Staged versus simultaneous bilateral total knee replacement

Brotherton, Stephen L.; Roberson, James R.; Andrade, J.R.; Fleming, Lamar L.

doi:10.1016/s0883-5403(86)80011-0

Cited by 90 publications

(51 citation statements)

References 3 publications

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“…The conclusion was that simultaneous bilateral TKR reduces LOS compared with staged bilateral TKR. 15,16 Nevertheless, patients who had simultaneous bilateral TKR had a longer LOS than patients who had a unilateral TKR only. Bullock et al reviewed 255 patients with simultaneous bilateral TKRs and 514 patients with unilateral TKRs.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome of staged bilateral knee replacements

Gabr

Withers

Pope

et al. 2011

annals

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INTRODUCTION The aim of this study was to compare the functional outcome between the first and second knee replacement in patients undergoing staged bilateral total knee arthroplasty. METHODS We identified 64 patients who had bilateral knee replacements and had at least one year of postoperative outcome studies. Data on pain scores, walking ability, use of walking aids, range of movement, instability, muscle strength, WOMAC ® (Western Ontario and McMaster Universities) scores, SF-12 (Short Form 12) scores, American Knee Society radiological scores and length of hospital stay (LOS) were recorded. The difference in data between the first and second knee was assessed. RESULTS Groups remained statistically comparable between the first and second operation. Four outcomes showed a significant difference between the second and first knee. The mean score for postoperative walking ability was 4.83 (second knee) vs 4.51 (first knee) (p=0.03). The mean score for postoperative walking aid requirement was 5.73 (second knee) vs 5.46 (first knee) (p=0.01). The mean postoperative SF-12 score was 54.26 (second knee) vs 52.45 (first knee) (p=0.04). The mean LOS was 4.73 days (second knee) vs 6.16 days (first knee) (p=0.05). All other data comparisons were statistically insignificant. CONCLUSIONS Patients have a reduced LOS and continue to improve after the second procedure with regards to walking ability, use of walking aids and psychological wellbeing.

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Section: Discussionmentioning

confidence: 99%

Functional outcome of staged bilateral knee replacements

Gabr

Withers

Pope

et al. 2011

annals

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“…anesthetic and admission, a diminished combined length of hospital stay, cost [9,45,49,61], use of narcotics, and a faster overall recovery than bilateral, staged TKA [5,11,17,57]. However, the use of simultaneous BTKA remains the subject of intense debate [55,60,76].…”

Section: Introductionmentioning

confidence: 99%

In-hospital Complications and Mortality of Unilateral, Bilateral, and Revision TKA: Based on an estimate of 4,159,661 Discharges

Memtsoudis

Valle

Besculides

et al. 2008

Clinical Orthopaedics &Amp; Related Research

175

136

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Patients undergoing bilateral total knee arthroplasty (BTKA) may have higher complication rates and mortality than those undergoing a unilateral procedure (UTKA). To evaluate this hypothesis, we analyzed nationally representative data collected for the National Hospital Discharge Survey on discharges after BTKA, UTKA, and revision TKA (RTKA) between 1990 and 2004. The demographics, comorbidities, in-hospital stay, complications, and mortality of each procedure were compared. An estimate of 4,159,661 discharges (153,259 BTKAs; 3,672,247 UTKAs; 334,155 RTKAs) were included. Patients undergoing BTKA were younger (1.5 years) and had a lower prevalence of comorbidities for hypertension (versus UTKA), diabetes, pulmonary disease, and coronary artery disease (versus UTKA and RTKA). The length of hospitalization was 5.8 days for BTKA, 5.3 for UTKA, and 5.4 for RTKA. Despite similar length of hospitalization, the prevalence of procedure-related complications was higher for BTKA (12.2%) compared with UTKA (8.2%) and RTKA (8.7%). In-hospital mortality was highest for patients undergoing BTKA (BTKA, 0.5%; UTKA, 0.3%; RTKA, 0.3%). Patients undergoing BTKA had a 1.6 times higher rate of procedure-related complications and mortality compared with those undergoing UTKA. Outcomes for patients undergoing RTKA for most variables were similar to those for UTKA. BTKA, advanced age, and male gender were independent risk factors for complications and mortality after TKA. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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“…There appear to be some differences in the complication rates reported, with some studies finding a decrease in morbidity [17,23], some similar [1,8,18,20] and some a higher morbidity rate [7,13]. Studies have shown financial savings ranging between 18% and 50% when performing bilateral rather than two unilateral replacements [4,19]. This study was carried out to determine the relative risk of postoperative complications of bilateral same anaesthetic knee arthroplasty using single joint replacements as the control within a single dedicated orthopaedic unit in the United Kingdom.…”

Section: Introductionmentioning

confidence: 99%

The relative safety of one-stage bilateral total knee arthroplasty

Luscombe

Theivendran

Abudu

et al. 2007

International Orthopaedics (SICO

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Patients with osteoarthritis of the knee often require bilateral knee replacement before fulfilling their full ambulatory potential. Despite extensive research there is considerable debate about the risks of performing simultaneous bilateral knee replacements under the same anaesthetic. Our aim was to compare the relative short-term morbidity of one-stage bilateral with unilateral total knee arthroplasty in a retrospective, consecutive cohort of patients. Seventy-two bilateral knee replacements were case-matched for age and gender with 144 unilateral knees. One-stage bilateral arthroplasty was associated with increased morbidity with respect to wound (6.0 vs 0.7%; p=0.003) and deep prosthetic (3.5% vs 0.7 %; p=0.02) infections, cardiac complications (3.5% vs 0.7%; p=0.04) and chest infections (7.0% vs 1.4%; p=0.04). No differences were observed in the mortality rates (p=0.30) and risk of thrombo-embolism (p=0.70). We conclude that one-stage bilateral total knee arthroplasty is associated with increased morbidity compared with unilateral knee replacement.Résumé Les patients ayant présenté une ostéoarthrite du genou nécessitent parfois une prothèse du genou bilatérale. Des travaux font état des risques survenant lors de la réalisation d'une prothèse totale unilatérale du genou, risques anesthésiques notamment. Le but de notre étude est de comparer la morbidité à cours terme du remplacement du genou par prothèse unilatérale en un temps d'un côté ou des deux côtés, ceci à propos de l'étude rétrospective d'une cohorte de patients. 72 prothèses totales du genou bilatérales en un temps ont été analysées en terme d'âge, de sexe en comparaison avec 144 prothèses du genou unilatérales. La prothèse totale du genou bilatérale en un temps est associée une augmentation de la morbidité (6.0 vs 0.7% ; p=0.003) et à un taux d'infection profonde important (3.5% vs 0.7% ; p=0.02), de même, en ce qui concerne les complications cardiaques (3.5% vs 0.7% ; p=0.04), les complications pulmonaires (7.0% vs 1.4% ; p=0.04). Nous n'avons pas observé de différence sur le plan de la mortalité (p=0.30) de même en ce qui concerne les risques thromboemboliques (p=0.70). Nous pouvons donc conclure que la prothèse totale du genou bilatérale en un seul temps entraîne une augmentation importante de la morbidité si on l'a compare à la prothèse totale du genou, unilatérale.

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Staged versus simultaneous bilateral total knee replacement

Cited by 90 publications

References 3 publications

Functional outcome of staged bilateral knee replacements

Functional outcome of staged bilateral knee replacements

In-hospital Complications and Mortality of Unilateral, Bilateral, and Revision TKA: Based on an estimate of 4,159,661 Discharges

The relative safety of one-stage bilateral total knee arthroplasty

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