Same-day Bilateral Total Knee Arthroplasty Did Not Increase 90-day Hospital Returns

Abstract

Purpose: Bilateral total knee arthroplasty (TKA) can be performed in patients with bilateral knee arthritis. Outside of nationwide database studies, which have limitations, few studies have compared outcomes for same-day versus staged TKA. We sought to compare patient outcomes at a single tertiary referral center. Methods: The institutional database was queried from March 2014 to December 2017 for primary TKA. Patients undergoing bilateral procedures were stratified by same-day versus staged; length of stay (LOS), disposition, 90-day emergency department (ED) visits, and 90-day readmissions were examined through univariable and multivariable analyses. Results: A total of 676 patients were evaluated (113 same-day and 563 staged bilateral TKA patients) with mean age 66.0 (8.5) at first surgery and 292.1 (241.6) days between staged procedures. Same-day bilateral TKA patients were younger ( p < 0.001), had lower body mass index (BMI) ( p = 0.010), and had lower American Society of Anesthesiologists (ASA) scores ( p = 0.030). They were more likely to have a prolonged LOS ( p < 0.001) and be discharged to skilled nursing facility or rehab facility ( p < 0.001). Total LOS for separate hospitalizations in staged procedures was greater than LOS for same-day bilateral TKAs ( p < 0.001). There was no difference in 90-day ED visits ( p = 0.623) or readmission ( p = 0.286). In a multivariable model controlling for age, BMI, and ASA score, same-day bilateral TKA was not significantly associated with ED visits or readmissions. Conclusions: Patients undergoing same-day bilateral TKAs were more likely to be discharged to post-acute care facilities, however they did not have increased 90-day readmissions.

Simultaneous Bilateral Total Knee Arthroplasty in Elderly: Are There Factors that Can Influence Safety and Clinical Outcome?

“…Hernandez et al found no correlation between the BMI, age, and the ASA score and hospital returns at 90 days after SiBTKA [ 16 ]. In addition, according to Takagawa S and coll., the ASA score and the BMI did not interfere with postoperative rehabilitation protocols in patients undergoing SiBTKA [ 17 ].…”

Clinical outcomes of simultaneous bilateral total knee arthroplasty.

“… 3 However, simBTKA could be associated with higher blood transfusion rates, mortality, and pulmonary embolism, but lower frequency of infection and revision of the procedure compared to staged bilateral total knee arthroplasty. 7 …”

“…3 However, simBTKA could be associated with higher blood transfusion rates, mortality, and pulmonary embolism, but lower frequency of infection and revision of the procedure compared to staged bilateral total knee arthroplasty. 7 Studies on simBTKA in Saudi Arabia are scarce. We evaluated the outcomes in 469 patients who had simBTKA in a single tertiary referral center.…”

Staged Bilateral Total Knee Arthroplasty for Neglected Blount Disease Using a Gap Balancing Technique

“…Other considerations for this case are the options for staged vs simultaneous bilateral TKAs and the possibility for outpatient TKA in severe Blount disease. Although some studies have shown higher risk of medical complications, thrombotic events, and need for blood transfusions with simultaneous bilateral TKA [ [26] , [27] , [28] ], other studies have shown that simultaneous bilateral TKA has an acceptable risk, especially in appropriately selected patients [ 29 , 30 ]. For this case, we performed staged TKAs; however, it should be noted that due to the severity of the patient’s deformity, the patient had an approximately 20-mm LLD after the first TKA, which made rehabilitation and ambulation difficult; however, this may have possibly avoided the medical complications associated with simultaneous TKA.…”