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Lee SJ, Choi JH, Kim BR, Park YG, Lee SY, Lee HJ, Jeong W. Differences in functional recovery after unilateral versus bilateral total knee arthroplasty. Knee 2025; 54:184-191. [PMID: 40073702 DOI: 10.1016/j.knee.2025.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 01/06/2025] [Accepted: 02/10/2025] [Indexed: 03/14/2025]
Abstract
BACKGROUND Understanding functional changes between unilateral and simultaneous bilateral total knee arthroplasty (TKA) patients remains limited. The purpose of this study was to investigate the differences in recovery times between unilateral and bilateral TKA. METHODS We retrospectively recruited patients who met the eligibility criteria. All patients engaged in a standard rehabilitation program and completed both self-reported questionnaires and performance-based physical function tests preoperatively, at 6 and 12 weeks postoperatively. RESULTS A total of 838 patients were included in this study. Those who underwent bilateral TKA (n = 281) were younger than those opting for unilateral TKA (n = 557), with no significant differences in baseline health status observed between the two groups. Both groups showed continuous improvements in pain, function, and performance-based physical functions from preoperatively to 12 weeks postoperatively. Notably, stiffness did not significantly improve from the preoperative to 6 weeks postoperatively and the stair-climbing test (SCT) showed delayed recovery, with deterioration at 6 weeks but subsequent improvement at 12 weeks in bilateral TKA group. Similarly, the recovery rate in the 6-min walking test (6MWT) was initially slow for the bilateral TKA group during the first 6 weeks, but later accelerated. Significant interactions between time and group were observed in the timed-up-and-go test, 6MWT, and SCT. CONCLUSION Patients who underwent bilateral TKA showed distinct recovery patterns, suggesting the need for tailored rehabilitation approaches compared those who underwent unilateral surgery. These findings underscore the need to provide patients with information about potential differences in recovery patterns based on their chosen surgical approach prior to surgery.
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Affiliation(s)
- Seung Jun Lee
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Jun Hwan Choi
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea.
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea
| | - Yong-Geun Park
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Hyun Jung Lee
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Wooseong Jeong
- Division of Rheumatology, Department of Internal Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
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Maman D, Dumov D, Nandakumar M, Litmanowicz B, Shpigelman D, Fournier L, Steinfeld Y, Yonai Y, Berkovich Y. Comparative Outcomes of Bilateral Versus Unilateral Total Knee Arthroplasty: A Big Data Analysis. Healthcare (Basel) 2025; 13:1033. [PMID: 40361811 PMCID: PMC12071963 DOI: 10.3390/healthcare13091033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2025] [Revised: 04/28/2025] [Accepted: 04/29/2025] [Indexed: 05/15/2025] Open
Abstract
Background: Bilateral total knee arthroplasty (B-TKA) is a surgical option for patients with bilateral osteoarthritis, offering potential efficiency and cost advantages but with increased perioperative risk. Methods: We conducted a retrospective analysis of 2,299,979 elective TKA cases from the Nationwide Inpatient Sample (2016-2019). Propensity score matching (PSM) was used to compare 83,980 B-TKA patients with matched unilateral TKA (U-TKA) patients. Outcomes included in-hospital mortality, complications, length of stay, and hospital charges. Results: B-TKA patients had higher rates of complications such as deep vein thrombosis (OR 1.798) and pulmonary embolism (OR 1.883), longer hospital stays (3.03 vs. 2.49 days), and higher charges (USD 83,639 vs. USD 59,215; all p < 0.001). Conclusions: Although B-TKA is associated with increased perioperative risk, it may offer logistical and economic advantages in well-selected patients. These findings support the need for risk stratification in surgical decision-making.
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Affiliation(s)
- David Maman
- Carmel Medical Center, Haifa 3436212, Israel; (L.F.); (Y.S.); (Y.Y.); (Y.B.)
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa 2611001, Israel; (D.D.); (B.L.)
| | - Daniel Dumov
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa 2611001, Israel; (D.D.); (B.L.)
| | - Maneesh Nandakumar
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia;
- Logan Hospital, Brisbane, QLD 4131, Australia
| | - Batia Litmanowicz
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa 2611001, Israel; (D.D.); (B.L.)
| | - Daniel Shpigelman
- Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Linor Fournier
- Carmel Medical Center, Haifa 3436212, Israel; (L.F.); (Y.S.); (Y.Y.); (Y.B.)
| | - Yaniv Steinfeld
- Carmel Medical Center, Haifa 3436212, Israel; (L.F.); (Y.S.); (Y.Y.); (Y.B.)
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa 2611001, Israel; (D.D.); (B.L.)
| | - Yaniv Yonai
- Carmel Medical Center, Haifa 3436212, Israel; (L.F.); (Y.S.); (Y.Y.); (Y.B.)
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa 2611001, Israel; (D.D.); (B.L.)
| | - Yaron Berkovich
- Carmel Medical Center, Haifa 3436212, Israel; (L.F.); (Y.S.); (Y.Y.); (Y.B.)
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa 2611001, Israel; (D.D.); (B.L.)
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Hirniak S, Edginton AN, Iorio A, Wong WWL. A Hemophilia Joint Health Score-Based Model for the Economic Evaluation of Hemophilia A Prophylaxis Interventions. PHARMACOECONOMICS 2025:10.1007/s40273-025-01484-1. [PMID: 40167950 DOI: 10.1007/s40273-025-01484-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND AND OBJECTIVE Hemophilia A is a costly, lifelong illness with multiple prophylaxis options. Previously, these options were assessed using a Peterson score-based model to simulate joint damage over time. This study built a model for the economic evaluation of hemophilia A with less socioeconomic selection bias utilizing the hemophilia joint health score (HJHS). METHODS A mechanistically defined HJHS-based state-transition microsimulation model was implemented for the cost-utility analysis conducted over a lifetime horizon from a Canadian provincial Ministry of Health perspective, with a 1.5% discount rate on (costs and outcomes), to compare the following interventions: standard half-life (SHL), extended half-life (EHL), emicizumab, and efanesocotog alfa (EA). The health states are HJHS levels, waiting for surgery, postoperative time, and death. Individuals experience bleeds, joint bleeds (increasing the HJHS), and surgery in each health state. Disutilities include injections and postoperative time. Model validation included face validity, internal validity, comparison analysis, external validity, and predictive validity. Probabilistic analysis, pricing threshold analysis, and one-way scenario analyses were completed. RESULTS EA showed lower levels of hospitalizations and surgeries and an improved joint damage experience in the simulation. However, EA was not cost-effective against emicizumab, which continued to be the most cost-effective intervention. Pricing threshold analysis indicated that a price decrease would be required for EA to dominate SHL (50% decrement) and emicizumab (55% decrement). CONCLUSIONS This is the first cost-effectiveness model incorporating HJHS to apply sequential joint damage to hemophilia A. While EA offers clinical benefits, our analysis suggests it will not be cost-effective from a Canadian provincial Ministry of Health perspective without a significant price decrease.
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Affiliation(s)
- Sam Hirniak
- School of Pharmacy, Faculty of Science, University of Waterloo, 10A Victoria St S, Kitchener, ON, N2G 1C5, Canada.
| | - Andrea N Edginton
- School of Pharmacy, Faculty of Science, University of Waterloo, 10A Victoria St S, Kitchener, ON, N2G 1C5, Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - William W L Wong
- School of Pharmacy, Faculty of Science, University of Waterloo, 10A Victoria St S, Kitchener, ON, N2G 1C5, Canada
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Zhang Y, Pei H, Wang C, Wang G, Shen Z, Hua J, He B. Comparison of Single Knee Arthroplasty and Bilateral Knee Arthroplasty in Haemophiliacs During a Single Operation: A Systematic Review and Meta-Analysis. Haemophilia 2025; 31:275-285. [PMID: 39868982 DOI: 10.1111/hae.15150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 12/11/2024] [Accepted: 12/16/2024] [Indexed: 01/28/2025]
Abstract
BACKGROUND Arthroplasty is the standard treatment for end-stage haemophilic knee arthritis; however, the choice between single knee arthroplasty (SKA) and bilateral knee arthroplasty (BKA) in a single operation remains controversial due to the risks specific to haemophiliacs. METHODS Two independent researchers conducted searches across CNKI, CBM, Wanfang, PubMed, Cochrane Library, Embase, and Web of Science, with the last search performed on 15 October 2024. Study results include joint function, complication and various cost. Literature quality was assessed using the Newcastle-Ottawa Scale (NOS). Outcomes were evaluated with fixed-effects or random-effects models, while heterogeneity and publication bias were also assessed. RESULTS Nine studies involving 309 haemophilia patients were included, with 166 in SKA group and 143 in BKA group. No statistically significant differences were observed between the SKA and BKA groups in range of motion (95% CI: -0.22 [-3.57, 3.13], p = 0.90), Hospital for Special Surgery score (95% CI: -2.13 [-4.89, 0.64], p = 0.13), flexion degree (95% CI: -2.38 [-7.22, 2.46], p = 0.33), cost (95% CI: -0.24 [-0.94, 0.45], p = 0.49), complication rate (95% CI: 1.31 [-0.79, 2.17], p = 0.29), hospital stay (95% CI: 0.25 [-2.06, 2.57], p = 0.83), and coagulation factor usage (p = 0.49). However, The SKA group outperformed the BKA group in terms of operative time, postoperative drainage, and transfusion volume (p < 0.001). CONCLUSIONS Our study indicates that, apart from differences in operative time, transfusion volume, and blood loss, SKA and BKA show no significant differences in postoperative joint function, complication rates, or costs.
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Affiliation(s)
- Yi Zhang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hang Pei
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chao Wang
- Department of Orthopedics, Anji County Hospital of Chinese Medicine, Zhejiang, China
| | - Guanyin Wang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zan Shen
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiang Hua
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bangjian He
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Sadagatullah AN, Sahadun M, Md-Isa MK, Yusof MF. Prevalence of Blood Transfusion and Factors Influencing Blood Loss Following Primary Total Knee Replacement Surgery. Malays Orthop J 2025; 19:49-56. [PMID: 40291962 PMCID: PMC12022704 DOI: 10.5704/moj.2503.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 10/10/2024] [Indexed: 04/30/2025] Open
Abstract
Introduction Total knee replacement (TKR) is a highly effective treatment for end-stage knee osteoarthritis and has been proven to have excellent results in relieving pain as well as improving mobility of the patient. Although becoming more increasingly performed, it is still associated with considerable perioperative blood loss requiring allogenic blood transfusion. Allogenic blood transfusion (ABT) can be lifesaving in certain clinical situations but also comes with their own risks and side effects. The reported incidence of ABT and blood loss following TKR surgery varies widely in the literature. The objectives of this study were to look at the prevalence of ABT, factors leading to transfusion as well as increase in blood loss. Material and Methods A cross-sectional retrospective study was conducted involving 296 adult patients who underwent elective primary unilateral TKR surgery from January 2015 until December 2019 at Hospital Melaka. Medical records of these patients were reviewed, and relevant data were extracted for final analysis. Incidence of ABT, demographic data, use of antiplatelet/anticoagulant, tourniquet time, types of general anaesthesia, and pre- and post-operative haemoglobin count were recorded. These factors were analysed to look at the association with ABT as well as increase in blood loss. Results Prevalence of ABT following primary unilateral TKR surgery were found to be 4.39% (95% confidence interval 2.04, 6.74). Pre-operative haemoglobin value was found to be the only significant variable associated with blood transfusion [P<0.001; Odds ratio (OR) = 0.35; 95% Confidence interval (CI) 0.22, 0.54]. Meanwhile, prolonged tourniquet time of >120 minutes was the only significant variable towards an increase in blood loss. Participants with tourniquet time >120 minutes has 2.67 times the odds to have blood loss >2 g/dL compared to participants with tourniquet time of less or equal to 120 minutes (95% CI=1.54, 4.64). Conclusion The prevalence of ABT following primary unilateral TKR was lower in our centre compared to other reported studies. Pre-operative optimisation of anaemic patients with haematinics will help surgeons reduce the need for ABT.
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Affiliation(s)
- A N Sadagatullah
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Maa Sahadun
- Department of Orthopaedics, Hospital Melaka, Melaka, Malaysia
| | - M K Md-Isa
- Department of Orthopaedics, Hospital Melaka, Melaka, Malaysia
| | - M F Yusof
- Department of Orthopaedics, Hospital Melaka, Melaka, Malaysia
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Ge L, Wang J, Fang H, Wang Y, Shen Z, Cai G. Effects of total knee arthroplasty on symptoms, function and activity over 5 years in knee osteoarthritis: A propensity-score matched study. J Exp Orthop 2025; 12:e70185. [PMID: 40123679 PMCID: PMC11928881 DOI: 10.1002/jeo2.70185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 12/06/2024] [Accepted: 12/11/2024] [Indexed: 03/25/2025] Open
Abstract
Purpose To evaluate the effects of total knee arthroplasty (TKA) on symptoms, function and activity over 5 years in knee osteoarthritis (KOA) patients. Methods Data were from the Osteoarthritis Initiative (OAI). Participants who conducted the first TKA from (not before) enrolment to 48 months were propensity score matching (PSM) on their characteristics at the visit before surgery (treated as baseline) to those who did not conduct a TKA at 48 months (treated as baseline). Changes in knee pain and functional disability were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function subscales. Changes in physical activity, physical function and overall physical health and mental health were assessed using the Physical Activity Scale for the Elderly, the 20-m walk speed and the five times chair-to-stand tests and the 12-Item Short Form Survey, respectively. Results Eighty-two pairs of participants in the TKA (56% women, mean 64.8 ± 8.4 years) and non-TKA groups were matched. Knee symptoms were significantly improved in the TKA group and flatted from 24 months (Pain: β = -3.29, 95% confidence interval [CI] = [-4.59 to -1.99], p < 0.001; Function: β = -10.12, 95% CI = [-14.21 to -6.03], p < 0.001). Physical function and overall physical health but not physical activity or mental health (PASE: β = 5.72, 95% CI = [-15.46 to 26.90], p = 0.597; Mental: β = 0.04, 95% CI = [-2.47 to 2.54], p = 0.976) was improved in the TKA group over 24 months. Conclusions TKA substantially improved knee symptoms and physical function over 60 months and physical health over 48 months, compared to those who had a similar severity of KOA but did not have a TKA, but this did not translate into increased physical activity or mental health. Level of Evidence Level III.
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Affiliation(s)
- Liru Ge
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Junjie Wang
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Haonan Fang
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Yining Wang
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Ziyuan Shen
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
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Aoun M, Chalhoub R, Nham FH, Kassis E, Daher M, El-Othmani MM. Evolution and Hotspots in Bilateral Total Joint Arthroplasty Research: A Bibliometric Analysis. Clin Orthop Surg 2024; 16:880-889. [PMID: 39618536 PMCID: PMC11604569 DOI: 10.4055/cios24114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 12/13/2024] Open
Abstract
Background Total joint arthroplasty (TJA) is a potent treatment for degenerative joint disorders. Bilateral total joint arthroplasty (BTJA) encompasses both bilateral total knee arthroplasty (BTKA) and bilateral total hip arthroplasty (BTHA). Both BTKA and BTHA can be performed as either a simultaneous procedure or a staged procedure. The goal of this study was to investigate trends in BTJA research, including pertinent authors, journals, countries, and papers. We also evaluated frequent keywords and topics to predict potential future study fields. Methods Articles published between 1982 and 2022 were retrieved from the Web of Science Core Collection of Clarivate Analytics. The search query included "hip" OR "knee" (Topic) AND "arthroplasty" OR "replacement" (Topic) AND "bilateral" OR "simultaneous" (Topic) AND 1992-2022 (Year published) AND Article (Document type). Metrics were imported for further analysis with Bibliometrix and VOSviewer. Results A total of 736 articles associated with BTJA were retrieved, originating from 44 countries with the United States being the biggest contributor. Top institutions were Cornell University and Ewha Womans University. Kim YH was the most productive and impactful author. The Journal of Arthroplasty had the highest impact and the greatest number of articles and citations. Williams Russo had the most cited article. Co-occurrence visualizations highlighted predominant topics in the literature. Conclusions Since 1982, there has been a growing interest in BTJA research. The United States institutions have been the primary providers in global scholarly production. This bibliometric analysis identified previous, present, and emergent tendencies in BTJA with the goal of forecasting new potential hotspots.
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Affiliation(s)
- Maroun Aoun
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ralph Chalhoub
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fong H Nham
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, USA
| | | | - Mohammad Daher
- Department of Orthopaedic Surgery, Brown University, Providence, RI, USA
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Tsui OWK, Chan PK, Cheung A, Chan VWK, Luk MH, Cheung MH, Lau LCM, Leung TKC, Fu H, Chiu KY. Comparison of the Cost-Effectiveness and Safety between Staged Bilateral Total Knee Arthroplasty and Simultaneous Bilateral Total Knee Arthroplasty: A Retrospective Cohort Study between 2001 and 2022. J Knee Surg 2024; 37:916-923. [PMID: 39019474 DOI: 10.1055/a-2368-4516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
A substantial proportion of Hong Kong's aging population suffers from osteoarthritis in both knees. Bilateral total knee arthroplasty (BTKA) is a surgical option for addressing this condition and can be performed via two approaches: simultaneous BTKA (SimBTKA) and staged BTKA (StaBTKA). We compared the cost-effectiveness and safety of these two methods in our institution. We retrospectively reviewed 2,372 patients (SimBTKA, 772; StaBTKA, 1,600; females, 1,780; males, 592; mean age at SimBTKA, 70.4 ± 7.99 years; mean age at StaBTKA, 66.4 ± 7.50 years; p < 0.001) who underwent BTKA in our institution from 2001 to 2022. Patients were categorized according to the surgical approach. Patients undergoing BTKA in our institution were included. Particularly for SimBTKA, patients were assessed by anesthetists to be medically fit before undergoing the procedure according to their age, American Society of Anesthesiologists status, and osteoarthritis severity. The primary outcome was the length of stay (LOS) after surgery. The secondary outcomes were the 30-day unintended readmission, intensive care unit (ICU) admission, and death. SimBTKA had a shorter mean total LOS (acute hospital + rehabilitation center; SimBTKA, 13.09 days; StaBTKA, 18.12 days; p < 0.001) and mean LOS in acute hospital (SimBTKA, 7.70 days; StaBTKA, 10.42 days; p < 0.001). However, no significant difference was found in the mean LOS in rehabilitation centers (SimBTKA, 5.47 days; StaBTKA, 6.32 days; p > 0.05) between the two approaches. The 30-day unintended readmission rate was lower in SimBTKA (SimBTKA, 2.07%; StaBTKA, 3.30%; odds ratio [OR] = 1.60; p > 0.05) but statistically insignificant. SimBTKA was less costly than StaBTKA by US$ 8,422.22 per patient. No significant differences in ICU admission and death rates were found (p > 0.05) between the two groups. SimBTKA had a shorter LOS and lower cost than StaBTKA and comparable complication rates. Therefore, SimBTKA should be indicated in medically stable patients.
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Affiliation(s)
- Omar W K Tsui
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ping-Keung Chan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Amy Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Vincent W K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Michelle H Luk
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Man-Hong Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lawrence C M Lau
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Thomas K C Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Henry Fu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kwong-Yuen Chiu
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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9
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Krimly A, Sharaf RM. Mortality Rates in Staged Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e70736. [PMID: 39493209 PMCID: PMC11531329 DOI: 10.7759/cureus.70736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2024] [Indexed: 11/05/2024] Open
Abstract
This systematic review and meta-analysis aimed to assess the mortality rates of staged bilateral total knee arthroplasty (staBTKA) procedures. This systematic review followed the suggestions and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. We performed a primary search in the PubMed, EBSCO, Scopus, Web of Science via Clarivate, and Google Scholar databases. A quantitative data synthesis was conducted to estimate the pooled prevalence of mortality among patients who underwent staBTKA using the MedCalc® Statistical Software version 20.115 (MedCalc Software Ltd., Ostend, Belgium). The Newcastle-Ottawa Scale was used for the quality assessment. The study included 29 studies with data from 115,348 patients. The mortality rate was estimated to be 0.34% (95% confidence interval: 0.18% to 0.55%). The data showed significant interstudy heterogeneity (I2 = 93.3%). We used funnel plot inspection to visually assess significant publication bias, which showed a symmetrical distribution of the plotted data. Our study found that the mortality rates following staBTKA are relatively high. However, the reliability of our findings is limited due to significant heterogeneity. We recommend that further studies be conducted to provide higher-quality evidence to assess mortality in staBTKA and its trends.
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Affiliation(s)
| | - Raed M Sharaf
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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10
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Akar B, Ugur F, Yucel MO, Aytug F. Effect of potential risk factors on renal functions in simultaneous bilateral total knee arthroplasty. Front Surg 2024; 11:1405487. [PMID: 39268493 PMCID: PMC11390695 DOI: 10.3389/fsurg.2024.1405487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/15/2024] [Indexed: 09/15/2024] Open
Abstract
Objective This retrospective study investigated the risk factors leading to a decrease in Renal glomerular filtration rate (eGFR) and the development of acute kidney injury (AKI) during the early postoperative period in patients undergoing simultaneous bilateral total knee arthroplasty (SBTKA). Methods SBTKA was performed on 862 patients between 2014 and 2021 in a single center, by a single surgeon. The risk factors affecting the development of AKI were analyzed by monitoring the changes in pre-and postoperative serum creatinine (Scr) levels and eGFR values. RIFLE criteria were used to evaluate the kidney functions of the patients, who were followed up for an average of 6 months. Results While there was no decrease in eGFR or AKI in 818 patients postoperatively, eGFR decreased and AKI of different stages developed in 44 patients, according to the RIFLE criteria. Of the 44 patients with AKI, 31 had Risk, 9 had Injury, 3 had Failure, and one had Loss of kidney function. Two patients with American Society of Anaesthesiologists (ASA) class IV died due to deepening of postoperative renal dysfunction. Conclusion We found that the direct risk factors in SBTKA in terms of eGFR decrease and AKI development include long operation time, increased need for blood transfusion, and diabetic nephropathy, while increased body mass index (BMI) is an indirect risk factor. When planning for a SBTKA, we presume that a thorough analysis of these factors will decrease AKI risk.
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Affiliation(s)
- Bedrettin Akar
- Deparmant of Orthopedics and Traumatology, Sakarya Yenikent State Hospital, Sakarya, Türkiye
| | - Fatih Ugur
- Deparmant of Orthopedics and Traumatology, Kastamonu University Faculty of Medicine, Kastamonu, Türkiye
| | - Mucahid Osman Yucel
- Deparmant of Orthopedics and Traumatology, Duzce University Faculty of Medicine, Sakarya, Türkiye
| | - Ferhan Aytug
- Deparmant of Orthopedics and Traumatology, Sakarya Yenikent State Hospital, Sakarya, Türkiye
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11
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Goree JH, Grant SA, Dickerson DM, Ilfeld BM, Eshraghi Y, Vaid S, Valimahomed AK, Shah JR, Smith GL, Finneran JJ, Shah NN, Guirguis MN, Eckmann MS, Antony AB, Ohlendorf BJ, Gupta M, Gilbert JE, Wongsarnpigoon A, Boggs JW. Randomized Placebo-Controlled Trial of 60-Day Percutaneous Peripheral Nerve Stimulation Treatment Indicates Relief of Persistent Postoperative Pain, and Improved Function After Knee Replacement. Neuromodulation 2024; 27:847-861. [PMID: 38739062 DOI: 10.1016/j.neurom.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Total knee arthroplasty (TKA) is an effective surgery for end-stage knee osteoarthritis, but chronic postoperative pain and reduced function affect up to 20% of patients who undergo such surgery. There are limited treatment options, but percutaneous peripheral nerve stimulation (PNS) is a promising nonopioid treatment option for chronic, persistent postoperative pain. The objective of the present study was to evaluate the effect of a 60-day percutaneous PNS treatment in a multicenter, randomized, double-blind, placebo-controlled trial for treating persistent postoperative pain after TKA. MATERIALS AND METHODS Patients with postoperative pain after knee replacement were screened for this postmarket, institutional review board-approved, prospectively registered (NCT04341948) trial. Subjects were randomized to receive either active PNS or placebo (sham) stimulation. Subjects and a designated evaluator were blinded to group assignments. Subjects in both groups underwent ultrasound-guided placement of percutaneous fine-wire coiled leads targeting the femoral and sciatic nerves on the leg with postoperative pain. Leads were indwelling for eight weeks, and the primary efficacy outcome compared the proportion of subjects in each group reporting ≥50% reduction in average pain relative to baseline during weeks five to eight. Functional outcomes (6-minute walk test; 6MWT and Western Ontario and McMaster Universities Osteoarthritis Index) and quality of life (Patient Global Impression of Change) also were evaluated at end of treatment (EOT). RESULTS A greater proportion of subjects in the PNS groups (60%; 12/20) than in the placebo (sham) group (24%; 5/21) responded with ≥50% pain relief relative to baseline (p = 0.028) during the primary endpoint (weeks 5-8). Subjects in the PNS group also walked a significantly greater distance at EOT than did those in the placebo (sham) group (6MWT; +47% vs -9% change from baseline; p = 0.048, n = 18 vs n = 20 completed the test, respectively). Prospective follow-up to 12 months is ongoing. CONCLUSIONS This study provides evidence that percutaneous PNS decreases persistent pain, which leads to improved functional outcomes after TKA at EOT.
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Affiliation(s)
- Johnathan H Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Stuart A Grant
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - David M Dickerson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Endeavor Health, Evanston, IL, USA; The University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Yashar Eshraghi
- Department of Anesthesiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Sandeep Vaid
- Better Health Clinical Research, Newnan, GA, USA
| | | | - Jarna R Shah
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G Lawson Smith
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - John J Finneran
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Nirav N Shah
- Department of Anesthesiology, Critical Care, and Pain Medicine, Endeavor Health, Evanston, IL, USA; The University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Maged N Guirguis
- Department of Anesthesiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Maxim S Eckmann
- Department of Anesthesiology, University of Texas San Antonio, San Antonio, TX, USA
| | | | - Brian J Ohlendorf
- Department of Anesthesiology, Duke University Hospital, Durham, NC, USA
| | - Mayank Gupta
- Neuroscience Research Center, Overland Park, KS, USA
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12
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Longo UG, Papalia R, Mazzola A, Campi S, De Salvatore S, Candela V, Vaiano A, Piergentili I, Denaro V. Bilateral simultaneous hip and knee replacement: an epidemiological nationwide study from 2001 to 2016. BMC Surg 2024; 24:172. [PMID: 38822306 PMCID: PMC11141036 DOI: 10.1186/s12893-024-02450-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/09/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Several studies have compared the pros and cons of simultaneous bilateral versus staged bilateral hip and knee replacement but the outcomes of these two surgical options remains a matter of controversy. This study aimed to evaluate demographic features, incidence and hospitalization rates of bilateral one stage total hip and knee arthroplasty in Italy. METHODS The Italian Ministry of Health's National Hospital Discharge Reports (SDO) were used to gather data. This study referred to the adult population (+ 20 years of age) from 2001 to 2015 for hip arthroplasty and from 2001 to 2016 for knee arthroplasty. RESULTS Overall, 1,544 bilateral simultaneous hip replacement were carried out. The incidence rate was 0.21 cases per 100,000 adult Italian residents. Male/female ratio was 1.1. The average days of hospital stay was 11.7 ± 11.8 days. The main primary codified diagnosis was: osteoarthrosis, localized, primary, pelvic region and thigh (ICD code: 715.15). 2,851 bilateral simultaneous knee replacement were carried out. The incidence rate was 0.37 cases per 100,000 adult Italian residents. Male/female ratio was 0.6. The average days of hospital stay was 7.7 ± 5.8 days. The main primary codified diagnosis was: osteoarthrosis, localized, primary, lower leg (ICD code: 715.16). CONCLUSIONS The burden of hip and knee osteoarthrosis as a leading cause of bilateral joint replacement is significant in Italy. The national registers' longitudinal analysis may provide data for establishing international guidelines regarding the appropriate indications for one stage bilateral simultaneous hip or knee replacement versus two stage.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy.
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Alessandro Mazzola
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Stefano Campi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Vincenzo Candela
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Andrea Vaiano
- Department of Statistical Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 5, Roma, 00185, RM, Italy
| | - Ilaria Piergentili
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Vincenzo Denaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
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13
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Ji F, Zhao Z, Zhang L, Liu T, Xu B, Li W, Yang S, Wang T. The interval between staged bilateral total knee arthroplasties does not affect early complications of the second knee or long-term function of the first and second knees. BMC Surg 2024; 24:152. [PMID: 38745287 PMCID: PMC11092125 DOI: 10.1186/s12893-024-02442-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND This study explored the optimal time interval between staged bilateral total knee arthroplasty (BTKA) to minimize early complications of the second TKA and maximise the long-term function of the first and second knees. METHODS We retrospectively reviewed 266 patients who underwent staged BTKA between 2013 and 2018. Groups 1-4 had time intervals between BTKAs of 1-6, 6-12, 12-18, and 18-24 months, respectively. Demographics, postoperative complications within 90 days of the second TKA, Knee Society Score (KSS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score were compared among the groups. RESULTS In total, 54, 96, 75, and 41 patients were assigned to groups 1-4, respectively. Although group 1 had the highest overall complication rate (11.11%), there was no significant difference in the complication rate among the four groups. Also, no significant differences were found among the four groups in functional and patient-reported outcomes, in either the first or second knee at 5 years postoperatively, including KSS-knee, KSS-function, WOMAC-pain, WOMAC-stiffness, and WOMAC-physical function. The interval between BTKA did not influence complications or the function of the second knee. The TKA type (posterior-stabilised vs. medial-pivot) and age did not correlate significantly with any scores. CONCLUSIONS There was no group difference in early complications of the second TKA, and postoperative function was equivalent between the two knees and did not vary by the interval between surgeries. The results of this study give surgeons and patients more choices. If patients cannot tolerate severe symptoms in the contralateral knee after the first TKA, the second TKA should be performed as early as possible. If knee joint function is not well recovered after the first TKA, and patients are anxious to undergo the second TKA, surgeons can advise patients to postpone the operation based on these results.
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Affiliation(s)
- Feng Ji
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, No. 89, Guhuai Road, Jining, 272000, Shandong, China
| | - Zhenguo Zhao
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, No. 89, Guhuai Road, Jining, 272000, Shandong, China
| | - Lei Zhang
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, No. 89, Guhuai Road, Jining, 272000, Shandong, China
| | - Tongkai Liu
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, No. 89, Guhuai Road, Jining, 272000, Shandong, China
| | - Baoqiang Xu
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, No. 89, Guhuai Road, Jining, 272000, Shandong, China
| | - Wei Li
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, No. 89, Guhuai Road, Jining, 272000, Shandong, China
| | - Shuai Yang
- Institute of Orthopedics, Hebei Medical University Third Hospital, No.139 Ziqiang Road, Shijiazhuang, 050000, Hebei, China.
| | - Tianrui Wang
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, Shandong, China.
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14
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Mihalopoulos M, Okewunmi J, Stern BZ, Huang HH, Galatz LM, Poeran J, Moucha CS. Did the Comprehensive Care for Joint Replacement Bundled Payment Program Impact Sex Disparities in Total Hip and Knee Arthroplasties? J Arthroplasty 2024; 39:1226-1234.e4. [PMID: 37972665 DOI: 10.1016/j.arth.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Sex disparities have been noted across various aspects of total hip/knee arthroplasty (THA/TKA). Given incentives to standardize care, bundled payment initiatives including the Comprehensive Care for Joint Replacement (CJR) program may reduce disparities. This study aimed to assess the CJR program's impact on sex disparities in THA/TKA care and outcomes. METHODS This retrospective cohort study included 259,673 THAs (61.7% women) and 506,311 TKAs (64.0% women) from a large national database (2013 to 2017). Sex disparities were assessed for care and outcomes related to the period (1) before surgery, (2) during hospitalization for THA/TKA, and (3) after discharge. Disparities were reported as women:men ratios. Difference-in-differences analyses estimated the impact of the CJR program on pre-existing sex disparities. RESULTS For both THA and TKA, women were less likely than men to present with a Charlson-Deyo comorbidity index >0 (women:men ratio 0.88 to 0.92), but were more likely to require blood transfusions (women:men ratio 1.48 to 1.79) and be discharged to institutional postacute care (women:men ratio 1.50 to 1.66). Difference-in-differences models demonstrated that the CJR bundled payment program reduced sex disparities in institutional postacute care discharges (THA: -2.28%; 95% confidence interval [CI] -4.20 to -0.35%, P = .02; TKA: -2.07%; 95% CI -3.93 to -0.20%; P = .03) and THA 90-day readmissions (-1.00%, 95% CI -1.88 to -0.13%, P = .02), indicating a differential impact of CJR in women versus men for some outcomes. CONCLUSIONS While sex disparities in THA/TKA persist, the CJR program demonstrates potential to impact such differences. Future research should focus on how potential mechanisms could be leveraged to reduce disparities.
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Affiliation(s)
- Meredith Mihalopoulos
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey Okewunmi
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brocha Z Stern
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hsin-Hui Huang
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jashvant Poeran
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Calin S Moucha
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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15
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Cohen JS, Agarwal AR, Gu A, Harris A, Kinnard MJ, Golladay GJ, Thakkar SC. No Difference in 30-day Mortality Between Patients Undergoing Bilateral Simultaneous Total Knee Arthroplasty With Technology Assistance Compared to Conventional Instrumentation. HSS J 2024; 20:230-236. [PMID: 39282001 PMCID: PMC11393621 DOI: 10.1177/15563316231160155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/29/2022] [Indexed: 09/18/2024]
Abstract
Background: Bilateral simultaneous total knee arthroplasty (BSTKA) has decreased in frequency due to concerns about higher rates of early mortality and complications than unilateral or staged surgeries. Purpose: We sought to evaluate whether technology assistance (encompassing robotics and computer assistance) decreases early mortality following BSTKA. Methods: We conducted a retrospective cohort study using a national all-payer claims database. Patients who underwent BSTKA from October 2015 to December 2020 were identified. Univariate and multivariable analyses were conducted to compare outcomes in patients who underwent BSTKA with technology assistance compared to conventional instrumentation. The primary outcome was 30-day postoperative mortality. Secondary outcomes were respiratory failure and fat embolism. A post-hoc analysis was performed to evaluate length of stay, readmission, and other medical complications. Results: A total of 14,870 patients who underwent BSTKA were included in this study. Of these, 860 patients underwent technology-assisted BSTKA, and 14,010 patients underwent BSTKA without technology assistance. After a multivariable analysis, patients who underwent technology-assisted BSTKA had equivalent odds of 30-day mortality compared to those who underwent BSTKA without technology assistance. Technology assistance was not protective against the development of acute respiratory failure or fat embolism. Conclusion: This retrospective cohort study found no differences in the rates of 30-day mortality, respiratory failure, or fat embolism after technology-assisted BSTKA compared to conventional BSTKA. On the post-hoc analysis, technology use was associated with a decreased length of stay, lower readmission risk, and decreased rates of deep vein thrombosis, pulmonary embolism, and blood transfusion.
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Affiliation(s)
- Jordan S. Cohen
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Amil R. Agarwal
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Andrew Harris
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew J. Kinnard
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Gregory J. Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Savyasachi C. Thakkar
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Baltimore, MD, USA
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16
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Lachance AD, Steika R, Lutton J, Chessa F. Total Joint Arthroplasty in Patients Who Are Obese or Morbidly Obese: An Ethical Analysis. J Bone Joint Surg Am 2024; 106:659-664. [PMID: 38377222 DOI: 10.2106/jbjs.23.00617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Andrew D Lachance
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, Pennsylvania
| | - Roman Steika
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, Pennsylvania
| | - Jeffrey Lutton
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, Pennsylvania
| | - Frank Chessa
- Maine Medical Center, Portland, Maine
- Tufts University School of Medicine, Boston, Massachusetts
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17
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Franceschetti E, Campi S, Gregori P, Giurazza G, Samuelsson K, Hirschmann MT, Laudisio A, Papalia GF, Zampogna B, Papalia R. No differences in terms of complications, readmissions, reoperations, and patient-reported outcomes in simultaneous bilateral versus staged bilateral total knee arthroplasty in selected patients. Knee 2024; 47:151-159. [PMID: 38394994 DOI: 10.1016/j.knee.2023.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/09/2023] [Accepted: 11/27/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND The safety and the clinical success of simultaneous bilateral total knee arthroplasty (BTKA) is controversial. The aim of this study was to compare complications and patient-reported outcomes following simultaneous BTKA (simBTKA) versus staged BKTA (staBTKA) in patients affected by bilateral symptomatic end-stage knee osteoarthritis (OA). METHODS Data from patients who underwent simBTKA or staBTKA at a single institution from January 2017 to December 2020, with a minimum 1-year follow up period were retrospectively collected. Differences in terms of complications and clinical success were compared among the simBTKA and staBTKA patient groups. Alpha was set at 0.05. RESULTS A total of 173 patients were included in this study. The results revealed no statistically significant differences between the two groups in terms of mortality, revision rate, readmission rate, local and systemic complications and patient-reported outcomes. SimBTKA group had a shorter operating room time (96 (73-119) vs. 195 (159-227); P < 0.0001), and length of hospital stay (4 (3-5) vs. 7 (6-9); P < 0.0001) compared with the staBTKA group. CONCLUSIONS SimBTKA performed in a selected patient population at a high-volume center can be considered comparable to staBTKA in terms of safety, postoperative complications, 30-day readmissions and patient satisfaction. Consequently, reduced operating room time and hospital stay renders simBTKA a cost-effective and advantageous option, not only for patients, but also for healthcare institutes. Furthermore, the current study also highlights the importance of correct patient selection based on clinical preoperative characteristics.
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Affiliation(s)
- Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Stefano Campi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Pietro Gregori
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giancarlo Giurazza
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland; University of Basel, Basel, Switzerland
| | - Alice Laudisio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy; Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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18
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Reda B, Sharaf R. Incidence of Postoperative Infection Following Simultaneous Bilateral Knee Arthroplasty: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54117. [PMID: 38487132 PMCID: PMC10938981 DOI: 10.7759/cureus.54117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
Total knee arthroplasty is one of the most common orthopedic procedures. Simultaneous bilateral knee arthroplasty involves performing total knee arthroplasty on both knees in a single anesthetic session. This systematic review and meta-analysis followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. A primary search was performed using PubMed, EBSCO, Scopus, Web of Science, Clarivate, and Google Scholar databases. Quantitative data synthesis was performed using MedCalc® Statistical Software version 20.115 to determine the pooled prevalence of the infection among patients who underwent simultaneous bilateral knee arthroplasty. The Newcastle-Ottawa Scale was used to assess study quality. We included 30 studies in our quantitative data synthesis, with a total population of 118,502 patients (237,004 knees). The pooled prevalence of superficial infection, deep infection, and unspecified surgical site infection was estimated to be 0.86% (95% confidence interval: 0.62-1.13%), 0.84% (95% confidence interval: 0.64-1.05%), and 1.18% (95% confidence interval: 0.45-2.27%), respectively. There was significant heterogeneity (I2 >50%) in all analyses, and inspection of funnel plots revealed a symmetrical distribution of plotted data. We found that the infection rates following simultaneous bilateral knee arthroplasty were relatively low but heterogeneous, as the data showed marked variability. Superficial infections were more common than deep infections; however, there was a small difference in their prevalence. Furthermore, the reliability of our findings was limited owing to significant heterogeneity.
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Affiliation(s)
- Bashar Reda
- Orthopedic Surgery, College of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Raed Sharaf
- College of Medicine, King Abdulaziz University, Jeddah, SAU
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19
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Alshaikh AM, Alshaeri NM, Jamal R, Almaghthawi OF, Al Eid MM, Alfageeh ZS, Alturkistani AM, Ali AMB. Mortality Following Simultaneous Versus Staged Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e50823. [PMID: 38125692 PMCID: PMC10732000 DOI: 10.7759/cureus.50823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 12/23/2023] Open
Abstract
Bilateral total knee arthroplasty (BTKA) is a common intervention for bilateral knee osteoarthritis, and the choice between simultaneous (SimBTKA) and staged (StaBTKA) procedures remains a critical decision. This meta-analysis systematically reviews and analyzes the existing literature to compare mortality outcomes associated with SimBTKA and StaBTKA. A comprehensive search was conducted across major databases for studies reporting mortality outcomes in SimBTKA and StaBTKA. Inclusion criteria encompassed studies published up to the cutoff date of January 2023, and a total of 37 studies were included in the quantitative synthesis. Meta-analysis was performed using a random-effects model to calculate odds ratios (ORs) with 95% confidence intervals (CIs) using the Review Manage 5.4 software. The meta-analysis included 86,333 SimBTKA cases and 115,146 StaBTKA cases. The overall mortality rate in SimBTKA was 0.66%, while StaBTKA's was 0.43%. The pooled OR for mortality in SimBTKA versus StaBTKA was 1.55 [1.16, 2.08], indicating a statistically significant higher mortality risk in SimBTKA. Our findings suggest that SimBTKA is associated with an increased risk of mortality compared to StaBTKA. This meta-analysis provides valuable insights into the comparative mortality outcomes of SimBTKA and StaBTKA. While SimBTKA may offer potential advantages, including a single anesthesia event and shorter recovery time, clinicians should consider the increased mortality risk associated with this approach. Future research should focus on prospective studies with standardized reporting to further elucidate the nuanced factors influencing mortality outcomes in bilateral knee arthroplasty.
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Affiliation(s)
| | - Naif M Alshaeri
- Orthopaedics, South Al-Qunfudhah General Hospital, Al Qunfudhah, SAU
| | - Rawaa Jamal
- Medicine, Umm Al-Qura University, Jeddah, SAU
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Esteves TA, Buljubasich M, Holc F, Costantini J, Nicolino TI, Carbo L. Complications in simultaneous bilateral total knee arthroplasty, is it a safe procedure? J ISAKOS 2023; 8:451-455. [PMID: 37619961 DOI: 10.1016/j.jisako.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND There is controversy regarding various aspects of simultaneous bilateral total knee replacement (SBTKR). We found disparity in the postoperative outcomes and complications associated with the procedure in the literature linked with the topic. OBJECTIVE To retrospectively analyze the need for blood transfusion after surgery and complications associated with total knee replacement according to the type of procedure (SBTKR or unilateral). METHODS Retrospective cohort analytical study. We included 251 patients with severe knee osteoarthritis that were divided into two groups. 124 (49%) who underwent SBTKR and 127 upon whom unilateral total knee replacement (UTKR) was performed. Demographic data, days of hospitalization, complications within the first 90 days after surgery (thromboembolic events, superficial and deep infection, stiffness, death); and percentages of patients transfused with blood products during hospitalization were evaluated. RESULTS There were no statistical differences in the analysis of postoperative complications in the first 90 days after surgery. In the SBTKR group, 8 patients (6.5%) presented some thromboembolic complication during the postoperative period, while this event was observed in only 2 patients (1.5%) from the other group. The analysis showed a statistically significant drop in postoperative hemoglobin, on average that of 0.8 g/dl, in the SBTKR patient group compared to the UTKR group (95% CI 0.44-1.13; p < 0.001). A higher proportion of patients who required transfusion were observed in the SBTKR group (40%) (OR = 7.12; 95% CI 3.3-16; p < 0.001). We analyzed the cause of postoperative transfusion in the patients who required transfusion taking into account two parameters: hemoglobin less than 8 g/dl and the clinical needs of the patients (symptoms of hypotension, decay, difficulty to rehabilitate without pain, dyspnea). 59 patients received transfusion (50 in the SBTKR group and 9 in the other group). Of these, 19 patients (32.2%) did not meet any transfusion criteria. CONCLUSION We consider SBTKR a safe procedure, which does not increase postoperative complications compared to UTKR. Although there is an increase in blood loss in SBTKR, it does not generate clinical symptoms of relevance. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Tomás Alfredo Esteves
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina.
| | - Martín Buljubasich
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina
| | - Fernando Holc
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina
| | - Julián Costantini
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina
| | - Tomás Ignacio Nicolino
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina
| | - Lisandro Carbo
- Department of Orthopedics and Traumatology, Sector of Knee Arthroscopy and Reconstruction Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, CABA, CP: 1199, Buenos Aires, Argentina
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21
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Okamoto T, Yamanashi Y, Ikemoto T, Miyagawa H, Ishida T, Akao M, Takata T, Kato T, Kobayakawa K, Deie M. Risk factors for contralateral total knee arthroplasty after unilateral total knee arthroplasty. J Orthop Sci 2023; 28:1311-1316. [PMID: 36208979 DOI: 10.1016/j.jos.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/10/2022] [Accepted: 09/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little attention has been focused on risk factors for undergoing bilateral total knee arthroplasty (TKA) after primary unilateral TKA among patients with knee osteoarthritis (OA). This study investigated the differences in characteristics between groups with and without additional TKA for the contralateral knee among patients with knee OA who underwent primary unilateral TKA. METHODS Seventy-six patients who underwent primary unilateral TKA were included in this study. We defined patients who underwent additional TKA for the contralateral knee within one year of the primary TKA as a bilateral TKA group, and patients who did not undergo bilateral TKA as a unilateral TKA group. Femorotibial angle (FTA), percentage of mechanical axis (%MA), Kellgren-Lawrence (KL) grade, range of motion, Japan Orthopaedic Association (JOA) score, 10 m-walking time, C-reactive protein, estimated glomerular filtration rate, and serum albumin levels were selected as independent variables including covariates of age, sex, and body mass index for predicting bilateral TKA. We compared differences in variables between the two groups using the t-test or Mann-Whitney U-test and general linear models. A multivariate stepwise logistic regression model was also used to determine which variables correlated with bailateral TKA. RESULTS In pairwise comparisons, the KL grade, FTA, %MA, JOA score, and knee flexion angle in the contralateral knee were significantly worse in the bilateral TKA group than in the unilateral TKA group after controlling for covariates (P < 0.01, respectively). A stepwise logistic regression revealed that significant contributors to undergoing the contralateral TKA were FTA (OR = 1.47, P < 0.001) and knee flexion angle (OR = 0.96, P = 0.022) of the contralateral knee. CONCLUSIONS Severe varus deformity and limitations of flexion in the contralateral knee were found to be risk factors for undergoing additional TKA within one year of primary unilateral TKA among patients with knee OA.
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Affiliation(s)
- Takuya Okamoto
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan; Department of Rehabilitation, Aichi Medical University Hospital, Japan; Department of Orthopaedic Surgery, Aichi Medical University, Japan
| | - Yuki Yamanashi
- Department of Orthopaedic Surgery, Aichi Medical University, Japan.
| | | | - Hirofumi Miyagawa
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan
| | - Tomohiro Ishida
- Department of Rehabilitation, Aichi Medical University Hospital, Japan
| | - Machiko Akao
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
| | - Takuya Takata
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
| | - Tomohiro Kato
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
| | | | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
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22
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Çelen ZE, Özkurt B, Aydin Ö, Akalan T, Gazi O, Utkan A. Comparison of safety and efficiency between sequential simultaneous bilateral and staged bilateral total knee arthroplasty at a high-volume center: a retrospective cohort study. Acta Orthop Belg 2023; 89:455-461. [PMID: 37935229 DOI: 10.52628/89.3.11954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The treatment strategy remains controversial for bilateral end-stage osteoarthritis, particularly with regard to patient safety. The aim of this study was to compare the safety and clinical results of sequential simultaneous bilateral total knee arthroplasty (ssBTKA) and staged bilateral total knee arthroplasty (staBTKA). Patients who underwent either simultaneous (n=168) or staged (n=63) bilateral total knee arthroplasty in a single center between February 2017 and April 2021 were identified retrospectively. Data related to age, gender, body mass index, ASA score, comorbidities, operative time, transfusion rate, length of stay, knee range of motion (ROM), Knee Society Score (KSS), complications, and mortality rates were evaluated. Mean follow-up duration was 39.0±14.7 months. Preoperative characteristics were similar among cohorts. Transfused units were significantly higher in the ssBTKA group (p<0.001). Operative time and length of stay were significantly higher in the staBTKA group (respectively, p<0.001 and p=0.004). Complication rates (except superficial infection rate which was significantly higher in the staBTKA group), revision rates, mortality rates and functional outcomes were statistically similar between the groups (p>0.05). Presence of preoperative coronary artery disease comorbidity was significantly associated with increased postoperative myocardial infarction risk (p=0.001). ssBTKA provided similar functional results, shorter cumulative hospital stay and shorter operative time without increasing complications and mortality rates compared to staBTKA procedure. For patients with pre-existing coronary artery disease, a more cautious approach should be preferred to decrease complications.
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23
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Longstaffe R, Shahid K, Verrelli A, Loucks L, Bohm E. Outcomes and motives for not proceeding with the second stage bilateral knee replacement: a comparison of cancelled and completed bilateral total knee arthroplasty. Can J Surg 2023; 66:E97-E102. [PMID: 36813302 PMCID: PMC9970620 DOI: 10.1503/cjs.008621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Staged bilateral total knee arthroplasty (TKA) is a common treatment option for patients with bilateral symptomatic knee osteoarthritis, yet some patients do not proceed with their second procedure. Our study aimed to identify the rate and reasons why patients did not proceed with their second procedure and compare their functional outcomes, satisfaction and complication rates with those of patients who had completed a staged bilateral TKA. METHODS We determined the proportion of patients who underwent TKA but did not proceed with planned surgery for the second knee within 2 years, and compared their satisfaction with surgery, improvement in the Oxford Knee Score (OKS) and complications between groups. RESULTS Our study included 268 patients: 220 patients who underwent staged bilateral TKA and 48 patients who cancelled their second procedure. The most common reason for not proceeding with the second procedure was a slow recovery after the first TKA (43.2%), followed by functional improvement in symptoms in the unoperated knee negating the need for surgery (27.3%), poor experience with the first surgery (22.7%), treatment of other comorbidities necessitating cancellation of their second procedure (4.6%) and employment reasons (2.3%). Patients who cancelled their second procedure were noted to have a worse postoperative OKS improvement (p < 0.001) and lower satisfaction rate (p < 0.001), than patients who underwent staged bilateral TKA. CONCLUSION About one-fifth of patients scheduled for staged bilateral TKA declined to proceed with the second knee surgery within 2 years showing a substantially decreased functional outcome and satisfaction rate. However, more than one-quarter (27.3%) of patients noted improvements in their contralateral (unoperated) knee, such that a second surgery was no longer felt to be necessary.
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Affiliation(s)
- Robert Longstaffe
- Concordia Hip and Knee Institute (Longstaffe, Shahid, Verrelli, Loucks, Bohm); Department of Surgery (Longstaffe, Bohm), University of Manitoba; Pan Am Clinic (Longstaffe), Winnipeg, Man; Practice Plus Group Hospital (Shahid), Shepton Mallet, UK
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Same-day bilateral total knee replacement versus unilateral total knee replacement: A comparative study. Orthop Traumatol Surg Res 2022; 108:103301. [PMID: 35508293 DOI: 10.1016/j.otsr.2022.103301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Bilateral total knee arthroplasty (TKA) in a single session is rarely done in France, mainly due to the increased risk of perioperative and late complications. The primary objective of this study was to compare the complication rates of same-day bilateral TKA (TKA bilat) with that of unilateral TKA (TKA unilat). The hypothesis was bilateral TKA increases the rate of early and late complications in a group of selected patients (ASA 1 or 2, less than 80 years of age). MATERIAL AND METHODS Retrospective comparative study of 91 bilat TKA and 182 unilat TKA cases operated on between 2009 and 2016 (1 bilat TKA paired with 2 controls). The patients were matched based on age, sex, indication and ASA score. The minimum follow-up was 2 years. Mortality along with early and late complications were documented. The secondary endpoints were implant survival, functional outcomes, and patient satisfaction. RESULTS The early mortality rate was zero in both groups. The early complication rate was lower in the bilat TKA group (9%) than in the unilat TKA group (22%) (p<0.001). The late complications did not differ between groups. Implant survival at 5 years was 99% (95% CI=[95.6-99.7]) in the bilat TKA group and 97% (95% CI=[92.8-98.8]) in the unilat TKA group. The autologous blood transfusion rate was 33% in the bilat TKA group and 2.2% in the unilat TKA group (p<0.001). There was no difference between groups in the satisfaction rate or the KOOS and New IKS scores. A larger share of patients in the unilat TKA group (54%) said they had forgotten about their knee than in the bilat TKA group (43%) (p=0.036). DISCUSSION There were few early complications in the bilat TKA group. There was no significant difference in the number of late complications, survival, functional scores, or patient satisfaction between the two groups. The transfusion rate was higher in the bilat TKA group, while the forgotten knee rate was higher in the unilat TKA group. CONCLUSION Our hypothesis was not confirmed: in the context of this study, in patients who are ASA 1 or 2, and less than 80 years old, same-day bilateral TKA does not increase the complication rate relative to unilateral TKA. LEVEL OF EVIDENCE III, comparative study of continuous paired cases.
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25
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Bilateral Knee Arthroplasty in Patients Affected by Windswept Deformity: A Systematic Review. J Clin Med 2022; 11:jcm11216580. [PMID: 36362808 PMCID: PMC9655254 DOI: 10.3390/jcm11216580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/13/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
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.
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Association of the joint line orientation angle of the contralateral limb with the alignment change of the unilateral and bilateral opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2022; 31:1593-1602. [PMID: 35994078 DOI: 10.1007/s00167-022-07123-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE This study aimed to evaluate and compare unilateral and bilateral open-wedge high tibial osteotomy (OWHTO) using mid-term serial assessment of clinical and radiological outcomes, especially focussing on coronal lower extremity alignment. METHODS Serial radiological assessments were performed in 40 patients (80 knees) with bilateral OWHTO and 49 patients (49 knees) with unilateral OWHTO. Both groups were further divided into four subgroups to compare each limb (unilateral involved and non-involved limbs and bilateral primarily and secondarily treated limbs). Radiological and clinical outcomes were evaluated and compared among the four groups. For the alignment change assessment, the pelvic tilt angle (PTA), weight-bearing line ratio (WBLR), joint line orientation angle (JLOA), medial proximal tibia angle (MPTA), joint line convergence angle (JLCA), distal tibia articular angle (DTAA), and talar inclination (TI) were measured pre- and postoperatively at 3, 6, and 12 months and annually thereafter. Student's t-test, one-way repeated-measures analysis of variance, and correlation analysis were used to compare the groups. RESULTS Patients in the unilateral and bilateral OWHTO groups had similar postoperative radiological and clinical outcomes. Each unilaterally involved limb and primarily treated bilaterally involved limb were negatively affected by the contralateral limb with respect to increased JLOA during the postoperative period (unilateral OWHTO group: r = -0.350, p = 0.023; bilateral OWHTO group: r = -0.520, p = 0.005). The correction change of the ankle parameters in the secondarily treated limb showed greater varus alignment than the primarily treated limb after bilateral OWHTO (DTAA (0.1 ± 3.0 vs. -0.5 ± 3.8°, p = 0.014) and TI (0.9 ± 3.2° vs. -0.3 ± 2.9, p = 0.001)). CONCLUSION Unilateral and bilateral OWHTOs shared similar postoperative radiological and clinical outcomes. Alignment changes of the unilateral OWHTO and the primarily treated limb of the bilateral OWHTO were associated with the JLOA of the contralateral limb. LEVEL OF EVIDENCE Cohort study; Level III.
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Efficacy of preoperative autologous blood storage in one-stage bilateral total knee arthroplasty. J Orthop Sci 2022; 27:648-651. [PMID: 35370041 DOI: 10.1016/j.jos.2020.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/12/2020] [Accepted: 12/25/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND One-stage bilateral total knee arthroplasty (TKA) has the advantages of a single hospital stay, shorter rehabilitation, and reduced financial burden on patients. However, perioperative bleeding is greater with one-stage bilateral TKA than with unilateral TKA and is more likely to require allogeneic blood transfusion. At our hospital, we normally store autologous blood about 1 month before surgery to reduce the need for allogeneic blood transfusion and avoid its adverse reactions as much as possible. The purpose of this study was to determine the efficacy of preoperative autologous blood storage for patients undergoing one-stage bilateral TKA. METHODS We retrospectively examined the allogeneic blood transfusion avoidance rate and the perioperative decrease in hemoglobin (Hb) level in 166 patients according to whether or not they had preoperative autologous blood stored. The patients for whom blood was stored were then subdivided according to whether the amount of blood stored was 400 mL or 200 mL. RESULTS Excluding allogeneic transfusion cases, the mean perioperative decrease in Hb was significantly lower in the patients with stored blood than in those without stored blood (3.5 g/dL vs 4.4 g/dL, p < 0.001). The allogeneic blood transfusion avoidance rate was significantly higher in the group with stored blood (98.5% vs 86.7%, p < 0.01). In the group with stored blood, the transfusion avoidance rate was higher, but not significantly, in the subgroup with 400 mL of blood stored than in those with 200 mL of blood stored (100% vs 97.5%) and the mean perioperative decrease in Hb was 3.5 g/dL in both blood storage volume groups. CONCLUSIONS Preoperative autologous blood storage can help increase the likelihood of avoiding allogeneic blood transfusion in patients undergoing one-stage bilateral TKA.
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Ghadimi K, Motififard M, Mohammadi R, Rafiee Zadeh A. Complete bilateral knee arthroplasty in staged or simultaneous surgeries in patients with osteoarthritis. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2022; 12:59-65. [PMID: 35620738 PMCID: PMC9123451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Considering the increasing importance of the new method of arthroplasty in the treatment of knee osteoarthritis and the possibility of its two-stage and one-stage process, as well as considering that each method has its own merits, this study examines these disadvantages and comparisons. METHODS In this cross-sectional study, 119 patients undergoing bilateral knee arthroplasty surgery were enrolled in the study, in the first group with the simultaneous process (60) and the second group who were willing two stages (from a period of three months or more) 59 patients, Then the treatment outcomes were compared in both groups. RESULTS The mean duration of hospitalization in the simultaneous group was significantly lower than that in the staged group (P < 0.05). The average surgery cost in the staged method was significantly higher than that of the same group (P < 0.05). The mean knee motion range and patients' satisfaction in the two groups did not significantly differ. In the short term, patients' satisfaction was higher in the stage method. CONCLUSION The simultaneous approach to hospitalization time and costs was better than the staged method, but in the long-term, there was a significant difference in other aspects.
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Affiliation(s)
- Keyvan Ghadimi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Mehdi Motififard
- Department of Orthopedic, Isfahan University of Medical SciencesIsfahan, Iran
| | - Reza Mohammadi
- Department of Orthopedic, Isfahan University of Medical SciencesIsfahan, Iran
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Wilkie W, Mohamed N, Remily E, Pastore M, Nace J, Delanois RE. Same Day versus Staged Total Knee Arthroplasty: Do Cost Savings Justify the Risk? J Knee Surg 2022; 35:288-293. [PMID: 32659823 DOI: 10.1055/s-0040-1713734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Same-day bilateral total knee arthroplasties (BTKAs) are associated with increased complications compared with staged procedures; however, as complication rates and lengths of stay (LOS) for same-day procedures decrease, they may become attractive alternatives to staged procedures. The void of recent nationwide studies comparing the 30-day total cost and risks of these procedures inspired this propensity matched review. Therefore, we compared 30-day outcomes in staged and same-day BTKAs occurring in 2016 and 2017 using the National Readmission Database (NRD), a nationwide database. The NRD was queried for all same-day and staged BTKA patients from January 1 to November 30 for both 2016 and 2017. Since the NRD links readmissions within one calendar year, TKAs occurring in this month were excluded to allow 30-day follow-up. Propensity matching was performed based on demographics, producing 19,334 patients in both cohorts. Thirty-day readmission, revision, and mortality rates, hospital costs, LOS, discharge dispositions, and complications were analyzed. Chi-square and Student's t-tests assessed categorical and continuous variables, respectively. A p-value of <0.05 was set as the threshold for statistical significance. The analysis demonstrated that less same-day patients were readmitted, with statistical but not clinical difference in revisions, and mortality (all p < 0.050). Higher 30-day cost ($33,522 vs. $29,053, p < 0.001), decreased total LOS (4.52 vs. 4.94 days, p < 0.001), and lower rates of PEs (0.3 vs. 1.1%, p < 0.001) and transfusions (2.1 vs. 8.5%, p < 0.001) but similar total complications (p >0.050) were associated staged compared with same-day BTKAs. The results suggest inpatient cost savings associated with same-day surgeries should be weighed against the slight increase in LOS and PEs. Ultimately, as LOS and PE rates continue to decrease from innovations and quality improvements, same-day BTKA may become an attractive alternative to staged BTKAs, especially if payer's incentive surgeons by increasing physician reimbursements.
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Affiliation(s)
- Wayne Wilkie
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nequesha Mohamed
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ethan Remily
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Mark Pastore
- Philadelphia College of Osteopathic Medicine Ringgold Standard Institution, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania
| | - James Nace
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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30
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Arif MA, Hafeez S. Comparison of Frequency and Morbidity of Unilateral Total Knee Replacement Versus Simultaneous Bilateral Total Knee Replacement. Cureus 2022; 14:e21655. [PMID: 35242458 PMCID: PMC8884456 DOI: 10.7759/cureus.21655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/05/2022] Open
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Laoruengthana A, Rattanaprichavej P, Samapath P, Chinwatanawongwan B, Chompoonutprapa P, Pongpirul K. Should we use similar perioperative protocols in patients undergoing unilateral and bilateral one-stage total knee arthroplasty? World J Orthop 2022; 13:58-69. [PMID: 35096536 PMCID: PMC8771417 DOI: 10.5312/wjo.v13.i1.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/28/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bilateral one-stage total knee arthroplasty (BTKA) is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy. However, postoperative pain and disablement during convalescence from BTKA, and procedure-related complications have been concerning issues for patients and surgeons. Although some studies reported that BTKA in selected patients is as safe as the staged procedure, well-defined guidelines for patient screening, and perioperative care and monitoring to avoid procedure-related complications are still controversial. AIM To compare the perioperative outcomes including perioperative blood loss (PBL), cardiac biomarkers, pain intensity, functional recovery, and complications between unilateral total knee arthroplasty (UTKA) and BTKA performed with a similar perioperative protocol. METHODS We conducted a retrospective study on consecutive patients undergoing UTKA and BTKA that had been performed by a single surgeon with identical perioperative protocols. The exclusion criteria of this study included patients with an American Society of Anesthesiologists score > 3, and known cardiopulmonary comorbidity or high-sensitivity Troponin-T (hs-TnT) > 14 ng/L. Outcome measures included visual analogue scale (VAS) score of postoperative pain, morphine consumption, range of knee motion, straight leg raise (SLR), length of stay (LOS), and serum hemoglobin (Hb) and hs-TnT monitored during hospitalization. RESULTS Of 210 UTKA and 137 BTKA patients, those in the BTKA group were younger and more predominately female. The PBL of the UTKA vs BTKA group was 646.45 ± 272.26 mL vs 1012.40 ± 391.95 mL (P < 0.01), and blood transfusion rates were 10.48% and 40.88% (P < 0.01), respectively. Preoperative Hb and body mass index were predictive factors for blood transfusion in BTKA, whereas preoperative Hb was only a determinant in UTKA patients. The BTKA group had significantly higher VAS scores than the UTKA group at 48, 72, and 96 h after surgery, and also had a significantly lower degree of SLR at 72 h. The BTKA group also had a significantly longer LOS than the UTKA group. Of the patients who had undergone the procedure, 5.71% of the UTKA patients and 12.41% of the BTKA patients (P = 0.04) had hs-TnT > 14 ng/L during the first 72 h postoperatively. However, there was no difference in other outcome measures and complications. CONCLUSION Following similar perioperative management, the blood transfusion rate in BTKA is 4-fold that required in UTKA. Also, BTKA is associated with higher pain intensity at 48 h postoperatively and prolonged LOS when compared to the UTKA. Hence, BTKA patients may require more extensive perioperative management for blood loss and pain, even if having no higher risk of complications than UTKA.
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Affiliation(s)
- Artit Laoruengthana
- Department of Orthopaedics, Naresuan University, Mueang 65000, Phitsanulok, Thailand
| | - Piti Rattanaprichavej
- Department of Orthopaedics, Naresuan University, Mueang 65000, Phitsanulok, Thailand
| | - Parin Samapath
- Department of Orthopaedics, Naresuan University, Mueang 65000, Phitsanulok, Thailand
| | | | | | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Hospital volume-outcome relationship in total knee arthroplasty: a systematic review and dose-response meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2862-2877. [PMID: 34494124 PMCID: PMC9309153 DOI: 10.1007/s00167-021-06692-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE This systematic review and dose-response meta-analysis aimed to investigate the relationship between hospital volume and outcomes for total knee arthroplasty (TKA). METHODS MEDLINE, Embase, CENTRAL and CINAHL were searched up to February 2020 for randomised controlled trials and cohort studies that reported TKA performed in hospitals with at least two different volumes and any associated patient-relevant outcomes. The adjusted effect estimates (odds ratios, OR) were pooled using a random-effects, linear dose-response meta-analysis. Heterogeneity was quantified using the I2-statistic. ROBINS-I and the GRADE approach were used to assess the risk of bias and the confidence in the cumulative evidence, respectively. RESULTS A total of 68 cohort studies with data from 1985 to 2018 were included. The risk of bias for all outcomes ranged from moderate to critical. Higher hospital volume may be associated with a lower rate of early revision ≤ 12 months (narrative synthesis of k = 7 studies, n = 301,378 patients) and is likely associated with lower mortality ≤ 3 months (OR = 0.91 per additional 50 TKAs/year, 95% confidence interval [0.87-0.95], k = 9, n = 2,638,996, I2 = 51%) and readmissions ≤ 3 months (OR = 0.98 [0.97-0.99], k = 3, n = 830,381, I2 = 44%). Hospital volume may not be associated with the rates of deep infections within 1-4 years, late revision (1-10 years) or adverse events ≤ 3 months. The confidence in the cumulative evidence was moderate for mortality and readmission rates; low for early revision rates; and very low for deep infection, late revision and adverse event rates. CONCLUSION An inverse volume-outcome relationship probably exists for some TKA outcomes, including mortality and readmissions, and may exist for early revisions. Small reductions in unfavourable outcomes may be clinically relevant at the population level, supporting centralisation of TKA to high-volume hospitals. LEVEL OF EVIDENCE III. REGISTRATION NUMBER The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42019131209 available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131209 ).
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Wang X, Huang Q, Pei F. Incidence and risk factors for blood transfusion in simultaneous bilateral total hip arthroplasty. Jt Dis Relat Surg 2021; 32:590-597. [PMID: 34842089 PMCID: PMC8650653 DOI: 10.52312/jdrs.2021.333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study aims to investigate the incidence and risk factors for blood transfusion in patients undergoing simultaneous bilateral total hip arthroplasty (SimBTHA). PATIENTS AND METHODS Between January 2011 and June 2021, a total of 341 patients (289 males, 52 females; median age: 53 years; range, 43 to 66 years) who underwent SimBTHA were retrospectively analyzed. The patients were divided into two groups as those who did and did not require allogeneic blood transfusion. Univariate and multivariate logistic regression models were used to identify independent risk factors for transfusion. RESULTS The incidence of transfusion in SimBTHA was 12.9%. We found that a higher preoperative hemoglobin level (odds ratio [OR]: 0.91; 95% confidence interval [CI]: 0.86-0.96), tranexamic acid (TXA) use (OR: 0.25; 95% CI: 0.09-0.58), and intraoperative autologous blood transfusion from a closed suction drainage system (OR: 0.30; 95% CI: 0.09-0.80) were protective against the need for transfusion in patients after SimBTHA. In addition, drainage use (OR: 3.52; 95% CI: 1.49-8.32) and intraoperative blood loss (OR: 1.17; 95% CI: 1.04-1.33) were the independent risk factors for blood transfusion. CONCLUSION The risk factors for transfusion after SimBTHA should be evaluated to establish specific, personalized transfusion risk assessments for each individual patient. For SimBTHA, the main risk factors include intraoperative bleeding and the use of drainage tube, while higher preoperative hemoglobin levels, TXA use, and autologous blood transfusion from a closed suction drainage system may reduce transfusion risk.
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Affiliation(s)
| | - Qiang Huang
- Department of Orthopaedic Surgery, West China Hospital, Chengdu, Sichuan Province, 610041 China.
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Sarzaeem MM, Amoozadeh Omrani F, Omidian MM, Sahebalzamani MA, Maniei E. Clinical Outcome Comparison between Staged -Bilateral Versus Simultaneous Bilateral Total Knee Replacements. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:641-646. [PMID: 35106328 PMCID: PMC8765198 DOI: 10.22038/abjs.2021.48053.2379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/08/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND This retrospective study aimed to compare the clinical outcomes of patients with staged and simultaneous bilateral total knee arthroplasty (TKA). METHODS The present study included 100 patients with a mean age of 62±3.72 years from 2014 to 2017. Among them, 51 and 49 patients underwent simultaneous and staged bilateral TKA, respectively. The two groups were compared regarding the range of motion (ROM), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) improvement, and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) scores. The mean follow-up duration was 24 months (range: 12-36 months). RESULTS According to the results obtained from the SF-36 questionnaire (possessing eight different factors of quality of life), there was no significant difference between the two groups. Furthermore, the OKSs were 39.98±1.52 and 38.68±2.55 in the simultaneous and staged groups, respectively. Moreover, the WOMAC improvement scores were obtained at 84.15±2.2 and 83.26±2.6 in the simultaneous and staged groups, respectively. The final knee ROM was acceptable without a significant difference between the two groups. CONCLUSION Substantial controversy about the complications, functional, and clinical outcomes has negatively affected the decision of the surgeons on conducting bilateral sequential TKA. This clinical assessment revealed that all determinants, including OKS, WOMAC, SF-36, ROM, postoperative bleeding, and hospitalization duration exhibited almost the same improvement in both groups. According to this study, no statistically significant difference exists in both procedures.
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Affiliation(s)
- Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences (SBUMS), Tehran, Iran
| | - Farzad Amoozadeh Omrani
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences (SBUMS), Tehran, Iran
| | - Mohammad Mahdi Omidian
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences (SBUMS), Tehran, Iran
| | - Mohammad Ali Sahebalzamani
- Department of Biomaterials, Faculty of Biomedical Engineering, Science and Research, Branch, Islamic Azad University, Tehran, Iran
| | - Ehsan Maniei
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
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Comparison of the Effect and Complications of Sequential Bilateral Arthroplasty at Different Time Intervals and Simultaneous Bilateral Total Knee Arthroplasty: A Single-Centre Retrospective Cohort Study. Adv Ther 2021; 38:5191-5208. [PMID: 34453702 DOI: 10.1007/s12325-021-01880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION To the authors' knowledge, there is no current consensus regarding the optimal interprocedural interval for patients who have undergone bilateral total knee arthroplasty (BTKA). The purpose of this study is to evaluate complication rates and functional outcome in patients who have undergone BTKA (simultaneous or sequential at different time intervals), and to determine an optimal time frame for the second knee. METHODS Data from 315 patients who were able to tolerate simultaneous BTKA according to the anaesthesiologist's preoperative assessment between 2016 and 2020 were analysed retrospectively. According to the operative time interval, they were divided into simultaneous, ≤ 1-month sequential, 1- to 3-month sequential, and ≥ 3-month sequential BTKA groups. The primary outcomes were revision and readmission rates during the follow-up period, and the secondary outcomes were hospital length of stay (LOS), transfusion and postoperative complications. RESULTS There was no difference in the implant survival or readmission rate between the groups (p > 0.05). Multivariable linear regression showed that interprocedural interval and body mass index (BMI) affected LOS; the LOS of simultaneous BTKA was the shortest (p < 0.05). BMI was associated with an increased LOS of 0.25 days (95% CI 0.02-0.48, p = 0.03). A modified Poisson regression model showed that the odds of blood transfusion were reduced in sequential BTKAs of any interval (p < 0.05), and preoperative haemoglobin (Hb) was also a risk factor (RR 0.96, 95% CI 0.95-0.98, p < 0.001). The interprocedural interval was not a risk factor for postoperative cardiovascular and cerebrovascular complications. CONCLUSION For appropriate patients, simultaneous BTKA is beneficial. However, higher preoperative haemoglobin was required to mitigate the high blood transfusion rate associated with simultaneous surgeries. If suitable patients refuse simultaneous BTKA for other non-medical reasons, sequential BTKA with an interval greater than 1 month is recommended.
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Wan RCW, Fan JCH, Hung YW, Kwok KB, Lo CKM, Chung KY. Cost, safety, and rehabilitation of same-stage, bilateral total knee replacements compared to two-stage total knee replacements. Knee Surg Relat Res 2021; 33:17. [PMID: 34118996 PMCID: PMC8196524 DOI: 10.1186/s43019-021-00098-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/29/2021] [Indexed: 11/27/2022] Open
Abstract
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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Affiliation(s)
- Raymond C W Wan
- Department of Orthopedics & Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
| | - Jason C H Fan
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China.
| | - Yuk-Wah Hung
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Ka-Bon Kwok
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Carmen K M Lo
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Kwong-Yin Chung
- Department of Orthopedics & Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
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Makaram NS, Roberts SB, Macpherson GJ. Simultaneous Bilateral Total Knee Arthroplasty Is Associated With Shorter Length of Stay but Increased Mortality Compared With Staged Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2021; 36:2227-2238. [PMID: 33589276 DOI: 10.1016/j.arth.2021.01.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/27/2020] [Accepted: 01/18/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Primary total knee arthroplasty (TKA) is associated with high patient satisfaction. However, controversy remains regarding the safety and efficacy of conducting simultaneous bilateral (simBTKA) versus staged bilateral TKA (staBTKA). The objective of this systematic review and meta-analysis was to evaluate the current evidence for simBTKA versus staBTKA and compare clinical outcomes including mortality, complications and length of stay (LOS). METHODS A search was performed of PubMed, MEDLINE, EMBASE and Cochrane central databases between January 2000 and March 2020. Search terms included "simultaneous," "staged," and "bilateral TKA." Inclusion criteria comprised studies comparing outcomes of simBTKA versus staBTKA. Quality of included studies was assessed and meta-analyses of pooled data was conducted. RESULTS 29 articles published between 2001 and 2020 were included in qualitative synthesis from 927 potentially relevant titles, comprising 257,284 patients. 104,207 patients underwent simBTKA and 153,632 patients underwent staBTKA. simBTKA was associated with significantly increased 90-day mortality rate (P < .00001, OR 2.24, 95% CI 1.79-2.81), increased incidence of pulmonary embolism (P < .00001, OR 1.69, 95% CI 1.51-1.89), venous thrombosis (P < .00001, OR 1.33, 95% CI 1.23-1.43), and neurological complications (P = .002, OR 1.42, 95% CI 1.13-1.77). Incidence of superficial and deep infection was significantly increased with staBTKA (P = .02, P < .00001 respectively). Revision rate within one year was equivocal. Mean LOS was 2.1 days shorter for simBTKA. CONCLUSION SimBTKA was associated with decreased incidence of infection and LOS but increased incidence of 90-day mortality, venous thromboembolism and neurological complications. Revision rates were equivocal. Patients should be selected and counseled based on the risks respective to each strategy.
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Affiliation(s)
- Navnit S Makaram
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Department of Orthopaedics and Trauma, The University of Edinburgh, Edinburgh, United Kingdom
| | - Simon B Roberts
- Department of Orthopaedics and Trauma, The University of Edinburgh, Edinburgh, United Kingdom
| | - Gavin J Macpherson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Khow YZ, Goh GS, Chen JY, Lo NN, Yeo SJ, Liow MHL. Change in Body Mass Index after Simultaneous Bilateral Total Knee Arthroplasty: Risk Factors and Its Influence on Functional Outcomes. J Arthroplasty 2021; 36:1974-1979. [PMID: 33602589 DOI: 10.1016/j.arth.2021.01.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Previous studies evaluating weight changes following total knee arthroplasty (TKA) were performed on heterogenous cohorts. However, no study has evaluated weight changes in a cohort of simultaneous-bilateral TKA (SB-TKA) patients. This study aimed to evaluate the prevalence of patients who lost or gained weight, determine if postoperative weight change influences functional outcome, and identify predictors of weight change after SB-TKA. METHODS Prospectively collected registry data of 560 patients who underwent SB-TKA were reviewed. Patients were assessed preoperatively, at 6 months, and 2 years using the Knee Society Score, Oxford Knee Score, Short-Form 36, and range of motion. Change in body mass index (BMI) >5% was used to categorize patients into 3 groups: lost, maintained, or gained weight. Analysis of variance, Kruskal-Wallis test, and chi-squared test were used to compare functional outcomes between groups. Multivariable logistic regression evaluated predictors for postoperative weight changes. RESULTS At 2 years, 59% of patients maintained weight, 28% of patients gained weight, and 13% of patients lost weight. All groups experienced similar improvements in functional outcomes, rates of minimal clinically important difference attainment, and patient satisfaction (P > .05). Older patients were more likely to gain weight (P < .05). Patients with higher preoperative BMI were more likely to gain weight (P < .05) and less likely to lose weight (P < .05). Patients with greater preoperative comorbidities were less likely to lose weight (P < .05). CONCLUSION Up to 41% of patients experience significant weight changes after SB-TKA. Older patients with higher preoperative BMI were more likely to gain weight, while higher preoperative BMI with more comorbidities were less likely to lose weight following SB-TKA; however, postoperative weight changes do not appear to affect functional outcomes. LEVEL OF EVIDENCE III, therapeutic study.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Tucker A, Warnock JM, Cassidy R, Napier RJ, Beverland D. Are patient-reported outcomes the same following second-side surgery in primary hip and knee arthroplasty? Bone Jt Open 2021; 2:243-254. [PMID: 33881349 PMCID: PMC8085620 DOI: 10.1302/2633-1462.24.bjo-2020-0187.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aims 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. Methods 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. Results 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. Conclusion 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.
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Hou JF, Hu C, Zhang Y, Tian LQ, Liu YZ, Zhang C, Li J. Cost analysis of staged versus simultaneous bilateral total knee and hip arthroplasty using a propensity score matching. BMJ Open 2021; 11:e041147. [PMID: 33653742 PMCID: PMC7929812 DOI: 10.1136/bmjopen-2020-041147] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Total joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is required for many patients. This study aimed to evaluate the medical costs, length of stay (LOS), blood transfusion and in-hospital complications in patients undergoing simultaneous and staged TJA. METHODS All patients who underwent primary bilateral TJA from 2013 to 2018 in our institute were included. The propensity score matching analysis was performed between simultaneous and staged TJA patients. The difference in medical costs, LOS, blood transfusion and in-hospital complications was compared between simultaneous and staged groups. RESULTS Except for materials fees and general therapy fees, medical costs (bed fees, general therapy fees, nursing care fees, check-up and laboratory test fees, surgical fees and drug fees) were significantly lower in the simultaneous TKA, THA and TJA group. The total average medical costs in simultaneous and staged TKA groups were $15 385 and $16 729 (p<0.001), respectively; THA groups were $14 503 and $16 142 (p=0.016), respectively; TJA groups were $15 389 and $16 830 (p<0.001), respectively. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common comorbidities and postoperative complications between the two subgroups. The simultaneous groups had a shorter LOS and the differences from the staged group for TKA, THA and the TJA group were 8, 6 and 8 days, respectively. The incidence of blood transfusion is higher for simultaneous groups and the difference from the staged group for TKA, THA and TJA is 32.69%, 18% and 29.3%, respectively. CONCLUSIONS Our results indicate that simultaneous TKA and THA with a shorter LOS would cost fewer (costs incurred during hospitalisation) than staged TKA and THA. Complication rates were not affected by the choice for staged or simultaneous arthroplasty, but the incidence of blood transfusion was higher in the simultaneous groups.
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Affiliation(s)
- Ji-Fei Hou
- The Affiliated Hospital of Qingdao University, QingDao, China
- Medical College, Qingdao University, Qingdao, China
| | - Chuan Hu
- The Affiliated Hospital of Qingdao University, QingDao, China
- Medical College, Qingdao University, Qingdao, China
| | - Yun Zhang
- The Affiliated Hospital of Qingdao University, QingDao, China
| | - Li-Qi Tian
- The Affiliated Hospital of Qingdao University, QingDao, China
| | - Yan-Zheng Liu
- Department of Research, Qilu Hospital,Cheeloo College of Medicine,Shandong University, Jinan, China
| | - Chi Zhang
- The Affiliated Hospital of Qingdao University, QingDao, China
- Medical College, Qingdao University, Qingdao, China
| | - Jing Li
- The Affiliated Hospital of Qingdao University, QingDao, China
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Gu A, Wu S, Mancino F, Liu J, Ast MP, Abdel MP, Sculco PK. Impact of Chronic Obstructive Pulmonary Disease on Postoperative Complications Following Simultaneous Bilateral Total Knee Arthroplasty. J Knee Surg 2021; 34:322-327. [PMID: 31470451 DOI: 10.1055/s-0039-1695766] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For patients who qualify, simultaneous bilateral total knee arthroplasty (TKA) is a viable option for the treatment of bilateral symptoms. However, the incidence of chronic obstructive pulmonary disease (COPD) has been steadily rising over the past few decades and may impact those who qualify as candidates for bilateral TKA. As such, the aim of this study was to determine the impact of COPD on postoperative outcomes in patients who receive simultaneous bilateral TKA. A retrospective cohort study was conducted utilizing data provided through the American College of Surgeons National Surgical Quality Improvement Program. All patients who had undergone simultaneous bilateral TKA between 2007 and 2016 were identified and further stratified into groups based upon the COPD status. Incidence of adverse events after TKA in the acute postoperative period was evaluated with univariate and multivariate analyses. COPD was found to be an independent risk factor for the development of major (odds ratio [OR]: 2.5; p = 0.015), renal (OR: 5.1; p = 0.02), and thromboembolic complications (OR: 2.5; p = 0.027). In addition, patients with COPD were at increased risk for having an extended hospital length of stay (LOS; p < 0.001) and development of urinary tract infections (p < 0.001). Patients with COPD are at higher risk for development of overall major complications, as well as renal and thromboembolic complications after simultaneous bilateral TKA. Interestingly, patients were not at increased risk for the development of pulmonary or wound complications. When considering a staged versus simultaneous bilateral TKA, surgeons should be aware of the impact COPD status has on the postoperative complication rate.
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Affiliation(s)
- Alex Gu
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York.,George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - Shitong Wu
- Department of Biology, Duke University, Durham, North Carolina
| | - Fabio Mancino
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jiabin Liu
- Department of Anesthesiology, Hospital for Special Surgery, New York, New York
| | - Michael P Ast
- Adult Reconstruction and Joint Service, Hospital for Special Surgery, New York, New York
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter K Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
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Remily EA, Wilkie WA, Mohamed NS, Gilson G, Smith T, Zweigle JW, Nace J, Delanois RE. Same-Day Bilateral Total Knee Arthroplasty: Incidence and Perioperative Outcome Trends from 2009 to 2016. Knee 2020; 27:1963-1970. [PMID: 33221694 DOI: 10.1016/j.knee.2020.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/28/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Same-day bilateral total knee arthroplasty (BiTKA) is a controversial topic in orthopedics, prompting a consensus statement to be released by national experts. To date, no studies have evaluated the trends of this method since these recommendations. This study utilized a national database to evaluate: 1) incidence; 2) patient characteristics; 3) hospital characteristics; and 4) inpatient course for same-day BiTKAs in the United States from 2009 to 2016. METHOD The National Inpatient Sample database was queried for individuals undergoing same-day BiTKAs, yielding 245,138 patients. Patient demographics included age, sex, race, obesity status and Charlson Comorbidity Index (CCI) score. Hospital characteristics consisted of location/teaching status, geographic region, charges, and costs. Inpatient course included length of stay, discharge disposition, and complications. RESULTS Same-day BiTKA incidence decreased from 5.6% to 4.0% over the study (p < 0.001). Decreases in patient age and female proportion (p < 0.001 for both) were seen, while African American and Hispanic patients increased (p < 0.001), as did obese patient proportions (p < 0.001). Patients with CCI scores of 2 increased, while those with ≥3 decreased (p < 0.001). Hospital charges increased, while costs decreased (p < 0.001 for both). Length of stay following same-day BiTKA decreased (p < 0.001) and routine home discharges increased (p < 0.001). Most inpatient complications decreased, although the percentage of mechanical complications and respiratory failures increased (p < 0.01 for all). CONCLUSIONS During the study period, younger patients with fewer comorbidities underwent BiTKAs, which likely resulted from improved patient assessment and management. Future investigations should include an evaluation of long-term complications and outcomes in certain patient populations for this procedure.
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Affiliation(s)
- Ethan A Remily
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, United States
| | - Wayne A Wilkie
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, United States
| | - Nequesha S Mohamed
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, United States
| | - Greg Gilson
- Philadelphia College of Osteopathic Medicine, Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, 4170 City Ave, Philadelphia, PA 19131, United States
| | - Tyler Smith
- Philadelphia College of Osteopathic Medicine, Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, 4170 City Ave, Philadelphia, PA 19131, United States
| | - Joshua W Zweigle
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, United States
| | - James Nace
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, United States
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, United States.
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One-session bilateral total knee replacement: Late complications and survivorship. Orthop Traumatol Surg Res 2020; 106:903-906. [PMID: 32631714 DOI: 10.1016/j.otsr.2020.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The early morbidity and mortality of one-session bilateral total knee arthroplasty (1-session BTKA) has been reported in the medical literature. However, there is less information about the long-term clinical impact of this strategy. The aim of this study was to report on the late complications (>90 days), clinical outcomes (KOOS and new KSS) along with the survivorship of 1-session BTKA. We hypothesised that 1-session BTKA will cause few late complications and that the implant survival will meet the criteria of the National Institute for Health and Clinical Excellence (NICE). METHODS This single-centre retrospective study analysed a cohort of ASA-1 and ASA-2 patients who underwent 1-session BTKR over an 8-year period (2009 to 2016). The cohort consisted of 116 patients (66% women, 34% men) with mean age at inclusion of 69 years (32-85 years); 22% of patients were ASA-1 and 78% were ASA-2. The implant-related, infection-related or mechanical complications that occurred more than 90 days after the operation, the clinical outcomes (KOOS and New KSS) and radiological outcomes, along with the survivorship were determined during the scheduled follow-up visits at 3 months, 6 months and 1 year postoperative and during the long-term follow-up or during an intercurrent event. RESULTS No patients were lost to follow-up. Fifteen complications occurred (6.5%): four infections, four patellar problems (three cases of clunk syndrome and one of patellofemoral pain), four cases of stiffness, two of unexplained pain and one femoral periprosthetic fracture. Eight patients were readmitted to the hospital (7%); seven were reoperated (3%) and two implants were revised (1%). The functional outcomes (KOOS and New KSS) were significantly improved and 87% of patients were satisfied or very satisfied with this procedure. At a mean follow-up of 5 years, the survivorship estimated using the Kaplan-Meier method was 98.4% (95% CI: 0.933-0.996). CONCLUSION Performing 1-session BTKA is a reliable strategy as it produces a low rate of late complications, excellent medium-term functional outcomes and survivorship that meets NICE criteria, thus confirming our hypothesis. LEVEL OF EVIDENCE IV, retrospective case series.
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Remily EA, Mohamed NS, Wilkie WA, Smith T, Judice A, Forte S, Nace J, Delanois RE. Obesity and its effect on outcomes in same-day bilateral total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:936. [PMID: 32953736 PMCID: PMC7475448 DOI: 10.21037/atm-20-806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background 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. Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- Ethan A Remily
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Nequesha S Mohamed
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Wayne A Wilkie
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Tyler Smith
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Anthony Judice
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Salvador Forte
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - James Nace
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
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High-Quality Skilled Nursing Facilities Are Associated With Decreased Episode-of-Care Costs Following Total Hip and Knee Arthroplasty. J Arthroplasty 2020; 35:1756-1760. [PMID: 32173616 DOI: 10.1016/j.arth.2020.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND With the increasing popularity of alternative payment models following total hip (THA) and knee arthroplasty (TKA), efforts have focused on reducing post-acute care (PAC) costs, particularly patients discharged to skilled nursing facilities (SNFs). The purpose of this study is to determine if preferentially discharging patients to high-quality SNFs can reduce bundled payment costs for primary THA and TKA. METHODS At our institution, a quality improvement initiative for SNFs was implemented at the start of 2017, preferentially discharging patients to internally credentialed facilities, designated by several quality measures. Claims data from Centers for Medicare and Medicaid Services were queried to identify patients discharged to SNF following primary total joint arthroplasty. We compared costs and outcomes between patients discharged to credentialed SNF sites and those discharged to other sites. RESULTS Between 2015 and 2018, of a consecutive series of 8778 primary THA and TKA patients, 1284 (14.6%) were discharged to an SNF. Following initiation of the program, 498 patients were discharged to an SNF, 301 (60.4%) of which were sent to a credentialed facility. Patients at credentialed facilities had significantly lower SNF costs ($11,184 vs $8198, P < .0001), PAC costs ($18,952 vs $15,148, P < .0001), and episode-of-care costs ($34,557 vs $30,831, P < .0001), with no difference in readmissions (10% vs 12%, P = .33) or complications (8% vs 6%, P = .15). Controlling for confounding variables, being discharged to a credentialed facility decreased SNF costs by $1961 (P = .0020) and PAC costs by $3126 (P = .0031) per patient. CONCLUSION Quality improvement efforts through partnership with selective SNFs can significantly decrease PAC costs for patients undergoing primary THA and TKA.
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One-Surgeon vs Two-Surgeon Single-Anesthetic Bilateral Total Knee Arthroplasty: Revision and Mortality Rates From the Australian Orthopedic Association National Joint Replacement Registry. J Arthroplasty 2020; 35:1852-1856. [PMID: 32234328 DOI: 10.1016/j.arth.2020.02.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/19/2020] [Accepted: 02/28/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Outcomes following 1-surgeon single-anesthetic sequential bilateral total knee arthroplasty (seq-BTKA) compared to 2-surgeon single-anesthetic simultaneous bilateral total knee arthroplasty (sim-BTKA) are largely unknown. The current study compared revision rates and all-cause mortality following seq-BTKA vs sim-BTKA using data from the Australian Orthopedic Association National Joint Replacement Registry. METHODS Seq-BTKA and sim-BTKA procedures recorded within the registry between September 1, 1999 and December 31, 2018 were analyzed for subsequent revision and patient mortality. Cumulative percent revision and cumulative percent survival were determined using the Kaplan-Meier method. Revision and mortality rates for sim-BTKA and seq-BTKA were compared using Cox proportional hazards models, adjusting for age and gender. RESULTS Included in the analysis were 27,480 seq-BTKAs and 471 sim-BTKAs. There was no difference in the cumulative percent revision between the 2 groups (hazard ratio 1.23, 95% confidence interval 0.82-1.85). Cumulative percent patient survival was not significantly different between the 2 groups (hazard ratio 1.20, 95% confidence interval 0.93-1.54). CONCLUSION Revision rates and mortality were similar for seq-BTKA and sim-BTKA. Investigation of additional outcomes such as complications not requiring revision, pain, function, and cost is required to comprehensively understand the relative merits of each procedure.
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Jo C, Ko S, Shin WC, Han HS, Lee MC, Ko T, Ro DH. Transfusion after total knee arthroplasty can be predicted using the machine learning algorithm. Knee Surg Sports Traumatol Arthrosc 2020; 28:1757-1764. [PMID: 31254027 DOI: 10.1007/s00167-019-05602-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE A blood transfusion after total knee arthroplasty (TKA) is associated with an increase in complication and infection rates. However, no studies have been conducted to predict transfusion after TKA using a machine learning algorithm. The purpose of this study was to identify informative preoperative variables to create a machine learning model, and to provide a web-based transfusion risk-assessment system for clinical use. METHODS This study retrospectively reviewed 1686 patients who underwent TKA at our institution. Data for 43 preoperative variables, including medication history, laboratory values, and demographic characteristics, were collected. Variable selection was conducted using the recursive feature elimination algorithm. The transfusion group was defined as patients with haemoglobin (Hb) < 7 g/dL after TKA. A predictive model was developed using the gradient boosting machine, and the performance of the model was assessed by the area under the receiver operating characteristic curve (AUC). Data sets from an independent institution were tested with the model for external validation. RESULTS Of the 1686 patients who underwent TKA, 108 (6.4%) were categorized into the transfusion group. Six preoperative variables were selected, including preoperative Hb, platelet count, type of surgery, tranexamic acid, age, and body weight. The predictive model demonstrated good predictive performance using the six variables [AUC 0.842; 95% confidence interval (CI) 0.820-0.856]. Performance was also good according to the external validation using 400 data from an independent institution (AUC 0.880; 95% CI 0.844-0.910). This web-based blood transfusion risk-assessment system can be accessed at http://safetka.net. CONCLUSIONS A web-based predictive model for transfusion after TKA using a machine learning algorithm was developed using six preoperative variables. The model is simple, has been validated, showed good performance, and can be used before TKA to predict the risk of transfusion and guide appropriate precautions for high-risk patients. LEVEL OF EVIDENCE Diagnostic level II.
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Affiliation(s)
- Changwung Jo
- Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Sunho Ko
- Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Woo Cheol Shin
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Taehoon Ko
- Office of Hospital Information, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Saini R, Powell J, Sharma R, Puloski S, Mahdavi S, Smith C, Johnston K. One-stage versus 2-stage bilateral total joint arthroplasty: a matched cohort study. Can J Surg 2020; 63:E167-E173. [PMID: 32302083 PMCID: PMC7828957 DOI: 10.1503/cjs.001019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2019] [Indexed: 01/29/2023] Open
Abstract
Background Patients with bilateral end-stage hip or knee arthritis want to know if it is safe to have bilateral surgery under a single anesthetic, to restore their quality of life as quickly as possible. The purpose of this study was to assess if there is an increase in the rate of postoperative medical adverse events, length of stay (LOS), blood transfusion rate and 30-day readmission rate among patients who undergo 1-stage bilateral total hip arthroplasty (BTHA) and 1-stage bilateral total knee arthroplasty (BTKA) compared with patients who undergo 2-stage BTHA and BTKA. Methods Our study cohorts included patients who underwent BTHA and BTKA between Apr. 1, 2009, and Jan. 31, 2016, in Alberta, Canada. To minimize selection bias associated with our retrospective study design, we matched patients who underwent 1-stage BTHA and BTKA with patients with patients who underwent 2-stage BTHA and BTKA, respectively, for age, sex and number of presurgical risk factors using propensity score in a matching ratio of 1:1. Results Our study included 1645 patients who underwent BTHA and 4125 patients who underwent BTKA. We matched 195 patients who underwent 1-stage BTHA and 302 patients who underwent 1-stage BTKA with patients who underwent 2-stage BTHA and BTKA, respectively. There was no significant difference in postoperative medical adverse events between the 1-stage and 2-stage matched cohort groups for both BTHA (adjusted odds ratio [OR] 1.3, 95% confidence interval [CI] 0.3-4.9) and BTKA (adjusted OR 0.9, 95% CI 0.3-2.6). There was no difference in inpatient, 30- or 90-day mortality between the 2 groups for BTHA or BTKA. Patients who underwent 1-stage BTHA and BTKA had a shorter acute length of stay but increased total length of stay (acute care and rehabilitation unit) and were less likely to be discharged home postoperatively. One-stage BTHA and BTKA were associated with higher odds of blood transfusion than 2-stage BTHA and BTKA. The 30-day readmission rate was significantly lower for 1-stage BTHA than for the 2-stage BTHA matched cohort (adjusted OR 0.3, 95% CI 0.1-0.8), whereas there was no difference in the 30-day readmission rate (adjusted OR 0.6, 95% CI 0.2-1.7) between the 1-stage and 2-stage BTKA matched cohorts. Finally, operating room time was significantly lower for 1-stage BTHA (49.6 min less) and 1-stage BTKA (66.7 min less) than for the 2-stage arthroplasty procedures. Conclusion Healthy patients who undergo 1-stage BTHA and BTKA have postoperative medical complication rates comparable to those of patients who undergo 2-stage procedures with the additional benefits of a shorter acute length of stay, but they do have a higher risk of blood transfusion and are less likely to be discharged directly home from the acute care hospital. A multicentre randomized controlled trial on this topic is currently being condcuted by the Canadian Arthroplasty Society.
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Affiliation(s)
- Raghav Saini
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - James Powell
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - Rajrishi Sharma
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - Shannon Puloski
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - Saboura Mahdavi
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - Christopher Smith
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
| | - Kelly Johnston
- From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith)
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Singh JA, Cleveland JD. Acute kidney injury is associated with increased healthcare utilization, complications, and mortality after primary total knee arthroplasty. Ther Adv Musculoskelet Dis 2020; 12:1759720X20908723. [PMID: 32127927 PMCID: PMC7036495 DOI: 10.1177/1759720x20908723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/24/2020] [Indexed: 01/20/2023] Open
Abstract
Background: The objective of this study was to assess healthcare utilization and
complications associated with acute kidney injury (AKI) in patients
undergoing primary total knee arthroplasty (TKA). Methods: We used the 1998–2014 US National Inpatient Sample to assess whether AKI is
associated with healthcare utilization or in-hospital postoperative
complications post-TKA using multivariable-adjusted logistic regression
analyses. We calculated odds ratios (ORs) and a 95% confidence intervals
(CIs). Sensitivity analyses additionally adjusted for hospital
characteristics (location/teaching status, bed size, and region). Results: Of the 8,127,282 people who underwent primary TKA from 1998 to 2014, 104,366
(1.3%) had a diagnosis of AKI. People with AKI had longer unadjusted mean
hospital stay, 6.1 versus 3.5 days, higher mean hospital
charges, US$71,385 versus US$42,067, and higher rates of
all in-hospital postoperative complications, including mortality. Adjusted
for age, sex, race, underlying diagnosis, medical comorbidity, income, and
insurance payer, AKI was associated with a significantly higher OR (95% CI)
of total hospital charges above the median, 2.76 (2.68, 2.85); length of
hospital stay > 3 days, 2.21 (2.14, 2.28); and discharge to a
rehabilitation facility, 4.68 (4.54, 4.83). AKI was associated with
significantly higher OR (95% CI) of in-hospital complications, including
infection, 2.60 (1.97, 3.43); transfusion, 2.94 (2.85, 3.03); revision, 2.13
(1.72, 2.64); and mortality, 19.75 (17.39, 22.42). Sensitivity analyses
replicated the main study findings, without any attenuation of ORs. Conclusions: AKI is associated with a significantly higher risk of increased healthcare
utilization, complications, and mortality after primary TKA. Future studies
should assess significant factors associated and interventions that can
prevent AKI.
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Affiliation(s)
- Jasvinder A Singh
- University of Alabama, Faculty Office Tower 805B, 510 20 Street S, Birmingham, AL 35294, USA
| | - John D Cleveland
- Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Singh JA, Cleveland JD. Socioeconomic status and healthcare access are associated with healthcare utilization after knee arthroplasty: A U.S. national cohort study. Joint Bone Spine 2020; 87:157-162. [DOI: 10.1016/j.jbspin.2019.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/27/2019] [Indexed: 01/23/2023]
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