Identifying an Ideal Time Frame for Staged Bilateral Total Knee Arthroplasty to Maximize Functional Outcome

Yeh, Jared Ze Yang; Chen, Jerry; Lee, Wu Chean; Chong, Hwei Chi; Pang, Hee Nee; Tay, Darren Keng Jin; Chia, Shi‐Lu; Lo, Ngai Nung; Yeo, Seng Jin

doi:10.1055/s-0036-1597273

Cited by 12 publications

(12 citation statements)

References 23 publications

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“…Another study of 306 patients with one to 12 months between procedures found no association between surgical interval and any outcomes (complications, 90-day readmission, and OKS at two years postoperatively). 37 This study is not without limitations. Because the first TKA is assumed to be undertaken on the worst knee, the first and second TKAs are not directly comparable although our within-subject design accounts for other potential confounders.…”

Section: Discussionmentioning

confidence: 89%

First knee for pain and function versus second knee for quality of life

Lewin,

Cashman,

Harries

et al. 2024

Bone Jt Open

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AimsThe aim of this study was to describe and compare joint-specific and generic health-related quality of life outcomes of the first versus second knee in patients undergoing staged bilateral total knee arthroplasty (BTKA) for osteoarthritis.MethodsThis retrospective cohort study used Australian national arthroplasty registry data from January 2013 to January 2021 to identify participants who underwent elective staged BTKA with six to 24 months between procedures. The primary outcome was Oxford Knee Score (OKS) at six months postoperatively for the first TKA compared to the second TKA, adjusted for age and sex. Secondary outcomes compared six-month EuroQol five-dimension five-level (EQ-5D-5L) domain scores, EQ-5D index scores, and the EQ visual analogue scale (EQ-VAS) between knees at six months postoperatively.ResultsThe cohort included 635 participants (1,270 primary procedures). Preoperative scores were worse in the first knee compared to the second for all instruments; however, comparing the first knee at six months postoperatively with the second knee at six months postoperatively, the mean between-knee difference was minimal for OKS (-0.8 points; 95% confidence interval (CI) -1.4 to -0.2), EQ-VAS (3.3; 95% CI 1.9 to 4.7), and EQ-5D index (0.09 points; 95% CI 0.07 to 0.12). Outcomes for the EQ-5D-5L domains ‘mobility’, ‘usual activities’, and ‘pain/discomfort’ were better following the second TKA.ConclusionAt six months postoperatively, there were no clinically meaningful differences between the first and second TKA in either the joint-specific or overall generic health-related quality of life outcomes. However, individual domain scores assessing mobility, pain, and usual activities were notably higher after the second TKA, likely reflecting the cumulative improvement in quality of life after both knees have been replaced.Cite this article: Bone Jt Open 2024;5(3):202–209.

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Section: Discussionmentioning

confidence: 89%

First knee for pain and function versus second knee for quality of life

Lewin,

Cashman,

Harries

et al. 2024

Bone Jt Open

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“…Yeh et al . revealed no significant differences in complication rates and knee functional outcomes evaluated by the Oxford Knee Score and Short‐Form‐36 among intervals of 31–90, 91–180, 181–270, and 271–365 days 21 . Chen et al .…”

Section: Discussionmentioning

confidence: 96%

“…revealed no significant differences in complication rates and knee functional outcomes evaluated by the Oxford Knee Score and Short‐Form‐36 among intervals of 31–90, 91–180, 181–270, and 271–365 days. 21 Chen et al . found no difference between staged groups (21–90, 91–180, 181–270, and 271–360 days after the first TKA).…”

Section: Discussionmentioning

confidence: 99%

The Optimal Period of Staged Bilateral Total Knee Arthroplasty Procedures under Enhanced Recovery: A Retrospective Study

Sun

et al. 2023

Orthopaedic Surgery

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Objective The implications of the interval of staged bilateral total knee arthroplasty (TKA) procedures for postoperative complications and costs are not clear. We aimed to determine the optimal time interval between the two stages of bilateral TKA procedures under the enhanced recovery after surgery (ERAS) protocol. Methods This retrospective study of collected data included bilateral TKA cases under the ERAS protocol performed between 2018 and 2021 at the West China Hospital of Sichuan University. The staged time was subdivided into three groups according to the interval between the first TKA and second contralateral TKA: group 1: 2‐ to 6‐month, group 2: 6‐ to 12‐month, and group 3: >12 months. The primary outcome was the incidence of postoperative complications. The secondary outcomes were the length of hospital stay (LOS), hemoglobin (Hb) decrease, hematocrit (Hct) decrease, and albumin (Alb) decrease. Results We analyzed 281 patients who underwent staged bilateral TKAs between 2018 and 2021 at the West China Hospital of Sichuan University. Regarding postoperative complications, there were no statistically significant differences among the three groups ( P = 0.21). For the mean LOS, the 6‐ to 12‐month group had a significantly shorter LOS compared with the 2‐ to 6‐month group ( P < 0.01). There was also a significant decrease in Hct of the 2‐ to 6‐month group compared with the 6‐ to 12‐month group and the >12 months group ( P = 0.02; P < 0.05, respectively). Conclusion Staging the second arthroplasty for more than a half year seems to offer a reduction in the rate of postoperative complications and LOS under ERAS protocol. ERAS shortens the interval of staged bilateral TKA by at least 6 months for patients who might receive their second surgery without the need to wait for an extended period.

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“…Although the optimal timing for staged BTKA remains inconclusive, there is some agreement that an interval of at least 3 months between the first and second TKA is necessary for minimizing postoperative complications and facilitating the recovery process 38,91,100,101 . Another common timing interval is 6 weeks between operations.…”

Section: Other Considerationsmentioning

confidence: 99%

Bilateral Total Knee Arthroplasty

et al. 2023

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Bilateral total knee arthroplasty (BTKA) is an effective surgical treatment for bilateral knee arthritis and can be performed as a simultaneous surgery under a single anesthetic setting or as staged surgeries on separate days.Appropriate patient selection is important for simultaneous BTKA with several factors coming into consideration such as age, comorbidities, work status, and home support, among others.While simultaneous BTKA is safe when performed on appropriately selected patients, current evidence suggests that the risk of complications after simultaneous BTKA remains higher than for staged BTKA.When staged surgery is preferred, current evidence indicates that complication risks are minimized if the 2 knees are staged at least 3 months apart.Simultaneous BTKA is the economically advantageous treatment option relative to staged BTKA, primarily because of shorter total operative time and total hospital stay.

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Identifying an Ideal Time Frame for Staged Bilateral Total Knee Arthroplasty to Maximize Functional Outcome

Cited by 12 publications

References 23 publications

First knee for pain and function versus second knee for quality of life

First knee for pain and function versus second knee for quality of life

The Optimal Period of Staged Bilateral Total Knee Arthroplasty Procedures under Enhanced Recovery: A Retrospective Study

Bilateral Total Knee Arthroplasty

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