Comparison of the major intraoperative and postoperative complications between unilateral and sequential bilateral total knee arthroplasty in a high-volume community hospital

Abstract

Comparison of the major intraoperative and postoperative complications between unilateral and sequential bilateral total knee arthroplasty in a high-volume community hospital Background: Total knee arthroplasty (TKA) is a common surgical treatment for arthritis. In the event of bilateral knee symptoms, a patient may elect for bilateral TKA (BTKA) under 1 anesthetic or 2 separate unilateral TKAs (UTKA). Controversy exists in the literature regarding the safety of BTKA versus UTKA. We compared the rate of major intraoperative and postoperative complications for BTKA versus UTKA at a high-volume community hospital. Methods:We compared 373 patients who underwent BTKA with 966 who underwent UTKA between May 2008 and May 2011. Health records were used to determine patient characteristics and major intraoperative and postoperative complications. The BTKA and UTKA cohorts were matched for demographic characteristics and comorbidities with the exception of previous transient ischemic attack and previous knee surgery (UTKA > BTKA). Results:Rates of intraoperative and postoperative complications, including cardiovascular, thromboembolic and neurologic complications; deep wound infections; and mortality, did not differ significantly between groups. Bilateral TKA was associated with a greater proportion of patients requiring blood transfusion than UTKA (29.8% v. 8.9%, p < 0.001). Among those transfused, there was no significant difference between the groups in the mean number of units required (1.72 ± 0.77 v. 1.53 ± 0.85 units, p = 0.68). Conclusion:Bilateral TKA was not associated with statistically greater rates of intraoperative and postoperative complications than UTKA, barring the proportion of patients requiring transfusion. Our results support the use of BTKA to treat bilateral knee arthritis in a high-volume community hospital setting.Contexte : La prothèse (ou arthroplastie) totale du genou (PTG) est un traitement chirurgical courant contre l'arthrite. Quand les 2 genoux sont atteints, le patient peut choisir entre une PTG bilatérale (PTGB), qui ne nécessitera qu'une seule anesthésie, ou 2 interventions unilatérales distinctes (PTGU). Dans la littérature, on ne semble pas s'entendre sur l'innocuité de la PTGB contre la PTGU. Nous avons comparé les taux de complications peropératoires et postopératoires majeures associées aux PTGB et aux PTGU dans un hôpital communautaire où s'effectue un volume élevé de telles interventions. Résultats : Les taux de complications peropératoires et postopératoires, y compris cardiovasculaires, thromboemboliques et neurologiques, les infections de plaies profondes et la mortalité n'ont pas varié significativement entre les groupes. Une proportion plus grande de patients soumis à la PTGB a nécessité une transfusion sanguine comparativement aux patients soumis à la PTGU (29,8 % c. 8,9 %, p < 0,001). Parmi les receveurs de transfusions, on n'a noté aucune différence significative entre les groupes quant au nombre moyen d'unités requises (1,72 ± 0,77 c. 1,53 ± 0,85 unité, p = 0,68). Méthodes

Predictive factors for length of hospital stay following primary total knee replacement in a total joint replacement centre in Hong Kong

“…Several previous studies have demonstrated a comparable safety profile between bilateral TKR and unilateral TKR in properly selected patients. [12][13][14][15] Patients with bilateral osteoarthritis of the knee should be encouraged to undergo bilateral TKR provided they can tolerate the procedure.…”

Perioperative Risk Assessment in Patients Aged 75 Years or Older: Comparison between Bilateral and Unilateral Total Knee Arthroplasty

“…The high incidence of cardiovascular complications after simultaneous bilateral TKA has been demonstrated in various studies 18 , 20 , 21) . However, in a recent study by Spicer et al 22) involving 373 bilateral TKAs and 966 unilateral TKAs, bilateral TKA was not associated with increased cardiovascular complications. Still, bilateral TKA has been frequently associated with cardiovascular complications in high risk groups consisting of patients aged 75 years or over.…”

Comment on "comparison of The major intraoperative and Postoperative complications Between unilateral and Sequential bilateral total knee Arthroplasty in a high-volume Community hospital"

“…Instead, candid ates with bilateral knee symptoms who were deemed eligible for surgery were given the option of BTKA or 2 UTKAs. 1 In our experience with patients who present with bilateral fixed flexion knee deformities, even if a UKTA is initially successful, it may develop stiffness and adopt the fixed flexion of the contralateral knee if the latter is not likewise replaced within a few months. Residual flexion contractures after knee replacement have been associated with poor outcomes.…”

“…We read Brown and colleagues' re c ent article 1 on culture transition in surgery with interest. We agree with the accompanying editorial by Harvey, 2 that this is an important addition to the literature and that open, frank discussion is needed from the pro fession.…”

“…The authors highlight 2 key factors influencing the culture and future of our profession: the (slow) movement toward gender balance and a generationally driven attitudinal shift. They study how "new" recruits perceive these changes by interviewing 17 surgeons (9 women, 8 men), 1 all of whom are assistant professor level or higher; have a mean age of 38 years; and are in heterosexual relationships. The ethnic profile of the sample was not reported.…”