At the final follow-up, the mean OKS improved from 39.48 ± 5.69 to 18.83 ± 3.82 (P < 0.01), with no statistical differences between the two groups (P > 0.05). Patients who underwent SS UKA had a faster recovery. Conclusions: The single-staged UKA offers the benefits of a single anesthesia administration, reduced total anesthetic time, decreased overall rehabilitation time, and absence of an increase in perioperative mortality or complications compared with the TS bilateral UKA.
Collapse
Affiliation(s)
| | - Yi-Hui Tu
- Department of Orthopedics, YangPu District Central Hospital Affiliated to Tongji University, Shanghai 200090, China
| | | | | | | |
Collapse
|
49
|
Lee WC, Kwan YH, Yeo SJ. Severe Bilateral Fixed Flexion Deformity-Simultaneous or Staged Total Knee Arthroplasty? J Arthroplasty 2016; 31:128-31. [PMID: 26404849 DOI: 10.1016/j.arth.2015.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 02/01/2023] Open
Abstract
Outcomes of 29 simultaneous (SimBTKA) and 38 staged bilateral total knee arthroplasty (StaBTKA) subjects with severe (≥16°) bilateral fixed flexion deformity (FFD) were retrospectively investigated. SimBTKA patients were significantly younger (63 ± 8 vs 68 ± 7, P > .01). At 2 years, SimBTKA subjects had significantly better residual FFD (2.5° ± 5.1° vs 5.4° ± 6.6°, P = .02) and Knee Society function score (75.7 ± 25.7 vs 69.3 ± 24.1, P = .02). However, Knee Society knee scores, Oxford Knee Scores, and Short Form-36 scores were similar. These suggest no large clinical advantage of SimBTKA over StaBTKA. We feel that severe bilateral FFD is not an absolute indication for SimBTKA.
Collapse
Affiliation(s)
- Wu Chean Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Yu Heng Kwan
- Centre of Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Republic of Singapore; Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Republic of Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
50
|
Simultaneous Bilateral Versus Unilateral Total Knee Arthroplasty: A Comparison of 30-Day Readmission Rates and Major Complications. J Arthroplasty 2016; 31:31-5. [PMID: 26297691 DOI: 10.1016/j.arth.2015.07.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/12/2015] [Accepted: 07/17/2015] [Indexed: 02/01/2023] Open
Abstract
We queried the National Surgical Quality Improvement Program to compare the rate of 30-day readmissions and major complications between simultaneous bilateral and unilateral total knee arthroplasty (TKA). We identified 1771 patients who underwent simultaneous (same-day) bilateral TKA and matched them to a control group of 6790 patients who underwent unilateral TKA. The simultaneous bilateral TKA patients had longer surgery, were more commonly performed under general anesthesia, had a higher rate of postoperative transfusion, and a greater proportion of patients discharged to rehabilitation facilities. Simultaneous bilateral TKA has a low incidence of major complications and was not associated with more readmissions as compared to unilateral TKA (3.6% versus 3.5% respectively). Nonetheless, the odds of major complications was slightly higher following simultaneous bilateral TKA (OR=1.58).
Collapse
|