Staggered Rather Than Staged or Simultaneous Surgical Strategy May Reduce the Risk of Acute Kidney Injury in Patients Undergoing Bilateral TKA

Koh, Won Uk; Kim, Ha-Jung; Park, Hee Sun; Jang, Min-Jeong; Ro, Young Jin; Song, Jae-Kwan

doi:10.2106/jbjs.18.00032

Cited by 17 publications

(16 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Minor complications rates were comparable to other studies 3,12,13,30 with complication rates being higher after bilateral procedures. 3,12,17 Significantly more minor complications were seen in an elderly BTKA, becoming the main contribution to overall complication rate. Hypotension, urinary tract infection, disorientation, and constipation were all markedly higher in the elderly BTKA group than in any of the other groups.…”

Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 84%

“…Patients requiring this procedure on both knees can be offered TKA in a staged manner of two separate surgeries or under a single anesthetic, either by one surgical team or by two surgical teams simultaneously. 3,4 There is an ongoing debate over which option is best, 5-7 with factors such as safety, efficacy, recovery time, and cost, all being potential considerations. 8 Recent review article confirms that a public misconception about TKA in the elderly is not supported by the literature, even for bilateral procedures.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

et al. 2020

View full text Add to dashboard Cite

Despite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 84%

mentioning

confidence: 99%

See 1 more Smart Citation

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…On the other hand, the difficulty in perioperative replacement therapy for severe patients may also lead to the higher risk of complications 10 . Staged or simultaneous bilateral TKAs always attract debates 9,19,20 . However, there were no significant differences in complication rates between unilateral or simultaneous bilateral TKA in HA patients.…”

Section: Discussionmentioning

confidence: 99%

Complications of total knee arthroplasty in patients with haemophilia compared with osteoarthritis and rheumatoid arthritis: A 20‐year single‐surgeon cohort

Zeng

Feng

et al. 2020

Haemophilia

View full text Add to dashboard Cite

Haemophilia, including type A and B, is a rare recessive X-linked hereditary disease which is characterized by a deficiency of coagulation factor VIII or IX, respectively. 1,2 The lack of such coagulation factors severely impair the normal process of coagulation by decreasing and delaying the generation of thrombin and finally lead to episodes of bleeding, which result in various severe consequences. 1 One of the most common and frequent manifestations of haemophilia is repetitive intra-articular bleeding, which induces chronic

show abstract

“…Staggered bilateral TKA refers to two procedures performed 4–7 days apart during a single hospitalization [7]. Patients indicated for staggered bilateral TKA sequentially receive a second operation, which may cause further blood loss without sufficient Hb recovery time after the first TKA [8].…”

Section: Introductionmentioning

confidence: 99%

Short‐term high‐dose intravenous iron reduced peri‐operative transfusion after staggered bilateral total knee arthroplasty: A retrospective cohort study

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background and Objectives Staggered bilateral total knee arthroplasty, two procedures performed 4–7 days apart during a single hospitalization, has an increased risk of blood transfusion. This observational study aimed to evaluate whether immediate post‐operative single, high‐dose intravenous iron supplementation could reduce transfusion requirements and facilitate anaemia recovery in patients. Materials and Methods We retrospectively analysed 131 patients who underwent staggered bilateral total knee arthroplasty. The ferric carboxymaltose (FCM) group received 1000 mg of FCM after the first operation. The non‐FCM group did not receive intravenous iron. The transfusion rate and post‐operative complications were compared between the groups. The anaemia rate was evaluated pre‐operatively, during hospitalization, and 5 weeks after the second total knee arthroplasty. Results The FCM group comprised 78 patients (59.5%). The rate (21.8% vs. 47.2%, p = 0.004) and amount of transfusion (0 [0–2] vs. 0 [0–0], p = 0.001) was significantly lower in the FCM group than in the non‐FCM group. Although both groups' pre‐operative haemoglobin concentrations were not significantly different, the FCM group demonstrated higher haemoglobin values 5 weeks post surgery (12.25 ± 0.83 mg/dl vs. 11.48 ± 1.36 mg/dl, p < 0.001). More non‐FCM patients developed moderate to severe anaemia at 5 weeks post surgery (p < 0.001). The mortality and complication rates were not significantly different. Conclusions Immediate post‐operative, high‐dose, intravenous iron treatment may contribute to reduced transfusion rates, facilitate haemoglobin recovery after staggered bilateral total knee arthroplasty, and minimize the development of moderate to severe anaemia.

show abstract

Staggered Rather Than Staged or Simultaneous Surgical Strategy May Reduce the Risk of Acute Kidney Injury in Patients Undergoing Bilateral TKA

Cited by 17 publications

References 38 publications

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

Complications of total knee arthroplasty in patients with haemophilia compared with osteoarthritis and rheumatoid arthritis: A 20‐year single‐surgeon cohort

Short‐term high‐dose intravenous iron reduced peri‐operative transfusion after staggered bilateral total knee arthroplasty: A retrospective cohort study

Contact Info

Product

Resources

About