Simultaneous Bilateral Total Knee Arthroplasties

Lombardi, Adolph V.; Mallory, Thomas H.; Fada, Robert A.; Hartman, Jodi F.; Capps, Susan G.; Kefauver, Cheryl; Dodds, Kathleen L.; Adams, Joanne B.

doi:10.1097/00003086-200111000-00042

Cited by 103 publications

(82 citation statements)

References 23 publications

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“…In a study of 22,540 patients, the 2679 patients who had simultaneous bilateral TKAs had a higher 30-day mortality than those having a unilateral procedure with mortality rates of 0.17% and 0.49%, respectively [16]. Several other studies that included fewer patients have had divergent results [2,4,9,11,13,19,21].…”

Section: Discussionmentioning

confidence: 99%

Higher Early Mortality with Simultaneous Rather than Staged Bilateral TKAs: Results From the Swedish Knee Arthroplasty Register

Stefánsdóttir¹,

Lidgren²,

Robertsson³

2008

Clinical Orthopaedics &Amp; Related Research

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Patients with knee osteoarthritis (OA) often present with symptoms that warrant bilateral TKAs. There are potential benefits to operating on both knees on the same day, but the safety of simultaneous bilateral TKAs has been questioned. To evaluate whether there were any differences in 30-day mortality between patients having simultaneous bilateral TKAs and those having staged bilateral TKAs, we analyzed data from the Swedish Knee Arthroplasty Register and the Swedish Cause of Death Register. We included 48,931 patients with OA having 60,062 primary TKAs during 1985 to 2004; 1139 had surgery on both knees on the same day (simultaneous bilateral) and 3432 had surgery on both knees on two different occasions with less than 1 year between operations (staged bilateral). The 30-day mortality after simultaneous bilateral TKAs was 7.53 (confidence interval, 2.62-21.69) times higher than after the second of staged TKA and 3.77 (confidence interval, 2.04-6.98) times higher than after a primary unilateral TKA. Assuming the total risk for a staged procedure is twice that of a unilateral procedure, the risk of mortality within 30 days is 1.94 (confidence interval, 1.05-3.59) times higher with simultaneous than staged TKA. It is safer to operate on one knee at a time.

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Section: Discussionmentioning

confidence: 99%

Higher Early Mortality with Simultaneous Rather than Staged Bilateral TKAs: Results From the Swedish Knee Arthroplasty Register

Stefánsdóttir¹,

Lidgren²,

Robertsson³

2008

Clinical Orthopaedics &Amp; Related Research

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“…Advocates of simultaneous TKA have cited benefits of a single anesthetic, shorter cumulative hospital stays, patient convenience and satisfaction, and increased cost effectiveness for the healthcare system without increasing perioperative morbidity and mortality and without compromising the clinical outcomes of the operation [8, 9, 11, 12, 17, 18, 24, 27-30, 32, 35]. Opponents of the simultaneous approach cite increased perioperative complications, including pulmonary embolism, major cardiac events, ileus, higher transfusion rates, confusion, and death [1,4,12,15,21,23,27,33,35]. Concern also exists regarding the financial disincentive to the surgeon for performing bilateral simultaneous arthroplasty procedures [2,6,28].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Complications of Simultaneous versus Staged Unicompartmental Knee Arthroplasty

Berend¹,

Morris²,

Skeels³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…surgery have been reported, including infection, 9,10 pulmonary embolism, 11,12 thromboses, 11,[13][14][15] fat embolism, 16 hemarthrosis, 17 patellar fracture, 18 heterotopic ossification, 19,20 stiffness, 21,22 nerve damage, 11,23 vascular injuries, 11,14,24,25 and urinary complications. 11,12 The perioperative mortality rate has been reported at 0.17%-0.46% for primary total knee arthroplasty within 90 days [26][27][28] and 0.33%-0.78% for bilateral knee replacements within 30 days.…”

mentioning

confidence: 99%

“…11,12 The perioperative mortality rate has been reported at 0.17%-0.46% for primary total knee arthroplasty within 90 days [26][27][28] and 0.33%-0.78% for bilateral knee replacements within 30 days. [28][29][30] Hylan G-F 20 (Synvisc) is a cross-linked hyaluronan derivative approved for the treatment of pain due to OA of the knee after other conservative approaches have failed.…”

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confidence: 99%

Total Knee Replacement Delayed With Hylan G-F 20 Use in Patients With Grade IV Osteoarthritis

Waddell¹,

Bricker²

2007

JMCP

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steoarthritis (OA) and other rheumatic conditions are the leading cause of disability in the United States. 1 The prevalence of OA of the knee in various countries can be estimated as 18% of men and women as inferred by a recent meta-analysis.2 OA can also result in significant direct and indirect costs, which are higher with greater disability. 3 Current therapeutic options for OA are approved to treat the pain associated with the disorder. The American College of Rheumatology recommends the initial use of nonpharmacologic techniques, such as patient education, weight loss, and physical therapy, followed by pharmacologic therapies such as acetaminophen and cyclooxygenase (COX)-2-specific inhibitors. 4 Intra-articular hyaluronan therapy is recommended for patients who are no longer responsive to nonpharmacologic and pharmacologic treatments or who may be experiencing adverse side effects with nonselective nonsteroidal inflammatory drugs or COX-2-specific inhibitors. 4 Total knee replacement (TKR) is considered a last resort for treatment of OA knee pain in appropriate patients when other therapies fail. According to the National Hospital Discharge Survey published by the U.S. Department of Health & Human Services, approximately 326,000 patients in the United States received a TKR in 2001. 5 In a sample of 6,856 decedents aged ≥65 years, 2.1% were found to have received knee replacements. 6 The cost of knee replacement surgery at patient discharge was reported as $24,045 for 2001. 7 The success of TKR in most patients has been supported by more than 20 years of follow-up data. 8 While TKR is an effective option for OA pain relief for many patients, it is not medically desirable for some patients (age, heart disease, diabetes, pulmonary disease, obesity, or generalized medical debilitation) or is not preferred by others. Additionally, complications of the ABSTRACT BACKGROUND: Total knee replacement (TKR), a last resort for treating knee pain due to osteoarthritis (OA), is not always medically indicated or preferred by many patients. Hylan G-F 20 is a cross-linked hyaluronan derivative approved for the treatment of pain due to OA of the knee after other conservative approaches have failed.OBJECTIVE: The objectives of this study were to (1) determine the effect of hylan G-F 20 on patient need for TKR as measured by time from hylan G-F 20 injection to TKR, and (2) assess patient factors that might influence time from hylan G-F 20 therapy to TKR.METHODS: This is a retrospective case series review of the medical records of patients seen in 1 orthopedic specialty practice. The incidence and time to TKR in patients who were TKR candidates (100% grade IV OA [severe]) treated with 1 or more courses of intra-articular hylan G-F 20 injections (3 weekly injections per course) were determined from October 1997 to November 2003. Survival analysis was used to evaluate time to TKR and the effects of age, gender, ethnicity, body mass index (BMI), and presence of effusion on this outcome. Logistic regression was also used to assess...

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Simultaneous Bilateral Total Knee Arthroplasties

Cited by 103 publications

References 23 publications

Higher Early Mortality with Simultaneous Rather than Staged Bilateral TKAs: Results From the Swedish Knee Arthroplasty Register

Higher Early Mortality with Simultaneous Rather than Staged Bilateral TKAs: Results From the Swedish Knee Arthroplasty Register

Perioperative Complications of Simultaneous versus Staged Unicompartmental Knee Arthroplasty

Total Knee Replacement Delayed With Hylan G-F 20 Use in Patients With Grade IV Osteoarthritis

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