Bilateral total knee arthroplasty: Simultaneous versus staging in the same or in twice hospitalization

Abstract

Background and objective: Arthroplasty is the main treatment in patients with advanced knee osteoarthritis. In bilateral lesions, it is frequently performed in two simultaneous or separate surgical procedures. In this regard, the present study aimed to compare the results of knee arthroplasty in two joints simultaneously at two different times. Method: In general, all 40e70 years old patients in need of complete bilateral total knee arthroplasty (BTKA) were enrolled in this descriptive cross-sectional study during 2009e2016. They were included in three groups of BTKA as simultaneously (n ¼ 272), staging in the same hospitalization ( 146), and staging in different hospitalizations (245). To assess the quantitative and qualitative function of the knees, patients' knees were evaluated before the surgery, and one month, three months, and two years after the surgery using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Finally, hospitalization time, anesthesia duration, and medical costs were compared between the three groups. Results: Based on the results, knee function improved based on WOMAC and KSS scales in all groups after arthroplasty although no significant differences were observed between the three groups. Patients' satisfaction in simultaneous BTKA was significantly higher compared to the other two groups (P ¼ 0.013). Eventually, complications demonstrated no significant differences between the three groups except for pulmonary and cerebral embolism which were more prevalent in old patients with a high body mass index in the simultaneous BTKA group (P ¼ 0.035 and P ¼ 0.043, respectively). Conclusion: Overall, simultaneous BTKA is a useful approach for reducing costs while increasing patients' function and satisfaction although it has certain complications such as embolism in older overweight patients.

Development and validation of a nomogram to predict complications in patients undergoing simultaneous bilateral total knee arthroplasty: A retrospective study from two centers

“…BUN: Blood urea nitrogen; ASA: American Society of Anesthesiologists. function and relieve pain (1)(2)(3)(4)(5)(6)(7)(19)(20)(21)(22). In recent years, the nomogram is a widely used prediction tool in the field of clinical medicine, which has the ability to predict the occurrence risk of adverse events individually.…”

“…Studies have found that after SBTKA, the infection rate and length of hospital stay of patients are reduced, but the incidence of 90-day mortality, venous thromboembolism and neurological complications is increased (4). In addition, the risk of pulmonary embolism, cerebral embolism (5), blood transfusion rate (6,7), cardiac complications, urinary retention, and deep infection are significantly increased (8). At present, the comparative studies after SBTKA and staged bilateral TKA are relatively common, and many studies have provided a comprehensive assessment of complication incidence, clinical efficacy and mortality after SBTKA (4,(8)(9)(10).…”

A artroplastia total de joelhos bilateral simultânea pode ser segura

“…[5][6][7] Consecutive procedures virtually double the surgery and anesthesia times, and such doubling has consequences. Furthermore, some authors used spinal anesthesia, 5 whereas others preferred epidural 7 or general anesthesia; 6 some used a pneumatic tourniquet, 6,7 and others did not. 5 The technique of TKA with two surgical teams working simultaneously allows the performance of both procedures in the time equivalent to one surgery and under the same amount of anesthesia.…”

Optimal Age Group Selection and Development of a Nomogram To Predict Complications in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty

“…Studies have found that after SBTKA, the infection rate and length of hospital stay of patients are reduced, but the incidence of 90-day mortality, venous thromboembolism and neurological complications is increased [4].In addition, the risk of pulmonary embolism, cerebral embolism [5], blood transfusion rate [6,7], cardiac complications, urinary retention, and deep infection are signi cantly increased [8].At present, the comparative studies after SBTKA and staged bilateral TKA are relatively common, and many studies have provided a comprehensive assessment of complication incidence, clinical e cacy and mortality after SBTKA [4,[8][9][10].Due to the lack of established indications for SBTKA, it is always controversial to determine the age of patients, and previous studies only con rmed that patients aged 75 and above are generally not recommended to undergo SBTKA [11][12][13].Recent studies by scholars [14] also only con rmed that patients under 75 years of age and ASA1 grade or grade 2 received SBTKA, and the incidence of complications was no different from that of unilateral TKA.Regrettably, these studies did not provide further studies on the incidence of complications at various ages of SBTKA and the selection of the optimal age.For complications after TKA, some scholars used the nomograms prediction model to predict the probability of complications within 30 days after primary TKA [15].Since the incidence of complications after bilateral TKA increased signi cantly during the same period, it was necessary to establish a nomogram prediction model for complications after SBTKA and identify high-risk patients as early as possible in order to reduce the risk of postoperative complications.…”