Cost, safety, and rehabilitation of same-stage, bilateral total knee replacements compared to two-stage total knee replacements

Wan, Raymond C. W.; Fan, Jason Chi Ho; Hung, Yuk Wah; Kwok, Ka-Bon; Lo, Carmen K. M.; Chung, Kwong-Yin

doi:10.1186/s43019-021-00098-z

Cited by 9 publications

(4 citation statements)

References 26 publications

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“…Since many factors influence the surgery outcomes, including patient expectations [9,20,23,24], the patient's mental condition before surgery [23,25,26], as well as the presence of other comorbidities [19,23,27], is also important to record these attributes when evaluating the results. The impact of one-time bilateral knee replacement on functional outcomes in groups, which we did not analyse in our study is questionable [28][29][30][31][32]. Krivanek et al [33] reported that there were no statistically significant differences in functional outcomes in the short-term follow-up between single bilateral and unilateral total knee replacement, although range of movement may be higher in the bilateral group.…”

Section: Discussionmentioning

confidence: 66%

Comparison of short-time functional outcomes after TKA between Multigen Plus CR and Physica KR prostheses

et al. 2021

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Background Aim of this study was to compare functional results within 36 months following primary total knee arthroplasty (TKA) using a conventional prosthesis Multigen Plus CR and a new Physica KR implant. Our hypothesis was that the use of the Kinematics-Retaining design of an TKA implant leads to a significantly greater improvement in the active range of motion and better functional results (KSS 1, KSS 2 and WOMAC score) than the conventional CR implant at short-term follow-up. Materials and methods We retrospectively analysed data of 234 patients who underwent primary TKA at our hospital from April 2010 to August 2015 with the CR type of implant and from July 2014 to August 2015 with the KR implant due to advanced knee arthrosis of IIIrd and IVth grade of Kellgren-Lawrence classification, with no major ligamentous instability. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Knee Society Scores 1 (KSS 1) and 2 (KSS 2) and flexion (AROM) were recorded preoperatively and at 6, 12 and 36 months after surgery. Results Our study showed a statistically significant difference in functional results at three years with better KSS 1 score, a tendency to higher values in the KSS 2 score, as well as a statistically significant overall improvement in AROM in favour of the new KR design over the conventional CR implant with a post-hoc power analysis of 83.8%. We found that there was no statistically significant difference between groups when comparing WOMAC score and complications at short-term follow-up. Conclusions Our study provided more favourable clinical results for using Kinematics-Retaining implant in primary TKA. Further studies should focus on radiological and functional outcomes from mid- to long-term follow-up.

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Section: Discussionmentioning

confidence: 66%

Comparison of short-time functional outcomes after TKA between Multigen Plus CR and Physica KR prostheses

et al. 2021

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“…Simultaneous bilateral arthroplasty of the knee and hip has been documented as a good alternative to staged procedures, 20 , 21 , 22 with benefits including shorter total recovery time, single anesthetic, and significantly reduced overall hospital stay and costs. 20 , 21 , 22 , 23 , 24 Compared to simultaneous bilateral TAR, simultaneous TAR and contralateral AA has the advantages of shorter operation time and low cost. However, this balance also relies on the local reimbursement policy by Medicare.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who underwent bilateral AA were noted to have great difficulty with inclines, stairs, and walking on uneven terrain. Simultaneous bilateral arthroplasty of the knee and hip has been documented as a good alternative to staged procedures, 20–22 with benefits including shorter total recovery time, single anesthetic, and significantly reduced overall hospital stay and costs 20–24 . Compared to simultaneous bilateral TAR, simultaneous TAR and contralateral AA has the advantages of shorter operation time and low cost.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Total Ankle Replacement and Contralateral Ankle Arthrodesis for Bilateral Ankle Osteoarthritis: A Retrospective Study Focused on Clinical Outcomes and Cost‐effectiveness

Chen

et al. 2022

Orthopaedic Surgery

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Objective Total ankle replacement (TAR) and ankle arthrodesis (AA) are two common surgical treatment options for end‐stage ankle osteoarthritis. However, few reports compare the outcomes of simultaneous TAR and contralateral AA for bilateral ankle osteoarthritis. The aim of this study was to assess changes in pain, joint range of movement (ROM), functional outcomes, patient satisfaction, and cost‐effectiveness following simultaneous TAR and contralateral AA. Methods A retrospective study was conducted on 12 patients with bilateral end‐stage ankle osteoarthritis who underwent simultaneous TAR and contralateral AA in our institution between May 2016 and August 2018, and who had a minimum of two‐year follow‐up data. Clinical and radiological follow‐up data for all patients were collected after 4 months, 1 year and 2 years. The results were assessed clinically on a visual analogue scale (VAS) and included ROM, American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score, and satisfaction questionnaire. The total hospital costs of patients were also recorded. Independent sample t tests were conducted to compare continuous variables between groups. Paired sample t ‐tests were conducted to compare changes from the preoperative to postoperative evaluations within each group. Results Both surgical groups presented with pain reduction ( P < 0.001) at the one‐year postoperative session, which was generally consistent until the two‐year follow‐up. There was a significant increase ( P < 0.001) in the mean AOFAS score postoperatively in both ankles. The functional outcomes at the one‐ and two‐year follow‐up were significantly better in patients in the TAR group than in those in the AA group ( P < 0.001). Joint ROM differences were observed between the two groups after surgery (decreased ankle ROM in arthrodesis, P < 0.001; increased ankle ROM in arthroplasty, P < 0.001). The mean satisfaction score was 2 (range, 1–4) for the TAR group and 3 (range, 1–5) for the AA group. A significant difference in the satisfaction score was observed between the two groups ( P = 0.036). Simultaneous TAR and contralateral AA was 34.1% less expensive than simultaneous bilateral TAR. No intraoperative complications were noted in either group. Wound healing occurred without problems within 2 weeks after surgery. No symptomatic deep venous thrombosis was found during follow‐up. Conclusion TAR had better patient‐perceived post‐operative function and preserves more anatomic sagittal plane motion compared to ankles undergoing AA. In addition, simultaneous TAR and contralateral AA are more cost‐effective than simultaneous bilateral TAR, with lower costs for the average patient.

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“…Degenerative arthritis of the knee is characterized by pain and deterioration of knee function in middle-aged and elderly patients, thereby affecting the quality of life. [1,2] With the aging population, the incidence of degenerative arthritis has been increasing, as well as its treatment cost. [3] Various treatment methods are available.…”

Section: Introductionmentioning

confidence: 99%

Integrative medicine in patients with degenerative arthritis of the knee: A pilot randomized control study

2022

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Background: We aimed to comparatively analyze the effect of integrative medicine treatments (lifestyle change education, use of anti-inflammatory drugs, acupuncture, manual therapy-type massage) and conventional medical treatments (lifestyle change education and use of anti-inflammatory drugs) on pain control, knee function improvement, and quality of life improvement in patients with degenerative knee arthritis. Methods: In this study, 30 patients were randomly divided into the control group (n = 15) and the experimental group (n = 15). Both groups were prescribed anti-inflammatory drugs and lifestyle change education for 12 weeks. The experimental group underwent acupuncture including electroacupuncture, moxibustion, and manual therapy-type massage 12 times during the first 6 weeks. Evaluations were performed at 3 visits: visit 1 (before treatment), visit 2 (6 weeks after initial treatment), and visit 3 (12 weeks after initial treatment). The effect of each treatment was measured using Visual Analog Scale (VAS, 0–10), Western Ontario and McMaster Universities index (WOMAC), and SF-36. Results: From visit 1 to visit 2, the mean value of VAS decreased by 0.72 and 3.17 in the control and experimental groups, respectively. From visit 2 to visit 3, the mean VAS value decreased by 0.25 in the control group but increased by 0.87 in the experimental group. Among the sub-area of SF-36, the physical role restriction area and mental health area showed significant differences between the 2 groups over time (P = .024, P = .006). Conclusion: Integrative medicine treatment has superior effects in pain control over conventional medical treatment. In integrative medicine treatment, pain control tends to decrease with time, but still superior over conventional medical treatment up to 6 weeks after treatment (12 weeks after initial treatment).

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Cost, safety, and rehabilitation of same-stage, bilateral total knee replacements compared to two-stage total knee replacements

Cited by 9 publications

References 26 publications

Comparison of short-time functional outcomes after TKA between Multigen Plus CR and Physica KR prostheses

Comparison of short-time functional outcomes after TKA between Multigen Plus CR and Physica KR prostheses

Simultaneous Total Ankle Replacement and Contralateral Ankle Arthrodesis for Bilateral Ankle Osteoarthritis: A Retrospective Study Focused on Clinical Outcomes and Cost‐effectiveness

Integrative medicine in patients with degenerative arthritis of the knee: A pilot randomized control study

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