Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery

Alghadir, Ahmad H.; Iqbal, Zaheen A.; Anwer, Shahnawaz; Anwar, Dilshad

doi:10.1186/s12891-020-03269-3

Cited by 22 publications

(36 citation statements)

References 45 publications

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“…[20] Therefore, when OA is present in bilateral knees, bilateral TKAs may be warranted. [1,11,21] The decision to perform simultaneous (SiTKA) or staged TKA (StTKA) for severe OA of bilateral knees remains controversial. [1,11,24] In a meta-analysis performed by Restrepo et al, the authors concluded that SiTKA carries a higher risk for serious cardiopulmonary complications (eg.…”

Section: Introductionmentioning

confidence: 99%

“…[15] When conservative treatment has failed, total knee arthroplasty (TKA) is a common surgical procedure to treat severe knee OA. [1] Primary, unilateral TKAs have been shown to be a cost-effective surgery that relieves pain and improves quality of life for patients with severe OA. [13,17,21] Interestingly, for patients that underwent an unilateral TKA, 37% will receive a TKA for the contralateral knee.…”

Section: Introductionmentioning

confidence: 99%

“…[1,11,21] The decision to perform simultaneous (SiTKA) or staged TKA (StTKA) for severe OA of bilateral knees remains controversial. [1,11,24] In a meta-analysis performed by Restrepo et al, the authors concluded that SiTKA carries a higher risk for serious cardiopulmonary complications (eg. gastrointestinal distress, deep vein thrombosis, pulmonary and fat embolism) and mortality.…”

Section: Introductionmentioning

confidence: 99%

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The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population

Chou

Hsu

et al. 2022

Preprint

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The purpose of this study was to investigate the safety of Simultaneous, bilateral TKA (SiTKA). Furthermore, we also assessed the cost reduction of SiTKA in comparison with Staged, bilateral TKA (StTKA). We retrospectively review all patients that underwent SiTKA or StTKA due to osteoarthritis (OA) or spontaneous osteonecrosis of the knee (SONK).We assessed length of stay, transfusion rate, early postoperative complications, 30-day and 90-day readmission rate, 1-year reoperation rate and the indication for reoperation. Furthermore, we analyzed the total cost of the two groups, reimbursement from the national health insurance (NHI), cost of the procedures, and net income from each case. A total of 2016 patients (1565 SiTKA and 451 StTKAs) were included in this study. There were no significant differences in terms of complication rates, 30-day and 90-day readmission, and 1-year reoperations between the two groups. The total length of stay was on average 5.0 days longer for StTKA (p<0.01). In terms of cost, all categories of medical costs were significantly lower in SiTKA, while the net hospital income was significantly higher for StTKA. In conclusion, SiTKA and StTKA have similar postoperative complication, readmission and reoperation rates, while SiTKA significantly reduces medical expenses for the patient and NHI. Level of evidence: level III, retrospective cohort study

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population

Chou

Hsu

et al. 2022

Preprint

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“…Simultaneous bilateral total knee arthroplasty (TKA) has been widely used due to financial advantages and overall resource usage in terms of time spent in the operating room. 1 The benefits of undergoing a single period of rehabilitation for both knees, as opposed to staged procedures requiring two periods of rehabilitation, are significant for the patient while also reducing absence from work, recreation, and social functions. Bilateral simultaneous TKA is known to induce a greater physiological insult when compared to staged procedures in the acute setting; Liu et al 2 demonstrated, in their meta-analysis of 73,617 simultaneous bilateral TKA, that there is a significantly higher risk of mortality, pulmonary embolism (PE), and all complications when compared to staged procedures, although the differences were small.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous bilateral total knee arthroplasty

2022

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Aims Simultaneous bilateral total knee arthroplasty (TKA) has been used due to its financial advantages, overall resource usage, and convenience for the patient. The training model where a trainee performs the first TKA, followed by the trainer surgeon performing the second TKA, is a unique model to our institution. This study aims to analyze the functional and clinical outcomes of bilateral simultaneous TKA when performed by a trainee or a supervising surgeon, and also to assess these outcomes based on which side was done by the trainee or by the surgeon. Methods This was a retrospective cohort study of all simultaneous bilateral TKAs performed by a single surgeon in an academic institution between May 2003 and November 2017. Exclusion criteria were the use of partial knee arthroplasty procedures, staged bilateral procedures, and procedures not performed by the senior author on one side and the trainee on another. Primary clinical outcomes of interest included revision and re-revision. Primary functional outcomes included the Oxford Knee Score (OKS) and patient satisfaction scores. Results In total, 315 patients (630 knees) were included for analysis. Of these, functional scores were available for 189 patients (378 knees). There was a 1.9% (n = 12) all-cause revision rate for all knees. Overall, 12 knees in ten patients were revised, and both right and left knees were revised in two patients. The OKS and patient satisfaction scores were comparable for trainees and supervising surgeons. A majority of patients (88%, n = 166) were either highly likely (67%, n = 127) or likely (21%, n = 39) to recommend bilateral TKAs to a friend. Conclusion Simultaneous bilateral TKA can be used as an effective teaching model for trainees without any significant impact on patient clinical or functional outcomes. Excellent functional and clinical outcomes in both knees, regardless of whether the performing surgeon is a trainee or supervising surgeon, can be achieved with simultaneous bilateral TKA. Cite this article: Bone Jt Open 2022;3(1):29–34.

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“…Hyperalgesia during the duration of the subsequent surgery [ 27 , 28 ] and perceptions associated with discomfort [ 29 ] could be accountable for the excessive encounter. Concomitant treatment restricts surgery to a single event [ 30 ], lowers hospitalization time and costs, reduces time and costs associated with hospitalization [ 31 ], encourages the symmetrical improvement of function [ 32 ], promotes the symmetrical change of function, and increases satisfaction [ 33 ]. It is reasonable to believe that patients requiring surgery on both knees can have greater severity of knee-related pain and swelling than expected postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

Local Efficacy of Corticosteroids as an Adjuvant for Periarticular Cocktail Injection in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Double-Blind Controlled Trial

Peng

Wang

Lin

et al. 2021

Pain Research and Management

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Multimodal cocktail periarticular injections comprising corticosteroids are the most suggested therapy for postoperative discomfort and swelling following total knee arthroplasty (TKA). Nevertheless, previous findings cannot be applied to instances of unilateral total knee arthroplasty on bilateral knees. This randomized, prospective, double-blind, controlled clinical study examines the efficacy as well as safety of periarticular multimodal cocktail injection along or sans corticosteroids in certain situations. The 60 patients (120 knees) that experienced concurrent bilateral total knee arthroplasty were provided periarticular injections along additional betamethasone (7 mg) in the randomized knee, as well as the other knee, where corticosteroid was not administered. Key results were “pain scores at rest as well as in action” on a visual analogue scale of 11 pt. Other results included motion range, swelling of the thigh, Hospital for Special Surgery score (HSS score), and adverse effects were measured between the two sides. No statistically promising variations were found in the visual analogue scale ranking, motion range, girth of the thigh, and HSS score, as well as complications between the two sides. The impact on treatment outcomes was maintained between the knees on postoperative day 3 or at 3 months of follow-up. Multimodal periarticular injection without corticosteroid will alleviate postoperative swelling and pain. More studies are needed for the use of betamethasone as a corticosteroid in periarticular multimodal cocktail injections. This Chinese Clinical Trial Registry is registered with ChiCTR-OPC-17013503, dated 2017-11-23, available from http://www.chictr.org.cn/showproj.aspxproj=23146.

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Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery

Cited by 22 publications

References 45 publications

The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population

The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population

Simultaneous bilateral total knee arthroplasty

Local Efficacy of Corticosteroids as an Adjuvant for Periarticular Cocktail Injection in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Double-Blind Controlled Trial

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