A Population-Based Comparison of the Incidence of Adverse Outcomes After Simultaneous-Bilateral and Staged-Bilateral Total Knee Arthroplasty

Abstract

Simultaneous-bilateral total knee arthroplasty was associated with a clinically important reduction in the incidence of periprosthetic joint infection and malfunction within one year after arthroplasty, but it was associated with a moderately higher risk of an adverse cardiovascular outcome within thirty days. If patients who are at higher risk for cardiovascular complications can be identified, simultaneous-bilateral knee arthroplasty may be the preferred surgical strategy for the remaining lower-risk patients.

Complications and Safety of Simultaneous Bilateral Total Knee Arthroplasty

“…Additionally, our results did not identify differences in the risk of myocardial infarction between our 2 cohorts. This is contrary to a study by Meehan et al, who reported an elevated risk of myocardial infarction (OR, 1.6) among patients undergoing simultaneous bilateral TKA 10 . We did note an elevated risk of stroke following simultaneous bilateral TKA compared with unilateral TKA, a finding supported by previous research 25,26 .…”

Complications and Safety of Simultaneous Bilateral Total Knee Arthroplasty

“…Additionally, our results did not identify differences in the risk of myocardial infarction between our 2 cohorts. This is contrary to a study by Meehan et al, who reported an elevated risk of myocardial infarction (OR, 1.6) among patients undergoing simultaneous bilateral TKA 10 . We did note an elevated risk of stroke following simultaneous bilateral TKA compared with unilateral TKA, a finding supported by previous research 25,26 .…”

Retrospective immediate post-operative comparative study of sequential bilateral total knee replacement versus unilateral total knee replacement for knee primary osteoarthritis

“…15,16 Our study also did not come across any case of superficial or deep knee infection which is similar to the findings from literature by Yoon et al, Fu et al 14,21 However another study by Meehan et al shows that infection rate in simultaneous bilateral TKR is lower than unilateral or staged TKR. 18 Our study has depicted a post op delayed and cumbersome rehabilitation process in cases of simultaneous bilateral TKR which is in coherence to past studies by Lombardi et al and Cushner et al…”

The Patient’s Age and American Society of Anesthesiologists Status Are Reasonable Criteria for Deciding Whether to Perform Same-Day Bilateral TKA

“…However, the type of TKA, such as SD BTKA or St BTKA, was not identified as a risk factor in this study cohort of patients for whom the type of TKA was chosen based on age and ASA classification. Our findings agree with those of several previous studies reporting that an increased risk for postoperative complications was associated with ASA score of 3 or 4, preoperative cardiovascular disease, and older age [8,15,18,24,[29][30][31][32][33][34][35][36][37]. Our data, together with the data of these previous studies, suggest that if patients are properly selected, the type of BTKA procedure, such as SD BTKA and St BTKA, may not increase the risk of postoperative complications and has a risk comparable to the risk of UTKA.…”

“…In this study, the rate for standard-risk patients of postoperative complications after SD BTKA was comparable to that of UTKA, even after controlling for the effects of age, gender, and BMI. Our findings are in agreement with previous studies that have reported similar risks for postoperative complications occurring in standard-risk (age b 75 years and ASA score 1 or 2) patients undergoing SD BTKA and UTKA [12,23,24]. The preoperative ASA scoring system has been shown to correlate well with the risks for postoperative complications after TKA, and it has been widely used for preoperative risk assessments of patients undergoing TKA [11,[15][16][17][18]21,25].…”

Complications and Safety of Simultaneous Bilateral Total Knee Arthroplasty

“…Additionally, our results did not identify differences in the risk of myocardial infarction between our 2 cohorts. This is contrary to a study by Meehan et al, who reported an elevated risk of myocardial infarction (OR, 1.6) among patients undergoing simultaneous bilateral TKA 10 . We did note an elevated risk of stroke following simultaneous bilateral TKA compared with unilateral TKA, a finding supported by previous research 25,26 .…”

Retrospective immediate post-operative comparative study of sequential bilateral total knee replacement versus unilateral total knee replacement for knee primary osteoarthritis

“…15,16 Our study also did not come across any case of superficial or deep knee infection which is similar to the findings from literature by Yoon et al, Fu et al 14,21 However another study by Meehan et al shows that infection rate in simultaneous bilateral TKR is lower than unilateral or staged TKR. 18 Our study has depicted a post op delayed and cumbersome rehabilitation process in cases of simultaneous bilateral TKR which is in coherence to past studies by Lombardi et al and Cushner et al…”

The Patient’s Age and American Society of Anesthesiologists Status Are Reasonable Criteria for Deciding Whether to Perform Same-Day Bilateral TKA

“…However, the type of TKA, such as SD BTKA or St BTKA, was not identified as a risk factor in this study cohort of patients for whom the type of TKA was chosen based on age and ASA classification. Our findings agree with those of several previous studies reporting that an increased risk for postoperative complications was associated with ASA score of 3 or 4, preoperative cardiovascular disease, and older age [8,15,18,24,[29][30][31][32][33][34][35][36][37]. Our data, together with the data of these previous studies, suggest that if patients are properly selected, the type of BTKA procedure, such as SD BTKA and St BTKA, may not increase the risk of postoperative complications and has a risk comparable to the risk of UTKA.…”

“…In this study, the rate for standard-risk patients of postoperative complications after SD BTKA was comparable to that of UTKA, even after controlling for the effects of age, gender, and BMI. Our findings are in agreement with previous studies that have reported similar risks for postoperative complications occurring in standard-risk (age b 75 years and ASA score 1 or 2) patients undergoing SD BTKA and UTKA [12,23,24]. The preoperative ASA scoring system has been shown to correlate well with the risks for postoperative complications after TKA, and it has been widely used for preoperative risk assessments of patients undergoing TKA [11,[15][16][17][18]21,25].…”

Complications and Safety of Simultaneous Bilateral Total Knee Arthroplasty

“…Additionally, our results did not identify differences in the risk of myocardial infarction between our 2 cohorts. This is contrary to a study by Meehan et al, who reported an elevated risk of myocardial infarction (OR, 1.6) among patients undergoing simultaneous bilateral TKA 10 . We did note an elevated risk of stroke following simultaneous bilateral TKA compared with unilateral TKA, a finding supported by previous research 25,26 .…”

Retrospective immediate post-operative comparative study of sequential bilateral total knee replacement versus unilateral total knee replacement for knee primary osteoarthritis

“…15,16 Our study also did not come across any case of superficial or deep knee infection which is similar to the findings from literature by Yoon et al, Fu et al 14,21 However another study by Meehan et al shows that infection rate in simultaneous bilateral TKR is lower than unilateral or staged TKR. 18 Our study has depicted a post op delayed and cumbersome rehabilitation process in cases of simultaneous bilateral TKR which is in coherence to past studies by Lombardi et al and Cushner et al…”

The Patient’s Age and American Society of Anesthesiologists Status Are Reasonable Criteria for Deciding Whether to Perform Same-Day Bilateral TKA

“…However, the type of TKA, such as SD BTKA or St BTKA, was not identified as a risk factor in this study cohort of patients for whom the type of TKA was chosen based on age and ASA classification. Our findings agree with those of several previous studies reporting that an increased risk for postoperative complications was associated with ASA score of 3 or 4, preoperative cardiovascular disease, and older age [8,15,18,24,[29][30][31][32][33][34][35][36][37]. Our data, together with the data of these previous studies, suggest that if patients are properly selected, the type of BTKA procedure, such as SD BTKA and St BTKA, may not increase the risk of postoperative complications and has a risk comparable to the risk of UTKA.…”

“…In this study, the rate for standard-risk patients of postoperative complications after SD BTKA was comparable to that of UTKA, even after controlling for the effects of age, gender, and BMI. Our findings are in agreement with previous studies that have reported similar risks for postoperative complications occurring in standard-risk (age b 75 years and ASA score 1 or 2) patients undergoing SD BTKA and UTKA [12,23,24]. The preoperative ASA scoring system has been shown to correlate well with the risks for postoperative complications after TKA, and it has been widely used for preoperative risk assessments of patients undergoing TKA [11,[15][16][17][18]21,25].…”