A retrospective comparative study of bilateral total knee replacement staged at a one-week interval

Abstract

The clinical results of bilateral total knee replacement staged at a one-week interval during a single hospital admission were compared with bilateral total knee replacements performed under the same anaesthetic and with bilateral total knee replacements performed during two separate admissions. The data were retrospectively reviewed. All operations had been performed by the same surgeon using the same design of prosthesis at a single institution. The operative time and length of stay for the one-week staged group were comparable with those of the separate admission group but longer than for the patients treated under one anaesthetic. There was a low rate of complications and good clinical outcome in all groups at a mean follow-up of four years (1 to 7.2). The group staged at a one-week interval had the least blood loss (p = 0.004). With appropriate patient selection, bilateral total knee replacement performed under a single anaesthetic, or staged at a one-week interval, is a safe and effective method to treat bilateral arthritis of the knee.

Perioperative Morbidity and Mortality of Same-admission Staged Bilateral TKA

“…We found no difference in mortality between sameadmission staged BTKA and mortality among patients whose BTKAs were staged several months apart. Our results are consistent with the findings of published studies comparing perioperative mortality between same-admission staged and staged BTKAs [5,6,28].…”

“…In such situations, and when the patient is not considered medically eligible for same-day BTKA, same-admission staged BTKA, although representing a compromise, may be considered as a treatment option. However, few studies have approached this controversial approach [5,6,15,28]. Thus, we compared 30-day mortality, in-hospital complications rates, and blood transfusion rates between sameadmission staged and staged-within 1 year BTKA at a high-volume institution where specific guidelines have been implemented encouraging same-day BTKA in younger and healthier patients.…”

“…Same-admission staged BTKA has been used as a treatment option with the intent to reduce the perioperative complication rate compared with sameday BTKA. However, the few studies reporting on this approach have conflicting results, possibly as a result of differences in study design and patient selection process [5,6,15,28].…”

In-hospital Complications and Mortality of Unilateral, Bilateral, and Revision TKA: Based on an estimate of 4,159,661 Discharges

“…The use of ICD-9 coding poses some limitations. Although we identified patients undergoing BTKA by the occurrence of the code for UTKA twice, it is not possible to distinguish patients who had BTKA performed during the same session from those who underwent surgery at different times during their hospitalization [17,62]. Furthermore, ICD-9 code 81.54 includes unicompartimental knee arthroplasty, which was not frequently performed during the study period in the United States.…”

“…anesthetic and admission, a diminished combined length of hospital stay, cost [9,45,49,61], use of narcotics, and a faster overall recovery than bilateral, staged TKA [5,11,17,57]. However, the use of simultaneous BTKA remains the subject of intense debate [55,60,76].…”