Safety and efficacy of sequential simultaneous bilateral total knee arthroplasty: A single centre retrospective cohort study

Agarwala, Sanjay; Menon, Aditya

doi:10.1016/j.jcot.2020.05.015

Cited by 9 publications

(10 citation statements)

References 35 publications

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“…While improvement in SSBTKA patients > 70 was significantly greater than in patients ≤ 70, the difference in improvement for SSBTKA patients > 70 was not significantly different when compared to unilateral TKA patients > 70. This aligns with similar studies of elderly TKA patients which report no significant differences in postoperative function between unilateral and bilateral TKA [9,[39][40][41]. Clinical improvement in the current study for SSBTKA patients > 70 is further supported by the high level of patient satisfaction at six weeks following surgery; satisfaction scores were significantly greater than those of bilateral patients ≤ 70 and unilateral patients > 70.…”

Section: Discussionsupporting

confidence: 89%

Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty?

Ishii

Wong

Shimoda

et al. 2023

Arch Orthop Trauma Surg

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IntroductionThe safety and benefits of single stage bilateral total knee arthroplasty (SSBTKA) among older patients as compared to unilateral TKA remains controversial. This study aimed to evaluate the influence of age and comorbidities on complications and early outcomes for unilateral and BTKA in patients over and under 70 years of age. Materials and methods This prospective study compared postoperative complications and early patient-reported outcomes at 6 weeks of 142 unilateral TKA patients (N = 75, ≤ 70; N = 67, > 70) and 89 SSBTKA patients (N = 48, ≤ 70; N = 41, > 70). Patients completed the KOOS JR and PROMIS Global Mental (GMH) and Global Physical Health (GPH) surveys. Knee Society Scores for Knee (KSS-K) and Function (KSS-F) were completed in the clinic. Parametric tests were performed for comparisons of unilateral and BTKA outcomes and complications for patients over and under 70. Results While patient demographics were similar, patients > 70 had more comorbidities than patients ≤ 70 (p < 0.004). There were no significant differences in postoperative complications or readmissions between age groups or procedures. Unilateral TKA patients > 70 had significantly lower pre-(p < 0.001) and post-operative (p = 0.011) KSS-F scores compared to those ≤ 70. SSBTKA patients > 70 had significantly higher preoperative GMH (p = 0.029), postoperative KSS-K (p = 0.027), KOOS JR scores (p = 0.039) and satisfaction (p = 0.048) compared to those ≤ 70. Conclusion Age did not influence the risk of early postoperative complications. Additionally, the greater improvements in KOOS JR and higher patient satisfaction for SSBTKA patients > 70 suggests that SSBTKA may meet elderly patient expectations and should not necessarily be discouraged due to safety concerns.

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Section: Discussionsupporting

confidence: 89%

Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty?

Ishii

Wong

Shimoda

et al. 2023

Arch Orthop Trauma Surg

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“…Studies have found that after SBTKA, the infection rate and length of hospital stay of patients are reduced, but the incidence of 90-day mortality, venous thromboembolism and neurological complications is increased (4). In addition, the risk of pulmonary embolism, cerebral embolism (5), blood transfusion rate (6,7), cardiac complications, urinary retention, and deep infection are significantly increased (8). At present, the comparative studies after SBTKA and staged bilateral TKA are relatively common, and many studies have provided a comprehensive assessment of complication incidence, clinical efficacy and mortality after SBTKA (4,(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the risk of pulmonary embolism, cerebral embolism ( 5 ), blood transfusion rate ( 6 , 7 ), cardiac complications, urinary retention, and deep infection are significantly increased ( 8 ). At present, the comparative studies after SBTKA and staged bilateral TKA are relatively common, and many studies have provided a comprehensive assessment of complication incidence, clinical efficacy and mortality after SBTKA ( 4 , 8 – 10 ). Due to the lack of established indications for SBTKA, it is always controversial to determine the age of patients, and previous studies only confirmed that patients aged 75 and above are generally not recommended to undergo SBTKA ( 11 – 13 ).…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a nomogram to predict complications in patients undergoing simultaneous bilateral total knee arthroplasty: A retrospective study from two centers

Zhang

Ren

et al. 2022

Front. Surg.

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PurposeComplications were significantly increased 30 days after Simultaneous bilateral total knee arthroplasty (SBTKA). In this study, an individualized nomogram was established and validated to predict the complications within 30 days after SBTKA.MethodsThe general data of 861 patients (training set) who received SBTKA in The Affiliated Hospital of Qingdao University between January 1, 2012 and March 31, 2017 were retrospectively analyzed. All patients were divided into complication group (n = 96) and non-complication group (n = 765) according to the incidence of complications within 30 years after SBTKA. Independent risk factors for postoperative SBTKA complications were identified and screened by binary logistic regression analyses, and then a nomogram prediction model was constructed using R software. The area under curve (AUC), calibration curve, and decision curve analysis (DCA) were selected to evaluate the line-chart. Meanwhile, 396 patients receiving SBTKA in the Third Hospital of Hebei Medical University who met the inclusion and exclusion criteria (test set) were selected to verify the nomogram.ResultsFive independent predictors were identified by binary logistic regression analyses and a nomogram was established. The AUC of this nomogram curve is 0.851 (95% CI: 0.819–0.883) and 0.818 (95% CI: 0.735–0.900) in the training and testing sets, respectively. In the training set and test set, calibration curves show that nomogram prediction results are in good agreement with actual observation results, and DCA shows that nomogram prediction results have good clinical application value.ConclusionOlder age, lower preoperative hemoglobin level, higher preoperative blood urea nitrogen (BUN) level, longer operation time, ASA grade ≥ III are independent predictors of SBTKA complications within 30 days after surgery. A nomogram containing these five predictors can accurately predict the risk of complications within 30 days after SBTKA.

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“…The prosthetic design plays a role in the development of the tibia and femoral problems. It has been postulated that patellofemoral kinematics are improved by retention of the posterior cruciate ligament and that this improvement is translated into improved kinemics 76,77 . Therefore, the friction between the tibia and femoral was improved and reduced the rate of non‐patellar revision.…”

Section: Discussionmentioning

confidence: 99%

Patellar Resurfacing in Primary Total Knee Arthroplasty: A Meta‐analysis and Trial Sequential Analysis of 50 Randomized Controlled Trials

Tang

et al. 2022

Orthopaedic Surgery

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Objective During total knee arthroplasty, femur and tibia parts are regularly replaced, while resurfacing the patellar or not is an ongoing discussion. To compare revision rate, anterior knee pain rate, patient‐reported outcome measures, complication, radiographic, and clinical outcomes after patellar resurfacing versus non‐resurfacing in total knee arthroplasty. Methods PubMed, Medline, EMBASE, CENTRAL, and CINAHL databases were searched on 25 April 2021 to enroll randomized controlled trials that compared patellar resurfacing versus non‐resurfacing. We used the grading of recommendations assessment, development and evaluation (GRADE) framework to assess the certainty of evidence. Our primary outcome was revision rate and secondary outcomes was anterior knee pain rate. Outcomes were pooled using the random‐effect model and presented as risk ratio (RR), or mean difference (MD), with 95% confidence interval (CI). Results Fifty studies (5586 knees) were included. Significant reductions in patellar revision rate (RR 0.41, 95% CI [0.19, 0.88]; P = 0.02; I2 = 24.20%) and non‐patellar revision rate (RR 0.64, 95% CI [0.55, 0.75]; P < 0.001; I2 = 0%) were seen after patellar resurfacing. Patellar resurfacing significantly reduced the anterior knee pain rate than nonresurfacing (RR 0.72, 95% CI [0.57, 0.91]; P = 0.006; I2 = 69.5%). Significant differences in patient‐reported outcome measures were found. However, these differences were inconsistent and lacked clinical importance. Patellar resurfacing resulted in a significant lower rate of patellar clunk (RR 0.58, 95% CI [0.38, 0.88]; P = 0.01; I2 = 0%), a higher patellar score (MD 1.24, 95% CI [0.67, 0.81]; P < 0.001; I2 = 73.8%), but prolonged surgical time (MD 8.59, 95% CI [5.27, 11.91]; P < 0.001; I2 = 88.8%). Conclusions The clear relationship is that patellar resurfacing reduces revisions, anterior knee pain, and patellar clunk. It will be interesting to compare the initial cost with the revision cost when required and cost‐utility analysis with long‐term results in future studies.

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Safety and efficacy of sequential simultaneous bilateral total knee arthroplasty: A single centre retrospective cohort study

Cited by 9 publications

References 35 publications

Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty?

Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty?

Development and validation of a nomogram to predict complications in patients undergoing simultaneous bilateral total knee arthroplasty: A retrospective study from two centers

Patellar Resurfacing in Primary Total Knee Arthroplasty: A Meta‐analysis and Trial Sequential Analysis of 50 Randomized Controlled Trials

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