Consensus Statement from the Consensus Conference on Bilateral Total Knee Arthroplasty Group

Memtsoudis, Stavros G.; Hargett, Mary J.; Russell, Linda; Parvızı, Javad; Cats-Baril, William L.; Stundner, Ottokar; Sculco, Thomas P.

doi:10.1007/s11999-013-2976-9

Cited by 92 publications

(68 citation statements)

References 37 publications

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“…Despite higher blood loss, risk for cardiopulmonary complications, and overall higher physiologic insult compared with staged procedures, recent studies have suggested that same-day BTKA can be performed safely in appropriately selected patients with perioperative complication rates no higher, or even lower, than staged bilateral procedures [11,13,14,19,26]. Same-day BTKA (either simultaneously or sequentially) is considered when severe bilateral knee deformity and symptomatology, certain patient expectations, or socioeconomic pressures are present [6,8,20,25].…”

Section: Discussionmentioning

confidence: 99%

“…If the patient had recovered without any systemic or local complications and was medically stable postoperatively after the first knee, the second knee was replaced during the same hospitalization, typically 5 to 7 days later. If the patient declined to proceed with same-admission staged BTKA or experienced a major complication postoperatively after the first knee, the patient underwent TKA on the contralateral side at a later date within 1 year from the index procedure [13,29].…”

Section: Study Populationmentioning

confidence: 99%

“…It has been postulated that same-day BTKA results in greater pathophysiological insult than that from separate unilateral procedures [18,25]. Although controversy still persists regarding the safety of same-day BTKA [12,13,17,23,27], large institutional series have shown that same-day BTKA can be performed safely without increased perioperative morbidity and mortality compared with staged BTKA if a selective preoperative screening process for same-day BTKA candidates is used [11,13,14,19]. When a BTKA candidate is not considered eligible for same-day BTKA, treatment options include same-admission staged BTKA (managed as separate procedures during a single hospitalization) or staged BTKA during two separate hospitalizations, usually performed within 1 year [25,26].…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Morbidity and Mortality of Same-admission Staged Bilateral TKA

Poultsides

Memtsoudis

Hương

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Controversy continues regarding the optimal timing of surgery for patients with symptomatic bilateral degenerative knee arthritis who are not considered eligible for same-day bilateral TKA (BTKA). Questions/purposes We compared (1) 30-day mortality; (2) rates of in-hospital complications; and (3) blood transfusion rates between patients undergoing sameadmission staged BTKA and patients undergoing BTKA staged within 1 year in a highly specialized center where specific guidelines have been implemented for same-day BTKA patient selection. Methods We analyzed institutional data for 149 patients undergoing same-admission staged and 1557 patients undergoing staged BTKA diagnosed with bilateral knee idiopathic osteoarthritis from 1998 to 2011. Although patients in both groups presented with bilateral knee disease, same-admission staged patients had more medical comorbidities and did not qualify for same-day BTKA. Specifically, patients with coronary artery disease with inducible ischemia, congestive heart failure, advanced chronic obstructive pulmonary disease, uncontrolled diabetes, peripheral vascular disease, renal failure, morbid obesity, history of venous thromboembolism, or those who were older than 75 years were not considered eligible for same-day BTKA. Patient demographics and Deyo comorbidity index were tabulated. The groups were similar in age, but same-admission staged patients were more likely to be male and had a higher overall comorbidity burden. The complications were categorized into systemic (medical) and local (orthopaedic). Furthermore, the systemic complications were subcategorized into major (required complex surgical or medical intervention or were deemed life-threatening) and minor (necessitated additional observation or required medical treatment), depending on their severity. Regression models were conducted to examine the association between surgery type and development of complications.Results There was no difference in 30-day mortality between the groups (0% versus 0.06%; p = 0.754). There was no difference in the local complication rates (0.7% versus 0.8%; p = 1.000). However, multivariable regression analysis adjusting for age, sex, and Deyo comorbidity index showed that same-admission staged patients were Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. 123Clin Orthop Relat Res (2015) 4...

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Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perioperative Morbidity and Mortality of Same-admission Staged Bilateral TKA

Poultsides

Memtsoudis

Hương

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…According to an analysis by the authors' group, use of BTKA more than doubled between 1990 and 2004, with the steepest increase towards the end of the observation period [47]. Even though there is wide agreement among perioperative physicians and orthopedic surgeons that increased complexity and invasiveness of BTKA, compared to UTKA, behooves special selection of appropriate candidates and stringent exclusion criteria [48,49], data allowing for creation of such guidelines is scarce to this day. Our group contributed to the ongoing discussion by performing a number of CER studies pertaining to the subject.…”

Section: Anesthesia Typementioning

confidence: 99%

Outcomes Research in Perioperative Medicine

Stundner

Memtsoudis

2014

Advances in Anesthesiology

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Outcomes research is emerging as an invaluable approach to the scientific evaluation of healthcare in a real-world rather than an experimental environment. There is much interest in the differential evaluation of existing interventions with regard to different patient populations. Moreover, various comorbid conditions necessitate analysis for the specific additional risk those factors convey in the perioperative arena, a task often difficult to accomplish without population-based techniques. The authors' group has conducted significant work in perioperative outcomes research utilizing CER and database analysis methodology, with focus on orthopedic surgery and anesthesiology. Our research resulted in numerous publications affecting policy and patient care over the last number of years. Knowledge on immediate perioperative outcomes of anesthesia and surgery is of very high interest not only to clinicians but also to administrators and policymakers, as it allows for risk assessment and allocation of resources. This review is not intended to be a systematic review but rather to (1) provide a brief overview over the theoretical basis of CER and populationbased database research, (2) give an overview of our work with various points of focus, and (3) offer a perspective on the future development in perioperative medicine.

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“…Surgical intervention in patients requiring BTKA can be done as a simultaneous bilateral procedure or in a staged bilateral fashion. Some have claimed that staged BTKA is associated with double pathophysiologic insults that increase the risks of mortality and morbidity (6)(7)(8)(9)(10)(11). However, whether simultaneous BTKA or two-staged unilateral TKA carry higher risks, remains controversial, and a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Staged Bilateral and Simultaneous Bilateral Total Knee Arthroplasty in Deep Vein Thrombosis Occurrence

Sarzaeem¹,

Omrani²,

Abousaidi³

et al. 2017

Trauma Mon

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Background: The present study aimed at determining the incidence of deep venous thrombosis (DVT) in 2 groups of patients who underwent simultaneous bilateral total knee arthroplasty (BTKA) or staged bilateral TKA. Methods: Patients with bilateral knee osteoarthritis, who were candidates for BTKA, were divided into 2 groups of patients undergoing either simultaneous bilateral or staged TKA. Incidence of DVT was measured during a 38-month follow-up period and compared between the 2 groups.

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Consensus Statement from the Consensus Conference on Bilateral Total Knee Arthroplasty Group

Abstract: Experts perceived that same-day BTKAs increase medical risk, and thus a systematic approach to the management of patients should be taken to minimize complications.

Cited by 92 publications

References 37 publications

Perioperative Morbidity and Mortality of Same-admission Staged Bilateral TKA

Perioperative Morbidity and Mortality of Same-admission Staged Bilateral TKA

Outcomes Research in Perioperative Medicine

Comparison of Staged Bilateral and Simultaneous Bilateral Total Knee Arthroplasty in Deep Vein Thrombosis Occurrence

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