Simultaneous Versus Staged Bilateral Total Knee Arthroplasty

Hussain, Nasir; Chien, Teresa; Hussain, Farrah; Bookwala, Ammar; Simunovic, Nicole; Shetty, Vijay; Bhandari, Mohit

doi:10.1007/s11420-012-9315-7

Cited by 55 publications

(25 citation statements)

References 32 publications

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“…They concluded that the simultaneous bilateral TKA is both more cost-effective and safe than staged bilateral TKA [12]. The safety of simultaneous bilateral TKA has been noted in some other studies [13][14][15].…”

Section: Discussionmentioning

confidence: 90%

Simultaneous bilateral total knee arthroplasty in patients with haemophilia: a safe and cost‐effective procedure?

et al. 2015

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Section: Discussionmentioning

confidence: 90%

Simultaneous bilateral total knee arthroplasty in patients with haemophilia: a safe and cost‐effective procedure?

et al. 2015

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“… 2013 , Hussain et al. 2013 ) all concluded that BSTKA carries a higher risk of postoperative mortality. Conclusions on postoperative complications are less sure, as meta-analyses by both Hussein et al.…”

Section: Discussionmentioning

confidence: 99%

Morbidity and mortality after bilateral simultaneous total knee arthroplasty in a fast-track setting

et al. 2016

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Background and purposeThe safety aspects of bilateral simultaneous total knee arthroplasty (BSTKA) are still debated. In this retrospective single-center study, we investigated early morbidity and mortality following BSTKA in a modern fast-track setting. We also identified risk factors for re-admission within 90 days and for a length of stay (LOS) of more than 5 days.Patients and methods284 patients were selected to receive BSTKA at our institution from 2008 through 2014 in a well-described, standardized fast-track setup (Husted 2012a, b). All re-admissions within 90 days were identified and mortality rates and time until death were recorded. Transfusion rates and numbers of transfusions were also recorded. Logistic regression analysis was used to identify risk factors for re-admission within 90 days, and also for a LOS of more than 5 days.Results90-day mortality was 0%. 10% of the patients were re-admitted within 90 days. Median time to re-admission was 18 (3–75) days. 153 patients (54%) received postoperative blood transfusions. An ASA score of 3 was identified as an independent risk factor for re-admission within 90 days (OR = 5, 95% CI: 1.3–19) and for LOS of > 5 days (OR = 6, 95% CI: 1.6–21). Higher BMI was a weak risk factor for re-admission within 90 days.InterpretationBSTKA in selected patients without cardiopulmonary disease in a fast-track setting appears to be safe with respect to early postoperative morbidity and mortality. Surgeons should be aware that patients with an ASA score of 3 have an increased risk of re-admission and a prolonged length of stay, while patients with higher BMI have an increased risk of re-admission following BSTKA.

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“… 2013 , Hussain et al. 2013 ), and 2 not finding an increased risk of pulmonary embolism (Hu et al. 2011 , Hussain et al.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of unilateral and bilateral total knee arthroplasty in 238,373 patients

et al. 2016

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Background and purpose — There is no consensus about the outcome of simultaneous vs. staged bilateral total knee arthroplasty (TKA). We examined this issue by analyzing 238,373 patients.Patients and methods — Demographic, clinical, and outcome data were evaluated for TKA patients (unilateral: 206,771; simultaneous bilateral: 6,349; staged bilateral: 25,253) from the Canadian Hospital Morbidity Database for fiscal years 2006–2007 to 2012–2013. Outcomes were adjusted for age, sex, comorbidities, and hospital TKA volume.Results — Simultaneous bilateral TKA patients were younger than staged bilateral TKA patients (median 64 years vs. 66 years), were more likely to be male (41% vs. 39%), and had a lower frequency of having ≥1 comorbid condition (2.9% vs. 4.2%). They also had a higher frequency of blood transfusions (41% vs. 19%), a shorter median length of stay (6 days vs. 8 days), a higher frequency of transfer to a rehabilitation facility (46% vs. 9%), and a lower frequency of knee infection (0.5% vs. 0.9%) than staged bilateral TKA patients, but they had higher rate of cardiac complications within 90 days (2.0% vs. 1.7%). Simultaneous patients had higher in-hospital mortality compared to the second TKA in staged patients (0.16% vs. 0.06%), but they had similar rates of in-hospital mortality compared to unilateral patients (0.16% vs. 0.14%). The cumulative 3-year revision rate was highest in the unilateral group (2.3%), but it was similar in the staged and simultaneous bilateral groups (1.4%).Interpretation — We found important differences between the outcomes of simultaneous and staged bilateral TKA. Further clarification of outcomes would be best determined in an adequately powered randomized trial, which would remove the selection bias inherent in this retrospective study design.

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Simultaneous Versus Staged Bilateral Total Knee Arthroplasty

Abstract: The results of the analysis suggest that simultaneous bilateral total knee arthroplasty has a significantly higher rate of mortality at 30 days, 3 months and 1 year after surgery, but similar infection and complication rates in comparison to staged bilateral total knee arthroplasty.

Cited by 55 publications

References 32 publications

Simultaneous bilateral total knee arthroplasty in patients with haemophilia: a safe and cost‐effective procedure?

Simultaneous bilateral total knee arthroplasty in patients with haemophilia: a safe and cost‐effective procedure?

Morbidity and mortality after bilateral simultaneous total knee arthroplasty in a fast-track setting

Outcomes of unilateral and bilateral total knee arthroplasty in 238,373 patients

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