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Wunderlich F, Schröder M, Appelmann P, Wegner E, Goldhofer M, Klonschinski T, Betz U, Drees P, Eckhard L. Simultaneous bilateral TKA in the context of fast track surgery - Do patients meet discharge criteria as anticipated? J Orthop Sci 2024; 29:861-866. [PMID: 37121790 DOI: 10.1016/j.jos.2023.04.005] [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: 01/23/2023] [Revised: 04/02/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND The efficacy and safety of enhanced recovery after surgery (ERAS) protocols for patients undergoing total knee arthroplasty (TKA) have been generally proven. Previous studies investigating patients undergoing simultaneous bilateral TKA (SBTKA) focused on complications, mortality, and pain and did not examine patients' functional limitations. Therefore, the aim of this study was to investigate to what extent patients undergoing SBTKA are able to meet functional discharge criteria originally designed for their counterparts undergoing unilateral TKA (UTKA) in an ERAS setting. MATERIALS AND METHODS All patients who received primary SBTKA between June 2015 and December 2018 were included in this retrospective analysis. For comparison, UTKA patients were matched 1:1 to SBTKA patients using Propensity Score Matching based on age, gender, and BMI. The times to achieving the rehabilitation checkpoints of walking 150 m, walking a flight of stairs, and 90° knee flexion were evaluated. RESULTS 63 (SBTKA group) and 64 (UTKA group) patients were included. Due to the Propensity-Score-Matching there were no differences regarding age, gender, and BMI. The mean length of stay (LOS) was 9.1 days in the SBTKA and 7.6 days in the UTKA group (p = 0.003). On average, it took SBTKA patients 5.4 days to achieve an uninterrupted walking distance of at least 150 m, while it took UTKA patients 4.1 days (p < 0.001). Mean time to walking a flight of stairs was 6.3 days for SBTKA patients and 4.7 days for UTKA patients (p < 0.001). 90° flexion was achieved after 4.1 days by SBTKA patients and 3.5 days by UTKA patients (p = 0.241). CONCLUSION The vast majority of SBTKA patients were able to achieve functional discharge criteria within their inpatient stay when allowed about 30% extra time. Therefore, functional discharge criteria in ERAS protocols designed for UTKA can be considered appropriate for SBTKA patients. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Felix Wunderlich
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Markus Schröder
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; Department of General and Visceral Surgery, St. Josef Hospital, Beethovenstr. 20, 65189 Wiesbaden, Germany.
| | - Philipp Appelmann
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; GALENOS Mainz, Helix Medical Excellence Center, Haifa-Allee 24, 55128 Mainz, Germany.
| | - Erik Wegner
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Markus Goldhofer
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; Department of Trauma and Orthopaedic Surgery, Hunsrück Hospital Kreuznacher Diakonie, Holzbacher Str. 1, 55469 Simmern/Hunsrück, Germany.
| | - Thomas Klonschinski
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Ulrich Betz
- Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Lukas Eckhard
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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Qadir I, Shah B, Waqas M, Ahmad U, Javed S, Aziz A. Component Alignment in Simultaneous Bilateral versus Unilateral Total Knee Arthroplasty. Knee Surg Relat Res 2019; 31:31-36. [PMID: 30871290 PMCID: PMC6425892 DOI: 10.5792/ksrr.18.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/04/2018] [Accepted: 10/31/2018] [Indexed: 01/30/2023] Open
Abstract
Purpose The purpose of this study was to investigate differences in component alignment between first and second knees in simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral TKA (UTKA). Materials and Methods 274 SBTKAs and 198 UTKAs were included in study. Patients were divided into three groups as SBTKA on the right knee (group A), SBTKA on the left knee (group B) and UTKA (group C). Femoral and tibial component alignment was checked in both coronal plane (alpha [α] and beta [β] angles) and sagittal plane (gamma [γ] and delta [δ] angles) radiographs. Results There were no statistically significant differences among groups in the preoperative anatomical varus angle and Kellgren–Lawrence gonarthrosis classification grade (p=0.139 and p=0.329, respectively). In the coronal plane, the alignment of femoral component (α angle) and tibial component (β angle) was similar in all three groups (α angle, 95.01 vs. 95.14 vs. 94.9, p=0.945; β angle, 90.03 vs. 89.67 vs. 89.98, p=0.483). The sagittal plane alignment of femoral component (γ angle) and tibial component (δ angle) did not show significant differences (γ angle, 7.04 vs. 6.98 vs. 7.00, p=0.132; δ angle, 86.56 vs. 87.41 vs. 86.73, p=0.610). Conclusions The angular alignment of components was similar between SBTKA and UTKA.
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Affiliation(s)
- Irfan Qadir
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Bahar Shah
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Muhammad Waqas
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Umair Ahmad
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Shahzad Javed
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Amer Aziz
- Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
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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.
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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
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Affiliation(s)
- Anil K Jain
- Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India,Address for correspondence: Dr. Anil K Jain, Prof. of Orthopaedics, Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi 110 095, India. E-mail:
| | - Sudhir Kumar
- Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India
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