Simultaneous, same-anaesthetic bilateral total knee arthroplasty has low mortality and complication rates

Wong, Eugene; Nguyen, Chu Luan; Park, Sean S.; Parker, David

doi:10.1007/s00167-018-4908-4

Cited by 15 publications

(11 citation statements)

References 50 publications

(49 reference statements)

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“…An age threshold of 75 years was chosen. The Literature found an increased surgical risk and anaesthetic risk for patients age older than 75 years [21][22][23]. Other thresholds including 80 years [24] or 85 years [25] were studied, but the benefit may be limited by a patient's life expectancy.…”

Section: Discussionmentioning

confidence: 99%

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

Wan

Fan

Hung

et al. 2021

Knee Surg & Relat Res

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Background Many patients experience bilateral knee osteoarthritis and require bilateral total knee replacement (TKR). Same-stage, bilateral TKR is proposed to be a cost-effective and safe solution compared to two-stage, but conflicting results in the literature are reported. We aim to compare the costs, safety, and rehabilitation performance of patients in same-stage versus two-stage, bilateral TKR with our centre’s perioperative protocol. Materials and methods We retrospectively reviewed 175 patients (95 same-stage, 80 two-stage) who had undergone bilateral TKR in our centre. Patient selection for same-stage, bilateral TKR was strictly protocol-driven and required fulfilment of all criteria, including age < 75 years, American Society of Anesthesiologists (ASA) grade 1 or 2, body mass index (BMI) < 40, and having non-complex arthritis. All patients followed a standardised pre-operative, intra-operative, and post-operative Enhanced Recovery After Surgery (ERAS) protocol. The cost, safety profiles, and rehabilitation outcomes were compared between the same-stage and two-stage groups. Results The same-stage, bilateral TKR reduced the length of hospital stays by 5.71 days per patient, decreased the operation time by 27.4 min, saved 3.34 (18.6%) physiotherapy sessions, and 3.78 (51.5%) occupational therapy sessions. The same-stage group experienced a higher haemoglobin drop but no significant difference in transfusion percentage, transfusion volume, complication rate, and readmission rate. The two-stage subgroup with anaesthetic risk, age, and BMI similar to the same-stage group showed the same results. Same-stage, bilateral TKR patients experienced no significant difference in final post-operative pain levels and rehabilitation outcomes as two-stage TKR patients. Conclusion This study showed that same-stage, bilateral TKR can reduce costs, with similar safety profiles and rehabilitation outcomes compared to the two-stage, bilateral TKR.

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Section: Discussionmentioning

confidence: 99%

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

Wan

Fan

Hung

et al. 2021

Knee Surg & Relat Res

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“…Third, many elements of perioperative care program changed and influenced the group dissimilarly with no certainty about surveillance. 49,50 Lastly, the individual contributions of less tourniquet use and TXA were not investigated and further comparative study may be done in the management of SBTKA. Nevertheless, the nonrandomized design in our subgroup study provided complete control of perioperative variables for a valid estimate of management outcomes using a similar surgical technique within a consecutive series.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Bilateral Total Knee Arthroplasty Becomes Safer after Institution of Optimal Perioperative Management: A Longitudinal Cohort Study

Chen

Wong

et al. 2020

J Knee Surg

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Simultaneous bilateral total knee arthroplasty (SBTKA) increases the rates of procedure-related complications and mortality compared with unilateral TKA. There are no well-defined guidelines for selecting patients to avoid mortality and proposing an upgrade treatment to decrease complication rates. This study aimed to evaluate whether optimal perioperative management could improve the safety of SBTKA. From 2005 to 2017, 1,166 cases of SBTKA were identified from 14,209 TKA procedures. We retrospectively examined the SBTKA patients' demographics, comorbidity profiles, procedure-related complications, and perioperative management during two time periods. Optimal perioperative workup for managing SBTKA significantly decreased the incidences of major complication from 6.2 to 2.4% (p = 0.001) and minor complications from 28.9 to 21.5% (p = 0.004) during period I and period II, respectively. The efficiency of less tourniquet use along with intraarticular tranexamic acid injection was demonstrated by the decreases of hemoglobin (Hb) change in the first 2 days after surgery (p = 0.005) and blood transfusion requirement (p = 0.035) during the SBTKA. Furthermore, the less tourniquet use group had less thigh pain (visual analog scale decreased from 6.0 to 4.2, p = 0.003), shorter duration of hospital stay (decreased from 7.8 to 7.1, p < 0.001), and lower coagulation time (decrease from 3.5 to 2.9, p < 0.001) than the routine tourniquet use group. Patient's screening must be performed carefully for cardiopulmonary compromise in patients aged >80 years and with an American Society of Anesthesiologists score of 3. Additionally, hospitalists should consider developing methods for the eligibility, testing, and perioperative monitoring of patients who undergo SBTKA with the aim of avoiding complications and improving outcomes.

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“…[3] Moreover, unilateral deformity correction for patients with severe deformities creates asymmetric lower limb alignment that can significantly affect rehabilitation. [4] Thus, simultaneous bilateral TKA (SBTKA) and staged bilateral TKA (StBTKA) without discharge have increased in popularity due to shorter overall recovery time and decreased total cost compared with unilateral TKA and StBTKA with discharge. [5] However, SBTKA and StBTKA without discharge are associated with potential issues such as increased perioperative complications, including pulmonary embolism, deep vein thrombosis, and stroke.…”

Section: Introductionmentioning

confidence: 99%

“…[8] Although the risk of stroke after TKA has been investigated in numerous studies, only small sample sizes were used, which can lead to reduced statistical power. [4,9] In addition, the incidence and risk factors of stroke in patients treated with unilateral TKA compared with subjects with bilateral TKA have been investigated in only a few large-scale studies.…”

Section: Introductionmentioning

confidence: 99%

Risk of stroke after unilateral or bilateral TKA in 327,438 matched patients using data from the National Health Insurance Claims

Han¹,

Yoon²,

Lee³

et al. 2020

Preprint

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Background: Limited data is available regarding the incidence rate and risk factors for stroke associated with unilateral total knee arthroplasty (TKA) and bilateral TKA. This study aims to investigate the incidence rate and risk factors of stroke in patients treated with bilateral TKA compared with patients with unilateral TKA.Methods: In this retrospective nationwide cohort study, we compared patients undergoing unilateral TKA or bilateral TKA using data from the Korean National Health Insurance claims database between January 1, 2009 and August 31, 2017 and included patients older than 40 years of age who underwent primary TKA by the index date as documented primary diagnosis and first additional diagnosis without a history of stroke during the preceding 1 year. We used matched Cox regression models to compare the incidence rate and risk factors of newly acquired stroke among patients treated with unilateral TKA or bilateral TKA after propensity score (PS) matching.Results: In the present study, 163,719 patients who received unilateral TKA were matched to163,719 patients with bilateral TKA based on PS. The risk of stroke during the study period was lower in patients treated with bilateral TKA than in patients with unilateral TKA (adjusted hazard ratio [HR] 0.79). Patients who received bilateral TKA were at decreased risk of stroke when the following variables were present: advanced age (70-79 years, HR 0.76), female sex (HR 0.75), rural area (HR 0.77), small- or medium-sized hospital (HR 0.75), health insurance (HR 0.77), history of hypertension drug use (HR 0.75), congestive heart failure (HR 0.70), connective tissue disease (HR 0.71), diabetes (HR 0.77), and diabetes with complication (HR 0.76).Conclusions: The risk of stroke was lower in patients treated with bilateral TKA than in patients with unilateral TKA. Patients treated with bilateral TKA were at decreased risk of stroke when the following variables were present: age (70-79 years), female sex, health insurance, history of hypertension drug use, and comorbidities, such as congestive heart failure, connective tissue disease, and diabetes. More importantly, we do state that those with simultaneous bilateral TKA and staged bilateral TKA without discharge could have been healthier. Therefore, those who underwent 2 unilateral TKAs could have been at more risk of stroke, especially in the 2nd unilateral TKA.

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Simultaneous, same-anaesthetic bilateral total knee arthroplasty has low mortality and complication rates

Abstract: IV.

Cited by 15 publications

References 50 publications

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

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

Simultaneous Bilateral Total Knee Arthroplasty Becomes Safer after Institution of Optimal Perioperative Management: A Longitudinal Cohort Study

Risk of stroke after unilateral or bilateral TKA in 327,438 matched patients using data from the National Health Insurance Claims

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