• Bilateral
• Mortality
• Revision
• Same day
• Simultaneous
• Total knee arthroplasty
• Unicondylar knee arthroplasty

• Humans
• Arthroplasty, Replacement, Knee/mortality
• Arthroplasty, Replacement, Knee/methods
• Arthroplasty, Replacement, Knee/adverse effects
• Registries
• Female
• Male
• Reoperation/mortality
• Reoperation/statistics & numerical data
• Germany/epidemiology
• Aged
• Middle Aged
• Osteoarthritis, Knee/surgery
• Osteoarthritis, Knee/mortality
• Time Factors
• Aged, 80 and over
• Treatment Outcome

• Universitätsklinikum Carl Gustav Carus Dresden an der Technischen Universität Dresden (8944)

• Arthroplasty
• Bilateral knee replacement
• Complications
• Cost
• Knee surgery
• Total knee arthroplasty

• BTKA
• bilateral total knee arthroplasty
• posteroperative outcomes
• staged arthroplasty
• surgical timing

• Bilateral simultaneous
• Complications
• Propensity score matching
• Total knee arthroplasty

• Humans
• Arthroplasty, Replacement, Knee/adverse effects
• Arthroplasty, Replacement, Knee/methods
• Male
• Female
• Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Japan/epidemiology
• Propensity Score
• Middle Aged
• Case-Control Studies
• Retrospective Studies
• Osteoarthritis, Knee/surgery
• Length of Stay
• Operative Time
• Aged, 80 and over
• East Asian People

• Patient satisfaction
• Propensity score matching
• Total hip arthroplasty
• Total knee arthroplasty
• WOMAC score

• Humans
• Arthroplasty, Replacement, Knee/statistics & numerical data
• Arthroplasty, Replacement, Hip
• Patient Reported Outcome Measures
• Male
• Female
• Aged
• Middle Aged
• Body Mass Index
• Osteoarthritis, Knee/surgery
• Patient Satisfaction
• Age Factors
• Osteoarthritis, Hip/surgery
• Propensity Score

• bilateral
• contribution margin
• cost
• simultaneous
• staged
• total hip arthroplasty

• Humans
• Arthroplasty, Replacement, Hip/economics
• Female
• Male
• Middle Aged
• Aged
• Length of Stay/economics
• Length of Stay/statistics & numerical data
• Retrospective Studies
• Treatment Outcome
• Cohort Studies
• Cost-Benefit Analysis

• Bilateral total knee arthroplasty
• Complication
• Readmission
• Reoperation
• Simultaneous
• Staged

• Humans
• Arthroplasty, Replacement, Knee/methods
• Female
• Male
• Retrospective Studies
• Aged
• Middle Aged
• Patient Readmission/statistics & numerical data
• Reoperation/statistics & numerical data
• Age Factors
• Comorbidity
• Postoperative Complications/epidemiology
• Aged, 80 and over
• Risk Assessment/methods

• Enhanced recovery after surgery
• Functional discharge criteria
• Functional milestones
• Simultaneous bilateral TKA
• TKA

• Humans
• Arthroplasty, Replacement, Knee/rehabilitation
• Arthroplasty, Replacement, Knee/methods
• Female
• Male
• Retrospective Studies
• Aged
• Patient Discharge
• Length of Stay/statistics & numerical data
• Middle Aged
• Enhanced Recovery After Surgery
• Recovery of Function
• Propensity Score
• Aged, 80 and over

• Humans
• Analgesics, Opioid/therapeutic use
• Arthroplasty, Replacement, Knee/methods
• Retrospective Studies
• Pain, Postoperative/drug therapy
• Postoperative Period
• Practice Patterns, Physicians'
• Endrin/analogs & derivatives

• TKA
• bilateral
• mortality
• robotics
• technology

• bilateral
• infection
• knee replacement
• simultaneous
• surgical site infection
• total knee arthroplasty

• Humans
• Arthroplasty, Replacement, Knee/adverse effects
• Retrospective Studies
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Patient Readmission
• Comorbidity
• Length of Stay

• bilateral timing
• knee replacement
• medical complications
• revision
• total knee arthroplasty

• Meta-analysis
• Patellar resurfacing
• Randomized controlled trials
• Total knee arthroplasty

Background: “Windswept” deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgical challenges that this condition might pose. Methods: A systematic review of the literature following the PRISMA guidelines was conducted. The relevant studies between 1979 and 2021 were identified. Four studies with a total of 68 patients were included for analysis. The mean follow-up for varus knees was 3.3 years, 3.1 years for valgus knees. The quality and rigor of the included studies was assessed using the Methodological index for non-randomized studies (MINORS). Results: All the studies reported improvement in knee function following knee replacement surgery, and a reduction in axial deviation of both knees, with similar results in valgus and varus knees in terms of patient satisfaction. The most relevant data were that unicompartmental knee arthroplasty (UKA) allowed for limited axial correction with slightly inferior functional results. Kinematic alignment (KA) allowed for similar results in both knees. Conclusion: The present review shows how satisfactory results can be achieved in both knees in patients with WSD and osteoarthrosis (OA). However, the operating surgeon should be aware of the importance of the implant choice in terms of functional outcomes. In the absence of extra-articular deformities, calipered KA total knee arthroplasty (TKA) can be performed on both knees with good axial correction and functional outcome. Level of evidence: II —Systematic review of cohort studies.

• Total knee arthroplasty
• balance
• fall risk
• knee function
• quality of life

• complications
• patient-reported outcomes
• safety
• simultaneous bilateral total knee arthroplasty
• staged bilateral total knee arthroplasty

• ERAS
• orthopedic surgery
• perioperative
• postoperative elements
• preoperative

• Complication rate
• Fast-track arthroplasty
• Same-day discharge arthroplasty

• Arthroplasty
• Bilateral simultaneous
• Complications
• Knee
• Risk factor

• Arthroplasty, Replacement, Knee/adverse effects
• Arthroplasty, Replacement, Knee/methods
• Comorbidity
• Humans
• Osteoarthritis, Knee/complications
• Patient Selection
• Postoperative Complications/etiology
• Retrospective Studies

• Bilateral total knee arthroplasty (TKA)
• Complications
• Cost
• National
• Outcomes
• Readmission

• Implant longevity
• Primary
• Simultaneous bilateral
• Staged bilateral
• Total knee arthroplasty

• Bilateral one-stage total knee arthroplasty
• Blood loss
• Cardiovascular events
• High-sensitivity Troponin-T
• Postoperative pain
• Unilateral total knee arthroplasty

• Different time interval
• Sequential bilateral
• Simultaneous bilateral
• Total knee arthroplasty

Purpose: In recent years, there has been increasing interest in the use of simultaneous hip and knee arthroplasty compared to staged procedures in patients with bilateral pathology. The aim of this study was to compare simultaneous and staged hip and knee arthroplasty in patients with bilateral pathology by assessing the transfusion rate, postoperative hemoglobin drop, length of stay (LOS), in-hospital complications, 30-day readmissions and early functional outcome. Methods: We conducted a retrospective cohort study that included all patients who were undergoing primary TKA, THA and UKA by a single surgeon in a high-volume arthroplasty center between 2015 and 2020 as simultaneous or staged procedures. Staged bilateral arthroplasties were performed within 12 months and were stratified by the time between procedures. Data were acquired through the electronic files at the Orthopädische Chirurgie München (OCM). For functional outcome, the ability of the patients to walk independently on the ward was compared with the ability to walk a set of stairs alone, which was recorded daily by the attending physiotherapist. Results: In total n = 305 patients were assessed for eligibility and included in this study. One hundred and forty-five patients were allocated to the staged arthroplasty group. This group was subdivided into a hip and a knee group, whereas the knee group was split into TKA and UKA. The second staged procedure was performed within 12 months of the first procedure. One hundred and sixty patients were allocated to the simultaneous arthroplasty group. This group was also subdivided into a hip and knee group, whereas the knee group was split again into a TKA and UKA group. No statistical difference was found between the two groups regarding demographic data. Primary outcome measurements: There was no significant difference in the transfusion rate or complication rate. Secondarily, no statistically significant difference was found between the postoperative hemoglobin drop and the functional outcome, or in the length of stay (LOS) between both groups. Walking the stairs showed a significant difference in the knee group. Conclusions: There were no significant differences observed in the transfusion rate in-hospital complications, or readmission rate between both groups. The early functional outcome showed no significant difference in mobility for all groups. Simultaneous arthroplasty for knee or hip is as safe as a staged procedure, with no higher risk for the patient, in a specialized high-volume center. Level of evidence: Level IV.

• complications
• joint replacement
• results
• specialized center

• Bilateral total knee arthroplasty
• Primary total knee arthroplasty
• Simultaneous bilateral total knee arthroplasty

Rehabilitation is an effective procedure for promoting functional recovery after simultaneous bilateral total knee arthroplasty (TKA); however, it has been cited as a significant economic burden of medical care. We hypothesized that preoperative factors, including age, sex, body mass index, living alone, the knee society function score (KSS), the American society of anesthesiologists (ASA) class, hemoglobin (Hb), albumin level, mean range of motion, and the Kellgren–Lawrence grade, would predict prolonged rehabilitation utilization.

In total, 191 patients undergoing simultaneous bilateral TKA in a single hospital were enrolled. The successful compliance group included patients who completed their rehabilitation program and could return to their residence within 3 weeks after surgery (n = 132), whereas the delayed group included the remaining patients (n = 59). Logistic regression analysis was performed using preoperative factors. A prediction scoring system was created using the regression coefficients from the logistic regression model.

Logistic regression analysis revealed that age (β = − 0.0870; P <  0.01) and Hb (β = 0.34; P <  0.05) were significantly associated with prolonged rehabilitation programs, whereas body mass index, living alone, KSS score, and ASA class were not significantly associated with successful completion of rehabilitation programs; however, these factors contributed to the prediction scoring formula, which was defined as follows: \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\displaystyle \begin{array}{l}\mathrm{Score}=10-\left(0.09\times \mathrm{age}\right)-\left(0.09\times \mathrm{body}\ \mathrm{mass}\ \mathrm{index}\right)-\left(0.56\times \mathrm{living}\ \mathrm{alone}\ \right[\mathrm{alone}:1,\\ {}\mathrm{others}:0\left]\right)+\left(0.03\times \mathrm{KSS}\ \mathrm{stairs}\right)+\left(0.34\times \mathrm{Hb}\right)-\left(1.1\times \mathrm{ASA}\ \mathrm{class}\right).\end{array}} $$\end{document}Score=10-0.09×age-0.09×body mass index-(0.56×living alone[alone:1,others:0])+0.03×KSSstairs+0.34×Hb-1.1×ASAclass.

The C-statistic for the scoring system was 0.748 (95% confidence interval, 0.672–0.824). The positive and negative likelihood ratios were 2.228 (95% CI, 1.256–3.950) and 0.386 (95% CI, 0.263–0.566), respectively. These results showed an increase of 15–20% and a decrease of 20–25% in the risk of prolonged rehabilitation. The optimal cutoff point for balancing sensitivity and specificity was 3.5, with 66.6% sensitivity and 78.0% specificity.

Older age and lower preoperative Hb were significantly associated with prolonged rehabilitation programs. We defined a new scoring formula using preoperative patient factors to predict prolonged rehabilitation utilization in patients undergoing simultaneous bilateral TKA.

• Delayed discharge
• Hemoglobin
• Length of hospital stay
• Rehabilitation
• Total knee arthroplasty

Up to one in five patients undergoing primary total hip (THA) and knee arthroplasty (TKA) require contralateral surgery. This is frequently performed as a staged procedure. This study aimed to determine if outcomes, as determined by the Oxford Hip Score (OHS) and Knee Score (OKS) differed following second-side surgery.

Over a five-year period all patients who underwent staged bilateral primary THA or TKA utilizing the same type of implants were studied. Eligible patients had both preoperative and one year Oxford scores and had their second procedure completed within a mean (2 SDs) of the primary surgery. Patient demographics, radiographs, and OHS and OKS were analyzed.

A total of 236 patients met the inclusion criteria, of which 122 were THAs and 114 TKAs. The mean age was 66.5 years (SD 9.4), with a 2:1 female:male ratio. THAs showed similar significant improvements in outcomes following first- and second-side surgery, regardless of sex. In contrast for TKAs, although male patients demonstrated the same pattern as the THAs, female TKAs displayed significantly less improvement in both OKS and its pain component following second-side surgery.

Female patients undergoing second-side TKA showed less improvement in Oxford and pain scores compared to the first-side. This difference in outcome following second-side surgery did not apply to male patients undergoing TKA, or to either sex undergoing THA.

Cite this article: Bone Jt Open 2021;2(4):243–254.

• arthroplasty
• hip
• knee
• outcomes
• second side
• staged bilateral

Fast-track surgery is a multimodal evidence-based approach to perioperative care aimed at reducing complications and recovery time. We compared a fast-track protocol to standard care in the setting of a small Italian general hospital. Propensity score estimation before and after the study was performed to compare pre-fast-track (pre-FT; January 2013–March 2014) and fast-track (FT; January 2016–December 2016) patients undergoing elective hip and knee replacement surgery with a three-year follow-up (up to January 2020). The primary endpoints were the mean hemoglobin drop, mean predischarge hemoglobin, transfusion and reinfusion rates, pain, ambulation day, hospital length of stay (LOS), and discharge to home/outpatient care or rehabilitation hospital center. The secondary endpoints were the adherence measures to the FT protocol, namely, tourniquet and surgical times, use of drains and catheters, type of anesthesia administered, and complications within three years. The risk difference (RD) and the adjusted odds ratio (aOR) were calculated for each outcome. After the propensity score estimation, we analyzed 59 patients in the pre-FT and 122 in the FT categories. The FT patients, with respect to the pre-FT patients, ameliorated their mean hemoglobin drop from 3.7 to 3.1 g/dl (p < 0.01) and improved their predischarge mean hemoglobin (10.5 g/dL versus 11.0 g/dL; p = 0.01). Furthermore, the aOR of being transfused was reduced by 81% (p < 0,01); the RD of being reinfused was reduced by 63% (p < 0.01); the aOR of having low pain on the first day was increased by more than six times (p < 0.01); the RD of ambulating the first day increased by 91% (p < 0.01); the aOR of admission to a rehabilitation hospital center was reduced by 98% (p < 0.01); the aOR of home discharge increased by 42 times (p < 0.01); the median LOS, tourniquet and surgical times, and use of catheters and drains significantly decreased. Patients with complications at 1 month were 43.1% and 38.2%, respectively, of pre-FT and FT patients (p = 0.63). Complications at 6, 12, 24, and 36 months were significantly lower for the FT patients. This study showed that the uptake of enhanced recovery practices was successful and resulted in the improvement of clinical and organizational outcomes. The fast-track concept and related programs may optimize perioperative care and streamline surgical and rehabilitation care paths.

• enhanced recovery after surgery
• fast-track
• hip arthroplasty
• knee arthroplasty
• orthopedic care pathway
• propensity score

• Outcomes
• Same-day bilateral total knee arthroplasty
• Simultaneous bilateral total knee arthroplasty
• Trends

• bilateral
• opioid dispension
• total knee arthroplasty
• unilateral

• Aged
• Analgesics, Opioid
• Arthroplasty, Replacement, Knee
• Female
• Hospitals
• Humans
• Postoperative Complications
• Retrospective Studies

The niche surgery of same-day bilateral total knee arthroplasty (sd-BTKA) continues to create debate amongst specialists in arthroplasty. To date, there is a significant lack of literature on obese patients undergoing sd-BTKA, and no study has evaluated outcomes of this procedure when compared to non-obese patients. Therefore, this study will perform a retrospective analysis to compare (I) incidence, (II) demographics, and (III) complications of sd-BTKA in non-obese, obese, and morbidly obese patients in the United States from 2009 to 2016.

The National Inpatient Sample (NIS) database was queried for all individuals that underwent sd-BTKA from 2009 to 2016. This returned 184,844 non-obese patients, 39,901 obese patients, and 20,394 morbidly obese patients. Analyzed variables included mean age, mean length of stay (LOS), race, payer, age-adjusted Charlson Comorbidity Index score, discharge disposition, hospital charges, hospital costs, and complications. Chi-square analyses and analyses of variance were utilized to assess categorical and continuous variables, respectively.

Non-obese patients most commonly underwent sd-BTKA over the course of the study. As weight status increased, mean age decreased and the proportion of females, LOS, hospital charges and costs, and proportion of discharges to skilled nursing facilities increased. Regression analysis demonstrated obese and morbidly obese cohorts were at an overall increased odds for experiencing complications. Specifically, obese patients were at increased risk for pulmonary emboli, periprosthetic joint infections, and respiratory failures, while morbidly obese patients are at increased risk for pulmonary emboli, respiratory failures, and urinary tract infections.

Surgeons should thoroughly evaluate the risks and benefits of performing sd-BTKA on obese and morbidly obese patients, as both confer higher overall complication rates and increased length of stay. More research is necessary to characterize the cost analysis of this procedure, as health care models continue to transition to more cost-effective procedures.

• Morbid obesity
• obesity
• same-day bilateral total knee arthroplasty (sd-BTKA)
• simultaneous

• Acetaminophen
• Analgesic drug
• Hip replacement
• Knee replacement
• NSAID
• Opioid
• Risk factors

• Age Factors
• Aged
• Analgesics/therapeutic use
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Knee/adverse effects
• Chronic Pain/drug therapy
• Chronic Pain/epidemiology
• Chronic Pain/etiology
• Female
• Humans
• Male
• Middle Aged
• Obesity/complications
• Osteoarthritis/surgery
• Risk Factors

• Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital