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Phillips M, Santori N, Gado I, Akinola B, Tecce S, Shahcheraghi G, Wadhwa M, Ekhtiari S. What Are the Contraindications for Performing Bilateral Total Knee Arthroplasty Under the Same Anesthesia? J Arthroplasty 2025; 40:S99-S101. [PMID: 39447926 DOI: 10.1016/j.arth.2024.10.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 10/16/2024] [Accepted: 10/18/2024] [Indexed: 10/26/2024] Open
Affiliation(s)
- Mark Phillips
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Salvatore Tecce
- Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Gholam Shahcheraghi
- Department of Orthopedics, School of Medicine, Bone and Joint Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seper Ekhtiari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Juravinski Hospital, Hamilton, Ontario, Canada
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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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Balachandran M, Prabhakar S, Zhang W, Parks M, Ma Y. Racial and Ethnic Disparities in Primary Total Knee Arthroplasty Outcomes: A Systematic Review and Meta-Analysis of Two Decades of Research. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02105-x. [PMID: 39158831 DOI: 10.1007/s40615-024-02105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024]
Abstract
Racial disparities in outcomes following total knee arthroplasty (TKA) remain persistent. This systematic review and meta-analysis aims to comprehensively synthesize data between 2000-2020. An electronic search of studies was performed on PubMed, SCOPUS, and the Cochrane Library databases from January 1, 2000, and December 31, 2020. Random effects models were used to report unadjusted and adjusted estimates for a comprehensive list of care outcomes in TKA. 63 studies met PRISMA criteria. Black patients report greater odds of in-hospital mortality (odds ratio [OR]: 1.37, 95% CI: 1.00-1.59 (p = 0.049); adjusted OR [aOR]: 1.34, 95% CI: 1.09-1.64), in-hospital complications (OR: 1.31, 95% CI: 1.27-1.35), 30-day complications (aOR: 1.19, 95% CI: 1.07-1.33), infection (OR: 1.11, 95% CI: 1.07-1.16; aOR: 1.30, 95% CI: 1.16-1.46), bleeding (OR: 1.33, 95% CI: 1.03-1.71; aOR: 1.47, 95% CI: 1.23-1.75), peripheral vascular events (PVE) (aOR: 1.46, 95% CI: 1.11-1.92), length of stay (LOS) (OR: 1.20, 95% CI: 1.08-1.34), extended-LOS (aOR: 1.89, 95% CI: 1.53-2.33), discharge disposition (OR: 1.59, 95% CI: 1.29-1.96; aOR: 1.96, 95% CI: 1.70-2.25), 30-day (OR: 1.20, 95% CI: 1.13-1.27; aOR: 1.17 95% CI: 1.09-1.26) and 90-day (OR: 1.46, 95% CI: 1.17-1.82) readmission compared to White patients. Disparities in bleeding, extended-LOS, discharge disposition, PVE, and 30-day readmission were observed in Asian patients. Hispanic patients experienced disparities in extended LOS and discharge disposition, while Native-American patients had disparities in bleeding outcomes. Persistent racial disparities in TKA outcomes highlight a need for standardized outcome measures and comprehensive data collection across multiple racial groups to ensure greater healthy equity.
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Affiliation(s)
- Madhu Balachandran
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, D.C., USA
| | - Sarah Prabhakar
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Washington, D.C., USA
| | - Wei Zhang
- Department of Mathematics & Statistics, University of Arkansas, Little Rock, AZ, USA
| | - Michael Parks
- Hospital for Special Surgery, New York City, NY, USA
- Weill Cornell Medical College, Cornell University, New York City, NY, USA
| | - Yan Ma
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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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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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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Hummel A, Matsumoto M, Shimoda B, Au DLMT, Andrews SN, Nakasone CK. Complications following single-stage bilateral total knee arthroplasty and unilateral procedures: experience of a high-volume community hospital. Arch Orthop Trauma Surg 2024; 144:315-322. [PMID: 37632532 DOI: 10.1007/s00402-023-05026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 08/09/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION The safety of single-stage bilateral total knee arthroplasty (SSBTKA) compared to unilateral total knee arthroplasty (TKA) remains controversial. The present study compares the 90-day postoperative complications encountered following SSBTKA and unilateral TKA in an unselected cohort of patients performed at a high-volume community hospital. MATERIALS AND METHODS The perioperative electronic medical records of an unselected consecutive cohort of 1032 patients (1345 knees) having undergone unilateral or SSBTKA were reviewed. Ninety-day postoperative complications or need for additional procedures were compared between unilateral and SSBTKA groups. RESULTS A total of 719 and 313 patients underwent unilateral and SSBTKA, respectively. There were no significant differences in age or BMI between groups. Patients undergoing SSBTKA were more likely to be male (p = 0.019), have longer lengths of stay (p < 0.001) and were less likely to discharge directly home (13.1%) compared to unilateral patients (80.9%) (p < 0.001). Patients undergoing SSBTKA were more likely to require a transfusion (14.7%) compared to unilateral patients (2.2%) (p < 0.001). Interestingly, mortality rate following unilateral TKA (1.7%) was significantly higher than SSBTKA (0.0%) (p = 0.013). There were no significant differences regarding other complications or need for additional procedures within 90 days following surgery. CONCLUSION SSBTKA did not result in greater complications when compared to unilateral TKA in this particular cohort. As expected, transfusion rates will likely be higher and there will be a greater need for acute inpatient care following surgery for SSBTKA patients.
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Affiliation(s)
- Amelia Hummel
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Maya Matsumoto
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Brent Shimoda
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Donna L M T Au
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Samantha N Andrews
- Department of Surgery, John A Burns School of Medicine, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Cass K Nakasone
- Department of Surgery, John A Burns School of Medicine, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA.
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Kazubski K, Tomczyk Ł, Bobiński A, Morasiewicz P. Prognostic Factors in Staged Bilateral Total Knee Arthroplasty-A Retrospective Case Series Analysis. J Clin Med 2023; 12:jcm12103547. [PMID: 37240651 DOI: 10.3390/jcm12103547] [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: 04/23/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Bilateral osteoarthritis of the knee is an indication for a bilateral total knee replacement (TKR) procedure. The goal of our study was to assess the sizes of the implants used during the first and second stages of TKR procedures in order to compare their size and identify the prognostic factors for the second procedure. METHODS We evaluated 44 patients who underwent staged bilateral TKR procedures. We assess the following prognostic factors from the first and second surgery: duration of anesthesia, femoral component size, tibial component size, duration of hospital stay, tibial polyethylene insert size, and the number of complications. RESULTS All assessed prognostic factors did not differ statistically between the first and second TKR. A strong correlation was found between the size of femoral components and the size of tibial components used during the first and second total knee arthroplasty. The mean duration of the hospital stay associated with the first TKR surgery was 6.43 days, whereas the mean duration of the second hospital stay was 5.5 days (p = 0.211). The mean sizes of the femoral components used during the first and second procedures were 5.43 and 5.2, respectively (p = 0.54). The mean sizes of the tibial components used during the first and second TKR procedures were 5.36 and 5.25, respectively (p = 0.382). The mean sizes of the tibial polyethylene inserts used during the first and second procedures were 9.45 and 9.34 (p = 0.422), respectively. The mean duration of anesthesia during the first and second knee arthroplasty was 117.04 min and 118.06 min, respectively (p = 0.457). The mean rates of recorded complications associated with the first and second TKR procedures were 0.13 and 0.06 per patient (p = 0.371). CONCLUSIONS We observed no differences between the two stages of treatment in terms of all analyzed parameters. We observed a strong correlation between the size of femoral components used during the first and second total knee arthroplasty. We noted a strong correlation between the size of tibial components used during the first and second procedure. Slightly weaker prognostic factors include the number of complications, duration of anesthesia and tibial polyethylene insert size.
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Affiliation(s)
- Krystian Kazubski
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Witosa 26, 45-401 Opole, Poland
| | - Łukasz Tomczyk
- Department of Food Safety and Quality Management, Poznan University of Life Sciences, Wojska Polskiego 28, 60-637 Poznan, Poland
| | - Andrzej Bobiński
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Witosa 26, 45-401 Opole, Poland
| | - Piotr Morasiewicz
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Witosa 26, 45-401 Opole, Poland
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Lee KH, Chang WL, Tsai SW, Chen CF, Wu PK, Chen WM. The impact of Charlson Comorbidity Index on surgical complications and reoperations following simultaneous bilateral total knee arthroplasty. Sci Rep 2023; 13:6155. [PMID: 37061607 PMCID: PMC10105729 DOI: 10.1038/s41598-023-33196-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/08/2023] [Indexed: 04/17/2023] Open
Abstract
Simultaneous bilateral total knee arthroplasty (TKA) might be associated with higher postoperative morbidity and mortality rates compared with staged bilateral TKA. However, risk factors for surgical complications and reoperations following simultaneous bilateral TKA remain elusive. We conducted this retrospective, single-surgeon case series from 2010 through 2019. A total of 1561 patients who underwent simultaneous bilateral TKA procedures were included. The outcome domains included 30-day and 90-day readmission events for medical or surgical complications and 1-year reoperation events. We performed logistic regression analysis and backward stepwise selection to identify possible risk factors, including age, sex, body mass index, diabetes mellitus (DM), rheumatoid arthritis, American Society of Anesthesiologist (ASA) classification, Charlson Comorbidity Index (CCI), receiving venous thromboembolism (VTE) prophylaxis, or blood transfusion. The overall 30-day, 90-day readmission, and 1-year reoperation rates were 2.11%, 2.88%, and 1.41%, respectively. Higher CCI score (CCI = 4+) was a risk factor for 90-day readmission (aOR: 2.783; 95% CI 0.621-12.465), 90 day readmission for surgical complications (aOR: 10.779; 95% CI 1.444-80.458), and 1 year reoperation (aOR: 4.890; 95% CI 0.846-28.260). Other risk factors included older age, higher ASA level, DM, and receiving VTE prophylaxis. In conclusion, high CCI scores were associated with increased risks of surgical complications and reoperations following simultaneous bilateral TKA procedures.
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Affiliation(s)
- Kun-Han Lee
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Beitou District, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Lin Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Beitou District, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Beitou District, Taipei, 112, Taiwan.
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Beitou District, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Beitou District, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Beitou District, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Kozai L, Matsumoto M, Mathews K, Andrews S, Nakasone C. Perioperative Complications in Patients over 70 Years of Age following Simultaneous Bilateral Total Knee Arthroplasty. J Knee Surg 2023; 36:362-367. [PMID: 34348399 DOI: 10.1055/s-0041-1733884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Single-stage bilateral total knee arthroplasty (ssBTKA) can be used for patients presenting with bilateral arthritis and may result in fewer systemic and wound complications compared with two, independent procedures. However, the safety of ssBTKA in the elderly remains controversial. Therefore, the purpose of this study was to compare early complications and transfusion rates following ssBTKA in patients ≤ 70 years old or > 70 years old. This retrospective chart review of 313 consecutive patients undergoing ssBTKA included 174 patients ≤ 70 years old and 139 patients > 70 years old. Perioperative variables and postoperative complications were compared with univariate analyses between age groups. Multivariate analyses were performed to determine risk factors for developing perioperative complications and transfusions. Compared with patients ≤ 70, patients > 70 had significantly lower body mass index (p < 0.001) and were more commonly female (p = 0.024). Although wound (p > 0.12) and systemic complications (p > 0.54) were similar, 23% of patients > 70 required transfusion compared with only 8% of patients ≤ 70 (p < 0.001). Patients with preoperative anemia (p < 0.001), age > 70 (p = 0.002), or diabetes mellitus (p = 0.007) were at 5.7, 3.3, and 2.9 times greater risk for requiring a transfusion, respectively. Patients > 70 undergoing ssBTKA have a similar complication profile to patients ≤ 70 years old, suggesting age should not be an absolute exclusion criterion for ssBTKA. However, the risk of transfusion was significantly higher in those > 70, despite lower tourniquet times. Treatment of preoperative anemia may decrease the risk of transfusion and could provide adequate safety for patients > 70 to undergo ssBTKA by an experienced surgeon.
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Affiliation(s)
- Landon Kozai
- John A. Burns School of Medicine, Honolulu, Hawaii
| | - Maya Matsumoto
- John A. Burns School of Medicine, Honolulu, Hawaii.,Straub Medical Center, Bone and Joint Center, Honolulu, Hawaii
| | - Kristin Mathews
- Straub Medical Center, Bone and Joint Center, Honolulu, Hawaii
| | - Samantha Andrews
- Straub Medical Center, Bone and Joint Center, Honolulu, Hawaii.,Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Cass Nakasone
- Straub Medical Center, Bone and Joint Center, Honolulu, Hawaii.,Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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Ishii M, Wong K, Shimoda B, Andrews S, Au D, Nakasone CK. Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty? Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04749-y. [PMID: 36604320 PMCID: PMC9815680 DOI: 10.1007/s00402-022-04749-y] [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: 09/23/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The safety and benefits of single stage bilateral total knee arthroplasty (SSBTKA) among older patients as compared to unilateral TKA remains controversial. This study aimed to evaluate the influence of age and comorbidities on complications and early outcomes for unilateral and BTKA in patients over and under 70 years of age. MATERIALS AND METHODS This prospective study compared postoperative complications and early patient-reported outcomes at 6 weeks of 142 unilateral TKA patients (N = 75, ≤ 70; N = 67, > 70) and 89 SSBTKA patients (N = 48, ≤ 70; N = 41, > 70). Patients completed the KOOS JR and PROMIS Global Mental (GMH) and Global Physical Health (GPH) surveys. Knee Society Scores for Knee (KSS-K) and Function (KSS-F) were completed in the clinic. Parametric tests were performed for comparisons of unilateral and BTKA outcomes and complications for patients over and under 70. RESULTS While patient demographics were similar, patients > 70 had more comorbidities than patients ≤ 70 (p < 0.004). There were no significant differences in postoperative complications or readmissions between age groups or procedures. Unilateral TKA patients > 70 had significantly lower pre- (p < 0.001) and post-operative (p = 0.011) KSS-F scores compared to those ≤ 70. SSBTKA patients > 70 had significantly higher preoperative GMH (p = 0.029), postoperative KSS-K (p = 0.027), KOOS JR scores (p = 0.039) and satisfaction (p = 0.048) compared to those ≤ 70. CONCLUSION Age did not influence the risk of early postoperative complications. Additionally, the greater improvements in KOOS JR and higher patient satisfaction for SSBTKA patients > 70 suggests that SSBTKA may meet elderly patient expectations and should not necessarily be discouraged due to safety concerns.
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Affiliation(s)
- Megan Ishii
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Krystin Wong
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Brent Shimoda
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Samantha Andrews
- Department of Surgery, University of Hawai'i, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| | - Donna Au
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Cass K Nakasone
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA.
- Department of Surgery, University of Hawai'i, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
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11
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Wang KY, LaVelle MJ, Gazgalis A, Bender JM, Geller JA, Neuwirth AL, Cooper HJ, Shah RP. Bilateral Total Knee Arthroplasty: Current Concepts Review. JBJS Rev 2023; 11:01874474-202301000-00011. [PMID: 36722826 DOI: 10.2106/jbjs.rvw.22.00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
» Bilateral total knee arthroplasty (BTKA) is an effective surgical treatment for bilateral knee arthritis and can be performed as a simultaneous surgery under a single anesthetic setting or as staged surgeries on separate days. » Appropriate patient selection is important for simultaneous BTKA with several factors coming into consideration such as age, comorbidities, work status, and home support, among others. » While simultaneous BTKA is safe when performed on appropriately selected patients, current evidence suggests that the risk of complications after simultaneous BTKA remains higher than for staged BTKA. » When staged surgery is preferred, current evidence indicates that complication risks are minimized if the 2 knees are staged at least 3 months apart. » Simultaneous BTKA is the economically advantageous treatment option relative to staged BTKA, primarily because of shorter total operative time and total hospital stay.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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12
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Gruenberger E, Bae AS, Kelly T, Ponce BA, McGrory J. Patient-reported dissatisfaction following second side in staged bilateral total knee arthroplasty: A systematic review. World J Orthop 2022; 13:1029-1037. [PMID: 36439367 PMCID: PMC9685631 DOI: 10.5312/wjo.v13.i11.1029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/16/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Around one third of patients who undergo total knee arthroplasty (TKA) will eventually have the contralateral knee replaced. Overall patient satisfaction after staged bilateral total knee arthroplasty procedures performed on different days is reportedly similar to unilateral TKA. Nevertheless, in our anecdotal experience patients often report less satisfying outcomes following the second side. A cursory review of available literature tended to confirm that observation. We sought therefore to consolidate all of the available data on this issue to further investigate this phenomenon.
AIM To consolidate available published data revealing satisfaction scores among patients following staged bilateral TKA, and to evaluate the phenomenon of less satisfying results following TKA2.
METHODS A systematic review of available literature reporting on satisfaction with TKA1 and TKA2 after staged bilateral knee arthroplasty was undertaken using PubMed, Google Scholar, and Embase. From 427 records, five full-length articles met criteria for inclusion in the meta-analysis. The data were then extracted and assessed on the basis of the Reference Citation Analysis (https://www.referencecitationanalysis.com/).
RESULTS A total of 1889 patients with an average age of 68 (range: 38–92) underwent staged bilateral TKA with outcomes reported at 1 year following each TKA with a mean 21.9 mo between surgeries (range: 2 d to 14.5 years). Overall satisfaction with both knees was 83.70% (1581) and dissatisfaction with both knees was 2.75% (52). In the remaining 13.56% (256) who were dissatisfied with one side, 61.0% were dissatisfied with TKA2, and 39.0% were dissatisfied with TKA1. Patient-reported outcome scores for TKA2 were frequently lower than TKA1 even in patients reporting overall satisfaction with both knees.
CONCLUSION At 1-year follow-up, there was a 50% greater risk of dissatisfaction with TKA2 among the 13.56% of patients reporting dissatisfaction in one knee after staged bilateral TKA. Whether the interval between procedures or long-term follow-up changes these results requires further investigation.
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Affiliation(s)
| | - Andrew S Bae
- Department of Orthopedic Surgery, Jack Hughston Memorial Hospital, Phenix City, AL 36867, United States
| | - Tyler Kelly
- The Hughston Foundation, Columbus, GA 31909, United States
| | - Brent A Ponce
- The Hughston Foundation, Columbus, GA 31909, United States
| | - James McGrory
- Department ofOrthopedic Surgery, Hughston Foundation and Jack Hughston Memorial Hospital, Columbus, GA 31909, United States
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13
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Gerner P, Memtsoudis SG, Cozowicz C, Stundner O, Figgie M, Sculco TP, Poultsides L. Improving Safety of Bilateral Knee Arthroplasty: Impact of Selection Criteria on Perioperative Outcome. HSS J 2022; 18:248-255. [PMID: 35645645 PMCID: PMC9096997 DOI: 10.1177/15563316211014891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/12/2021] [Indexed: 02/04/2023]
Abstract
Background: Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. Questions/Purpose: We sought to investigate the effect of these selection criteria on perioperative outcomes. Methods: In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998-2006) and those who underwent surgery after (2007-2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. Results: Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. Conclusion: After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes.
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Affiliation(s)
- Philipp Gerner
- Department of Anesthesia, Critical Care
and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Stavros G. Memtsoudis
- Department of Anesthesiology, Critical
Care & Pain Management, Hospital for Special Surgery, Weill Cornell Medical
College, New York, NY, USA,Stavros G. Memtsoudis, MD, PhD, MBA,
Department of Anesthesiology, Critical Care & Pain Management, Department of
Public Health, Hospital for Special Surgery, Weill Cornell Medical College, 535
E 70th St., New York, NY 10021, USA.
| | - Crispiana Cozowicz
- Department of Anesthesiology,
Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University,
Salzburg, Austria
| | - Ottokar Stundner
- Department of Anesthesiology,
Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University,
Salzburg, Austria
| | - Mark Figgie
- Department of Orthopedic Surgery,
Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Thomas P. Sculco
- Department of Orthopedic Surgery,
Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Lazaros Poultsides
- Academic Orthopedic Department,
Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki,
Greece; Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for
Interdisciplinary Research and Innovation (CIRI), Aristotle University of
Thessaloniki, Thessaloniki, Greece; Department of Orthopaedic Surgery, Division of
Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill
Medical College of Cornell University, New York, NY, USA
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14
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Follett MA, Arora P, Maloney WJ, Goodman SB, Huddleston JI, Amanatullah DF. Staging Bilateral Total Knee Arthroplasties Reduces Alignment Outliers. J Arthroplasty 2022; 37:694-698. [PMID: 35017050 PMCID: PMC8934296 DOI: 10.1016/j.arth.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients frequently present with bilateral symptomatic knee osteoarthritis and request simultaneous total knee arthroplasties (TKAs). Technical differences between simultaneous and staged TKAs could affect clinical and radiographic outcomes. We hypothesized that staged TKAs would have fewer mechanical alignment outliers than simultaneous TKAs. METHODS We reviewed 87 simultaneous and 72 staged TKAs with at least 2 years of follow-up. Radiographic assessment was done using standing long leg and lateral radiographs of the knee. Coronal and sagittal measurements were performed by 4 blinded observers on 2 separate occasions with an intraobserver agreement of 0.95 and interobserver of 0.92. RESULTS The first simultaneous knee had no difference in the probability of establishing the mechanical axis outside 3° of neutral (45%) compared to the first staged knee (54%, P = .337). However, the second simultaneous knee (49%) was more likely to establish the axis outside mechanical neutral compared to the second staged knee (28%; odds ratio 2.54, confidence interval 1.31-4.94, P = .006). There was an increased risk of deep venous thrombosis with staged TKA (odds ratio 2.96, confidence interval 1.28-6.84, P = .011), but other perioperative complication rates were not significantly different. There were no clinically significant differences in range of motion or Knee Society Score. CONCLUSION There is a significantly increased risk of establishing the second knee outside mechanical neutral during a simultaneous TKA compared to staged bilateral TKAs, possibly related to a number of surgeon-related and system-related factors. The impact on clinical outcomes and radiographic loosening may become significant in long-term follow-up.
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Affiliation(s)
- Matthew A. Follett
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - Prerna Arora
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - William J. Maloney
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - James I. Huddleston
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - Derek F. Amanatullah
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway Street, Redwood City, CA 94063,Corresponding Author: Department of Orthopaedic Surgery, Stanford Hospital and Clinics, 450 Broadway Street, Redwood City, CA 94063-6342, Phone: 650-723-2257,
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15
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Amit P, Marya SKS. Age-adjusted Charlson comorbidity index as a novel guideline for patient selection between unilateral versus bilateral simultaneous total knee arthroplasty. Arch Orthop Trauma Surg 2022; 142:657-663. [PMID: 33713185 DOI: 10.1007/s00402-021-03841-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to validate the age-adjusted Charlson comorbidity index as a clinical practice guideline for patient selection between unilateral total knee arthroplasty (UTKA) and bilateral simultaneous total knee arthroplasty (BSTKA). METHODS A consecutive series of 1016 patients undergoing UTKA (402 patients) or BSTKA (614 patients) was analysed. The age-adjusted Charlson comorbidity index (ACCI) was measured for all the patients and graded as low (0-2 score), moderate (3-4 score) and high risk (≥ 5 score). The complications occurring within 3 months of surgery were compared between UTKA and BSTKA recipients. RESULTS Following surgery, the complication rate was comparable between both the groups. However, among high-risk patients, there was significant difference in the complication rates between UTKA and BSTKA groups (12% versus 30.76%, minor; 8% versus 23.07%, major complication). The high-risk patients who had bilateral surgery were at more than three times greater risk of developing major and minor complications than those who had unilateral surgery. CONCLUSION The BSTKA procedure is associated with significantly higher risk of post-operative complications than UTKA procedure in patients with ≥ 5 ACCI scores.
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Affiliation(s)
- Priyadarshi Amit
- Department of Orthopaedics and Joint Replacement, Max Smart Super Speciality Hospital, Saket, New Delhi, 110017, India.
- Department of Trauma & Orthopaedics, Barts Health NHS Trust, Whitechapel, Lodon, E11FR, UK.
| | - S K S Marya
- Department of Orthopaedics and Joint Replacement, Max Smart Super Speciality Hospital, Saket, New Delhi, 110017, India
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16
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Xie C, Ou S, Lin Z, Zhang J, Li Q, Lin L. Prediction of 90-Day Local Complications in Patients After Total Knee Arthroplasty: A Nomogram With External Validation. Orthop J Sports Med 2022; 10:23259671211073331. [PMID: 35224115 PMCID: PMC8873555 DOI: 10.1177/23259671211073331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Local complications after total knee arthroplasty (TKA) significantly affect the patient’s prognosis. Nomograms can be a useful tool for predicting such complications. Purpose: To compare the preoperative and intraoperative factors of patients who underwent TKA with and without complications and to construct and validate a nomogram based on selective predictors of local complications within 90 days postoperatively. Study Design: Case-control study; Level of evidence, 3. Methods: The nomogram was developed in a primary cohort that consisted of 410 patients who underwent primary TKA at the authors’ institution between January 2015 and September 2018. Predictor variables included 4 major local complications that can occur within 90 days: reoperation (including implant revision or removal for any reason and manipulation under anesthesia), infection, bleeding requiring ≥4 unit transfusion of red blood cells within 72 hours of surgery, and peripheral nerve injury. The authors used least absolute shrinkage and selection operator (LASSO) regression analysis for data dimension reduction and feature selection. Multivariable logistic regression analysis was used to develop the nomogram. Performance of the nomogram was assessed using C-index, calibration plot, area under the receiver operating characteristic curve (AUC), and decision curve analysis (DCA). The model was subjected to bootstrap validation and external validation using a prospective cohort of 249 patients. Results: Four significantly prognostic factors were incorporated into the nomogram: age-adjusted Charlson Comorbidity Index, American Society of Anesthesiologists score, tourniquet time, and estimated intraoperative blood loss. The model displayed good discrimination, with a C-index of 0.819 and an AUC of 0.819. The calibration curves showed optimal agreement between nomogram prediction and actual observation. A high C-index value of 0.801 could still be reached in bootstrap validation. Application of the nomogram in the validation cohort showed good discrimination (C-index, 0.731) and good calibration. DCA demonstrated that the nomogram was clinically useful. Conclusion: The authors developed and validated a novel nomogram that can provide individual prediction of local complications within 90 days for patients after TKA. This practical tool may be conveniently used to estimate individual risk and help clinicians take measures to minimize or prevent the incidence of complications.
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Affiliation(s)
- Chao Xie
- Department of Joint and Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Songwen Ou
- Department of Joint and Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou, China
- The Eighth People’s Hospital of Dongguan, Guangdong Medical University, Dongguan City, China
| | - Zhaowei Lin
- Department of Joint and Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Jinwei Zhang
- Department of Joint and Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Qi Li
- Department of Joint and Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Lijun Lin
- Department of Joint and Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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17
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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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18
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Frane N, Stapleton EJ, Petrone B, Atlas A, Lutsky L, Cohn RM. Patient Satisfaction After Lower Extremity Total Joint Arthroplasty: An Analysis of Medical Comorbidities and Patient Demographics. J Patient Exp 2021; 8:23743735211018089. [PMID: 34179447 PMCID: PMC8205331 DOI: 10.1177/23743735211018089] [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] [Indexed: 11/23/2022] Open
Abstract
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
survey has received increased attention to determine which demographics may
influence patient satisfaction after Total Hip and Knee Arthroplasty. The
purpose of this study was to evaluate the various effects that patient-specific
factors, medical comorbidities, and demographics had on patient satisfaction.
Two thousand and ninety-two patients underwent lower extremity total joint
arthroplasty at our institution between 2014 and 2018. Nine hundred twenty-three
of these patients responded to their HCAHPS survey (44%). Most patients (609,
66%) underwent primary total knee arthroplasty followed by 244 (26.4%) total hip
arthroplasties, 35 (3.8%) revision total knee arthroplasties, 28 (3.0%)
bilateral total knee arthroplasties, and 7 (0.8%) revision total hip
arthroplasties. Increasing age and length of stay were associated with a
decrease in patient satisfaction whereas patients who were married reported
higher satisfaction. Patients discharged to a rehabilitation facility had a 12%
decrease in top-box response rate compared to those discharged home. Contrary to
our hypothesis, specific procedure type and the presence of comorbidities failed
to predict patient satisfaction. The results of this study shed light on the
intricate relationship between patient satisfaction and patient-specific
factors. Furthermore, health care workers can counsel patients on expected
satisfaction when considering total hip and knee arthroplasty.
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Affiliation(s)
- Nicholas Frane
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Plainview, NY, USA
| | - Erik J Stapleton
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Plainview, NY, USA
| | - Brandon Petrone
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Plainview, NY, USA
| | - Aaron Atlas
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, USA
| | - Larry Lutsky
- Karsnoff Quality Management Institute, New Hyde Park, NY, USA
| | - Randy M Cohn
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Plainview, NY, USA
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19
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Warren JA, Siddiqi A, Krebs VE, Molloy R, Higuera CA, Piuzzi NS. Bilateral Simultaneous Total Knee Arthroplasty May Not Be Safe Even in the Healthiest Patients. J Bone Joint Surg Am 2021; 103:303-311. [PMID: 33369981 DOI: 10.2106/jbjs.20.01046] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bilateral total knee arthroplasty (TKA) has been shown to increase both mortality and complications, but has potential benefits including decreased length of stay, rehabilitation time, and costs. The purpose of this study was to use data from a nationally representative database to identify if there is a population of patients undergoing TKA in whom bilateral TKA can be safely performed, by comparing 30-day mortality and complication rates with those of patients undergoing unilateral TKA. METHODS The National Surgical Quality Improvement Program (NSQIP) was queried to compare 30-day rates of mortality and any complication between bilateral TKA and unilateral TKA. A total of 8,291 patients who underwent bilateral TKA were matched 1:1 with a unilateral TKA control cohort (n = 315,219) by morbidity probability, which is a cumulative variable encompassing demographic characteristics, comorbidities, and laboratory values. Patients were divided into quartiles based on morbidity probability. Binary logistic regression comparing bilateral TKA and unilateral TKA for the same quartiles was performed to establish if any population could safely have bilateral TKA performed. RESULTS Bilateral TKA had an increased risk for all complications (p < 0.001) and major complications (p < 0.001) when compared with unilateral TKA regardless of health status. For all complications, there was a greater than threefold increase for the first quartile (healthiest patients) (p < 0.001), a greater than fourfold increase for the second and third quartiles (p < 0.001), and a greater than threefold increase for the fourth quartile (least healthy patients) (p < 0.001). For major complications, there was a greater than twofold increase for the first quartile (p = 0.001) and the second quartile (p < 0.001), an almost threefold increase for the third quartile (p < 0.001), and a 57% increase for the fourth quartile (p = 0.005). CONCLUSIONS This study will assist shared decision-making between orthopaedic surgeons and patients by suggesting that bilateral TKA may not be as safe an option for even healthy individuals compared with unilateral TKA. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jared A Warren
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ahmed Siddiqi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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20
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Shah S, Otsuka T, Bhattacharjee M, Laurencin CT. Minimally Invasive Cellular Therapies for Osteoarthritis Treatment. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2020. [DOI: 10.1007/s40883-020-00184-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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Shearer J, Agius L, Burke N, Rahardja R, Young SW. BMI is a Better Predictor of Periprosthetic Joint Infection Risk Than Local Measures of Adipose Tissue After TKA. J Arthroplasty 2020; 35:S313-S318. [PMID: 32139192 DOI: 10.1016/j.arth.2020.01.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/15/2020] [Accepted: 01/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Both body mass index (BMI) and local measures of adiposity at the surgical site have been identified as independent risk factors for periprosthetic joint infection (PJI) (periprosthetic joint infection) after total knee arthroplasty (TKA). We aimed to 1) evaluate previously used measures of assessing knee adiposity and 2) determine the best measure for predicting both surgical duration and PJI after TKA. METHODS We performed a multicentre retrospective review of 4745 patients who underwent primary TKA between January 2013 and December 2016. Patient demographic information, surgical duration and postoperative infection status within one year were obtained. Preoperative weight-bearing AP and lateral x-rays were analyzed to determine prepatellar adipose thickness, bony width of the tibial plateau, and total soft tissue knee width. The knee adipose index (KAI) was calculated from the ratio of bone to total knee width. RESULTS We observed substantial variability in both local measures of adiposity compared with BMI. Neither measure of local knee adipose showed a significant correlation with PJI risk. By contrast, there was a strong correlation between PJI risk and BMI >35 (odds ratio 2.9, 95% CI 1.4-6.1). Surgical duration increased with both BMI and measures of local adipose tissue (KAI and prepatellar fat thickness). CONCLUSION Local adipose deposition varies greatly for any given BMI. In this study, BMI was a better predictor of PJI after TKA than local measures of knee adipose tissue.
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Affiliation(s)
- Julia Shearer
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Lewis Agius
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Neil Burke
- Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland
| | - Richard Rahardja
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Simon W Young
- School of Medicine, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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The Utilization of Vital Signs During Physical Therapy Evaluation and Intervention After Elective Total Joint Replacement: A Mixed-Methods Pilot Study. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clement ND, Merrie KL, Weir DJ, Holland JP, Deehan DJ. Asynchronous Bilateral Total Knee Arthroplasty: Predictors of the Functional Outcome and Patient Satisfaction for the Second Knee Replacement. J Arthroplasty 2019; 34:2950-2956. [PMID: 31331702 DOI: 10.1016/j.arth.2019.06.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The primary aim of this study is to identify independent preoperative predictors of outcome and patient satisfaction for the second total knee arthroplasty (TKA). METHODS A retrospective cohort of 454 patients undergoing an asynchronous (6 weeks or more apart) bilateral primary TKA were identified from an arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-12 scores were collected preoperatively and 1 year postoperatively. Overall patient satisfaction was assessed at 1 year. RESULTS The 1 year WOMAC pain score (P = .01), and improvement in WOMAC pain (P < .001) and functional (P = .002) scores were significantly lower for the second TKA. Worse preoperative WOMAC pain, function, and stiffness scores were demonstrated to be independent predictors of improvement in the WOMAC pain, function, and stiffness scores, respectively, for both the first and second TKA. The overall rate of satisfaction with the first TKA was 94.0% and 94.7% for the second TKA (P = .67). The rate of satisfaction for the second TKA was 77.8% for patients that were dissatisfied with their first TKA, which was an independent predictor of dissatisfaction (P = .02). CONCLUSION Improvement in pain and function is less with the second TKA, but the satisfaction rate remains similar. There are common independent predictors for change in the WOMAC score for the first and second TKA; however, the predictors of satisfaction were different with no common factors. Patients that were dissatisfied with their first TKA were more likely to be dissatisfied with their second TKA. LEVEL OF EVIDENCE II Prognostic retrospective cohort study.
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Affiliation(s)
- Nicholas D Clement
- Department of Orthopedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Katie L Merrie
- Department of Orthopedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - David J Weir
- Department of Orthopedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - James P Holland
- Department of Orthopedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - David J Deehan
- Department of Orthopedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Management of Severe Pulmonary Hypertensive Disease for Surgical and Nonsurgical Procedures. Int Anesthesiol Clin 2019; 56:e28-e55. [PMID: 30204604 DOI: 10.1097/aia.0000000000000202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Liu L, Liu H, Zhang H, Song J, Zhang L. Bilateral total knee arthroplasty: Simultaneous or staged? A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15931. [PMID: 31145362 PMCID: PMC6708906 DOI: 10.1097/md.0000000000015931] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is one of the most successful orthopedic surgeries performed in recent decades. However, controversies still exist between conducting simultaneous or staged bilateral TKA. The objective of this study is to conduct a systematic review assessing the clinical outcome associated with simultaneous bilateral and staged bilateral total knee arthroplasty (BTKA). METHODS A search was applied to CNKI, Embase, Medline, and Cochrane central database (January 2000-July 2018). All studies that compared simultaneous bilateral TKA (simBTKA) with staged bilateral TKA (staBTKA) without language restriction were reviewed, and qualities of included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled and a meta-analysis completed. RESULTS The 18 studies were identified to be eligible. The 18 comparative studies published from 2001 to 2018, covered 73617 participants in the simBTKA group and 61838 in the staBTKA group, respectively. Results of meta-analyses indicated that simBTKA showed a lower risk of deep infection and respiratory complications, but increased mortality, pulmonary embolism (PE), and deep-vein thrombosis (DVT) compared with staBTKA. There were no significant differences in revision, superficial infection, arthrofibrosis, cardiac complications, neurological complications and urinary complications between procedures. CONCLUSIONS Since there are risks and benefits to both procedures, these potential complications must be interpreted in light of each individual patient's needs and concerns. Further research must be conducted, in the form of a randomized clinical trial, to evaluate the outcomes mentioned in this review.
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Affiliation(s)
- Limin Liu
- Department of Orthopaedic Surgery, The North China Petroleum Administration Bureau General Hospital, Renqiu
| | - Hongtian Liu
- Tuberculosis prevention and control center, Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang, Hebei, P.R. China
| | - Hui Zhang
- Department of Orthopaedic Surgery, The North China Petroleum Administration Bureau General Hospital, Renqiu
| | - Jingtao Song
- Department of Orthopaedic Surgery, The North China Petroleum Administration Bureau General Hospital, Renqiu
| | - Ling Zhang
- Department of Orthopaedic Surgery, The North China Petroleum Administration Bureau General Hospital, Renqiu
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Early morbidity and mortality after single-stage bilateral total knee replacement. Orthop Traumatol Surg Res 2018; 104:1199-1203. [PMID: 30309768 DOI: 10.1016/j.otsr.2018.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Single-stage bilateral total knee replacement (TKR) has the advantages of requiring only one hospital stay and one anesthesia session, having a shorter rehabilitation period, and reducing the cost of patient care. However, this strategy is controversial because of the perioperative risk. We hypothesized that this strategy did not cause early perioperative mortality and that the early morbidity and readmission rates would be low when patients are selected based on their ASA score. METHODS This single-center retrospective study analyzed a cohort of ASA-1 and ASA-2 patients who underwent single-stage bilateral TKR over an 8-year period (2009 to 2016). The study cohort consisted of 116 patients, mainly women with mean age of 69 years at inclusion; 22.4% of patients were ASA-1 and 77.6% were ASA-2. Death and early complications during the first 90 days postoperative, the early readmission rate and the blood-sparing strategy were analyzed using the clinical and paraclinical data collected during the hospital stay, during the convalescent care center stay, and during the follow-up visits at 6 weeks and 3 months postoperative. The analysis was completed using the intrahospital software Clinicom, which allowed us to trace all the events and episodes for each patient. RESULTS The early mortality rate was 0%. There were five major complications (4.3%) and thirteen minor complications (11%). The early readmission rate was 5.2%. Homologous blood transfusion was performed in 36% of patients. Administration of tranexamic acid reduced this rate to 24.3% versus 44% in patients not taking it (p=0.06). CONCLUSION The perioperative mortality in this selected population is zero and the early morbidity is acceptable. The early readmission rate is also low. Thus proposing single-stage bilateral TKR to patients meeting the criteria defined in this study is a valid strategy. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Masrouha KZ, Hoballah JJ, Tamim HM, Sagherian BH. Comparing the 30-Day Risk of Venous Thromboembolism and Bleeding in Simultaneous Bilateral vs Unilateral Total Knee Arthroplasty. J Arthroplasty 2018; 33:3273-3280.e1. [PMID: 29970325 DOI: 10.1016/j.arth.2018.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Simultaneous bilateral total knee arthroplasty (SBTKA) may offer certain benefits; however, its overall safety is still disputed. This study aimed at comparing the risk of thromboembolism and bleeding in patients who underwent SBTKA vs unilateral total knee arthroplasty (TKA). METHODS The American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2015 was used to investigate the short-term postoperative complications and their risk factors following SBTKA as compared to unilateral TKA. Demographics, comorbidities, and 30-day outcomes were analyzed. Complications with an increased incidence following SBTKA were stratified to identify subgroups of patients at high risk. RESULTS A total of 155,022 patients were identified, of which 150,581 underwent unilateral TKA and 4441 underwent SBTKA. The SBTKA group was found to be at a higher risk of venous thromboembolism (VTE), bleeding, and composite morbidity. Stratification analysis revealed that SBTKA subgroups at higher risk of VTE include patients of black or Asian origin, obese patients, and those who underwent anesthesia other than general or spinal/epidural. SBTKA subgroups at higher risk of bleeding include patients older than 85 years, those with race other than white, underweight and obese patients, and patients who underwent anesthesia other than spinal/epidural. Although none of the subgroups were protected from bleeding, patients who underwent spinal/epidural anesthesia had a lower risk of bleeding compared to other types of anesthesia. CONCLUSION SBTKA confers an increased risk of postoperative VTE, bleeding, and composite morbidity at 30 days, with no increase in mortality.
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Affiliation(s)
- Karim Z Masrouha
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jamal J Hoballah
- Division of Vascular Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani M Tamim
- Department of Internal Medicine, Biostatistics Unit in the Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bernard H Sagherian
- Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Lizaur-Utrilla A, Serna-Berna R, Vizcaya-Moreno MF, Martinez-Mendez D, Marco-Gomez L, Lopez-Prats FA. Comparison of Functional Outcomes Between the First and Second Knee in Staged Bilateral Total Knee Arthroplasty With Diverse Intervals Between Stages. J Arthroplasty 2018; 33:2863-2867. [PMID: 29776854 DOI: 10.1016/j.arth.2018.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The objective of the study was to analyze if the length of interval time between stages influenced functional and quality of life outcomes in patients with staged bilateral primary total knee arthroplasty (TKA). METHODS This is a retrospective comparative study between 93 patients with an interval between stages of 6-8 months (6-month group), 112 of 12-14 months (1-year group), and 108 of 24-26 months (2-year group). Outcome variables were Knee Society scores, Western Ontario and McMaster Universities, Short Form, and patient satisfaction. RESULTS Overall, the mean follow-up for the first TKA was 8.2 (range, 7-10) years, and for the second TKA, 6.7 (range, 5-10) years. At last follow-up, functional and patient-related outcomes were similar for both knees, regardless of the interval. However, mental score and patient satisfaction were significantly better for the second than for the first TKA in the 2-year group. Age did not correlate significantly with the functional scores but was significantly correlated with the mental score. CONCLUSION The performing staged bilateral TKA with a wide interval between surgeries provided equivalent functional outcomes and quality of life for both knees. Postoperative outcomes were not affected by the length of the time interval between procedures or age. Our results can help the surgeon to inform the patients reliably about what they can expect in the delay of a second knee replaced. Thus, patients could make an informed decision.
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Affiliation(s)
- Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain; Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad, Alicante, Spain
| | - Ricardo Serna-Berna
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain
| | - Maria F Vizcaya-Moreno
- Clinical Research Group, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | | | - Luis Marco-Gomez
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain
| | - Fernando A Lopez-Prats
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad, Alicante, Spain
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Shaw B, Darrow M, Derian A. Short-Term Outcomes in Treatment of Knee Osteoarthritis With 4 Bone Marrow Concentrate Injections. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118781080. [PMID: 29977117 PMCID: PMC6024328 DOI: 10.1177/1179544118781080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/06/2018] [Indexed: 12/27/2022]
Abstract
Background Preliminary research suggests that bone marrow concentrate (BMC), which contains mesenchymal stem cells and platelets, is a promising treatment for knee osteoarthritis. The aim of this study was to build on this preliminary research by reporting the short-term progress of 15 patients (20 knees) with knee osteoarthritis through 4 BMC treatments. Methods Patients underwent four sequential BMC treatments with mean injection times of 13.80 days after the first treatment, 21.40 days after the second treatment, and 33.50 days after the third treatment. The last follow-up was conducted a mean 86 days after the first treatment. Baseline and posttreatment outcomes of resting pain, active pain, lower functionality scale, and overall improvement percentage were compared after each treatment. Results Patients experienced statistically significant improvements in active pain and functionality score after the first treatment. Additionally, patients experienced a mean decrease in resting pain after the first treatment, yet outcomes were not statistically significant until after the second treatment. On average, patients experienced an 84.31% decrease in resting pain, a 61.95% decrease in active pain, and a 55.68% increase in functionality score at the final follow-up. Patients also reported a mean 67% total overall improvement at study conclusion. Outcomes at the final follow-up after the fourth treatment were statistically significant compared to outcomes at baseline, after first treatment, after second treatment, and after third treatment. Conclusions These results are promising, and additional research with a larger sample size and longer follow-up is needed to further examine the treatment effectiveness of multiple BMC injections for knee osteoarthritis.
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Affiliation(s)
- Brent Shaw
- Darrow Stem Cell Institute, Los Angeles, CA, USA
| | - Marc Darrow
- Darrow Stem Cell Institute, Los Angeles, CA, USA
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Does blood transfusion type affect complication and length of stay following same-day bilateral total knee arthroplasty? J Orthop 2018; 15:308-312. [PMID: 29556115 DOI: 10.1016/j.jor.2018.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/18/2018] [Indexed: 12/18/2022] Open
Abstract
Same-day Bilateral Total Knee Arthroplasty (BTKA) safety is still controversial. The aim of this study was to examine the association of blood transfusion type (pure autologous, pure allogeneic, and combined) with complication and prolonged length of stay (PLOS) following same-day BTKA. 649 consecutive patients were retrospectively identified over a two-year period. Pure allogeneic transfusions were associated with increased odds of minor complication when compared to patients who had pure autologous transfusions. No association was found between blood transfusion type and major complication or PLOS. Our results suggest that blood transfusion type may be influential in minor complication after BTKA.
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Mutsuzaki H, Watanabe A, Komatsuzaki T, Kinugasa T, Ikeda K. Investigation of perioperative safety and clinical results of one-stage bilateral total knee arthroplasty in selected low-risk patients. J Orthop Surg Res 2018; 13:14. [PMID: 29343282 PMCID: PMC5772713 DOI: 10.1186/s13018-018-0720-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 01/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background An increased perioperative complication rate has been a concern with one-stage bilateral total knee arthroplasty (TKA). The purpose of this study was to retrospectively investigate the perioperative safety and clinical results of one-stage bilateral TKA in selected low-risk patients. Methods Sixty-seven patients who received one-stage bilateral TKAs for osteoarthritis who were American Society of Anesthesiology (ASA) class 1 or 2 were included in this study. Perioperative complications, blood loss, transfusion rate, blood laboratory results, and clinical results were evaluated up to 1 year after surgery. Results No major complications (deep infection, pulmonary embolism, cerebrovascular accident, myocardial infarction, death, or removal or revision of the implants) were observed. The average total blood loss was 1139.5 ml. The transfusion rate was 95.5%. Postoperative hemoglobin level and C-reactive protein level gradually improved up to postoperative day 21 (P < 0.01). Bilateral knee extension knee angles and clinical scores improved postoperatively as compared with preoperative values (P < 0.01). Conclusions Although total blood loss and transfusion rate can be high, this preliminary case series suggested that the one-stage bilateral TKA in ASA class 1 or 2 patients can have high perioperative safety levels, and good clinical results can be obtained up to 1 year after surgery. If low-risk patients are selected for bilateral TKA, a one-stage procedure can be beneficial for patients, with a minimal increase in the risk of complications.
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Affiliation(s)
- Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0394, Japan. .,Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan.
| | - Arata Watanabe
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
| | - Tetsuya Komatsuzaki
- Department of Anesthesiology, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
| | - Tomonori Kinugasa
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
| | - Kotaro Ikeda
- Department of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 300-3295, Japan
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Abstract
Total joint arthroplasty is one of the most common surgical procedures performed for end-stage osteoarthritis. The increasing demand for knee and hip arthroplasties along with the improvement in life expectancy has created a substantial medical and economic impact on the society. Effective planning of health care for these individuals is vital. The best method for providing anesthesia and analgesia for total joint arthroplasty has not been defined. Yet, emerging evidence suggests that the type of anesthesia can affect morbidity and mortality of patients undergoing these procedures.
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Affiliation(s)
- Dalia H Elmofty
- Department of Anesthesia & Critical Care, The University of Chicago, Chicago, Illinois
| | - Asokumar Buvanendran
- Department of Anesthesia & Critical Care, Rush University Medical Center, Chicago, Illinois
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Jørgensen CC, Kehlet H. Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty. Acta Anaesthesiol Scand 2017; 61:436-444. [PMID: 28150297 DOI: 10.1111/aas.12860] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/05/2017] [Accepted: 01/07/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Post-operative mortality is an important adverse outcome, including in total hip (THA) and knee arthroplasty (TKA). However, whether mortality is due to anaesthetic/surgical complications, surgically induced organ dysfunction or unrelated to surgery is rarely considered. METHODS Prospective observational study in 13,775 consecutive THA/TKAs with similar fast-track protocols and a median length of stay of 2 days. Complete 90-days follow-up through national registries, followed by review of medical records and death certificates. Relation between mortality and surgically induced organ dysfunction were classified as certain, probable, possible or unlikely. RESULTS Of a total of 44 deaths (0.3%), 28 (0.2%) were found to have certain or probably relation with surgery and were considered as surgery-related. Surgery-related deaths were more common after THA than TKA (0.3% vs. 0.1% P = 0.044), occurred after median 14 days and 19 of 28 were between day 0-30. Of the remaining 16 deaths (0.1%), nine were found to be possible and seven to be unlikely related to surgery, and occurred a median of 42 and 61 days after surgery. The most common initial organ dysfunction for surgery-related deaths was pulmonary (6/28) and gastrointestinal (6/28), while the most common reported cause of death were pulmonary (9/28) and cardiac events (6/28). In five of the seven unlikely related deaths mortality was attributed to underlying cancer. CONCLUSION Ninety-days mortality was 0.3% in THA and TKA, but only 28 of 44 deaths (64%) were found to be surgery-related. Reporting total mortality rate or cause of death without considerations on surgery induced organ dysfunction, may be insufficient for future aims to reduce post-operative mortality.
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Affiliation(s)
- C. C. Jørgensen
- Section for Surgical Pathophysiology; Rigshospitalet; Copenhagen University; Copenhagen Denmark
- The Lundbeck Foundation Centre for Fast-track Hip and Knee replacement; Copenhagen Denmark
| | - H. Kehlet
- Section for Surgical Pathophysiology; Rigshospitalet; Copenhagen University; Copenhagen Denmark
- The Lundbeck Foundation Centre for Fast-track Hip and Knee replacement; Copenhagen Denmark
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Goyal R, Mittal G, Yadav AK, Sethi R, Chattopadhyay A. Adductor canal block for post-operative analgesia after simultaneous bilateral total knee replacement: A randomised controlled trial to study the effect of addition of dexmedetomidine to ropivacaine. Indian J Anaesth 2017; 61:903-909. [PMID: 29217856 PMCID: PMC5703004 DOI: 10.4103/ija.ija_277_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background and Aims: Knee replacement surgery causes tremendous post-operative pain and adductor canal block (ACB) is used for post-operative analgesia. This is a randomised, controlled, three-arm parallel group study using different doses of dexmedetomidine added to ropiavcaine for ACB. Methods: A total of 150 patients aged 18–75 years, scheduled for simultaneous bilateral total knee replacement, received ultrasound-guided ACB. They were randomised into three groups -Group A received ACB with plain ropivacaine; Groups B and C received ACB with ropivacaine and addition of dexmedetomidine 0.25 μg/kg and 0.50 μg/kg, respectively, on each side of ACB. The primary outcome was the duration of analgesia. Total opioid consumption, success of early ambulation, and level of patient satisfaction were also assessed. Results: The patient characteristics and block success rates were comparable in all groups. Group C patients had longer duration of analgesia (Group C 18.4 h ± 7.4; Group B 14.6 ± 7.1; Group A 10.8 ± 7; P < 0.001); lesser tramadol consumption (Group C 43.8 mg ± 53.2; Group B 76.4 ± 49.6; Group A 93.9 mg ± 58.3; P < 0.001) and lesser pain on movement (P < 0.001). The patients in Group B and C walked more steps than in Group A (P < 0.002). The level of patient satisfaction was highest in Group C (P < 0.001). Conclusions: The addition of dexmedetomidine to ropivacaine resulted in longer duration of analgesia after adductor canal block for simultaneous bilateral total knee replacement surgery.
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Affiliation(s)
- Rakhee Goyal
- Department of Anaesthesia and Critical Care, Army Hospital (Research and Referral), New Delhi, India
| | - Gaurav Mittal
- Department of Orthopaedics, Army Hospital (Research and Referral), New Delhi, India
| | - Arun Kumar Yadav
- Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rishab Sethi
- Department of Anaesthesia and Critical Care, Army Hospital (Research and Referral), New Delhi, India
| | - Animesh Chattopadhyay
- Department of Anaesthesia and Critical Care, Army Hospital (Research and Referral), New Delhi, India
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Marya SKS, Amit P, Singh C. Impact of Charlson indices and comorbid conditions on complication risk in bilateral simultaneous total knee arthroplasty. Knee 2016; 23:955-959. [PMID: 27802921 DOI: 10.1016/j.knee.2016.05.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/14/2016] [Accepted: 05/25/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the influence of Charlson indices and comorbid conditions on the risk of perioperative complications in bilateral simultaneous total knee arthroplasty (BSTKA). METHODS In our retrospective analysis, 556 patients including 133 males and 423 females (mean age 65.8years), who had undergone bilateral simultaneous total knee arthroplasty between 2011 and 2014 were included. Risk factors (Charlson comorbidity index (CCI), age-adjusted Charlson comorbidity index (ACCI), and comorbid illnesses) and perioperative complications were noted, and subsequently, statistical tests were applied. RESULTS There was significant association between Charlson indices and most of the complications (P<0.05) with high-risk ACCI groups (a score>5) bearing maximum odds for cumulative major complication (OR 4.165, P<0.001, 95% CI 1.874 to 9.256). In addition, hypertension, non-ischemic cardiac illness, and moderate to severe chronic kidney disease proved be to be determinants for major complications (P=0.031, P=0.041, and P=0.014, respectively). We also found significant associations between organ-specific illnesses and complications such as cardiac, pulmonary, neurological and renal complications (P<0.05). CONCLUSIONS Both CCI and ACCI are predictors of post-operative complications with ACCI being the better predictive determinant. Hence, these predictors should be used for risk stratification prior to patient selection for BSTKA. The influence of hypertension, non-ischemic cardiac illness and moderate to severe chronic kidney disease should also be considered during patient selection. Moreover, optimum organ function at the time of surgery should be a priority to avoid these complications.
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Affiliation(s)
- S K S Marya
- Department of Orthopaedics and Joint Replacement, Max Institute of Musculoskeletal Sciences, Saket, New Delhi, India.
| | - Priyadarshi Amit
- Department of Orthopaedics and Joint Replacement, Max Institute of Musculoskeletal Sciences, Saket, New Delhi, India.
| | - Chandeep Singh
- Department of Orthopaedics and Joint Replacement, Max Institute of Musculoskeletal Sciences, Saket, New Delhi, India.
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Abstract
Abstract
Background
This propensity score–matched cohort study evaluates the effect of anesthetic technique on a 30-day mortality after total hip or knee arthroplasty.
Methods
All patients who had hip or knee arthroplasty between January 1, 2003, and December 31, 2014, were evaluated. The principal exposure was spinal versus general anesthesia. The primary outcome was 30-day mortality. Secondary outcomes were (1) perioperative myocardial infarction; (2) a composite of major adverse cardiac events that includes cardiac arrest, myocardial infarction, or newly diagnosed arrhythmia; (3) pulmonary embolism; (4) major blood loss; (5) hospital length of stay; and (6) operating room procedure time. A propensity score–matched-pair analysis was performed using a nonparsimonious logistic regression model of regional anesthetic use.
Results
We identified 10,868 patients, of whom 8,553 had spinal anesthesia and 2,315 had general anesthesia. Ninety-two percent (n = 2,135) of the patients who had general anesthesia were matched to similar patients who did not have general anesthesia. In the matched cohort, the 30-day mortality rate was 0.19% (n = 4) in the spinal anesthesia group and 0.8% (n = 17) in the general anesthesia group (risk ratio, 0.42; 95% CI, 0.21 to 0.83; P = 0.0045). Spinal anesthesia was also associated with a shorter hospital length of stay (5.7 vs. 6.6 days; P < 0.001).
Conclusions
The results of this observational, propensity score–matched cohort study suggest a strong association between spinal anesthesia and lower 30-day mortality, as well as a shorter hospital length of stay, after elective joint replacement surgery.
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Kandemir T, Muslu S, Kalaycı D, Kandemir E. Effects of Systemic Disorders on Postoperative Complications After Simultaneous Bilateral Total Knee Replacement. Turk J Anaesthesiol Reanim 2016; 43:169-73. [PMID: 27366490 DOI: 10.5152/tjar.2015.48378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/21/2014] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The aim of the present study was to retrospectively evaluate the association between accompanying systemic disorders and major complications developing in the early postoperative period in patients who underwent simultaneous bilateral total knee arthroplasty with combined spinal and epidural anaesthesia. METHODS In the present study, the medical records of a total of 456 patients were analyzed. Preoperative data, including the American Society of Anesthesiologists physical status and presence of coronary artery disease (CAD), chronic pulmonary disease, diabetes mellitus (DM), hypertension and renal insufficiency were recorded. Furthermore, the data related to major complications, such as cardiac complications, respiratory complications, acute myocardial infarction (AMI), thromboembolism, cerebrovascular accident (CVA), confusion, acute renal failure (ARF), shock and cardiopulmonary arrest were recorded. RESULTS We found that the frequency of complications markedly increased in the presence of concurrent DM and hypertension, or DM, hypertension and CAD, or DM and CAD. Further, 0.2% of the patients developed AMI, 3.3% developed cardiac complications, 2.2% developed respiratory complications, 0.9% developed thromboembolism, 0.2% developed CVA, 2% developed confusion and 0.4% developed cardiac arrest and shock in the first week after the operation. The frequency of cardiac and pulmonary complications and confusion was higher in patients aged above 65 years compared to patients below 65 years. CONCLUSION We observed that the frequency of cardiac and pulmonary complications and confusion in the early postoperative period was markedly higher in patients aged above 65 years and in patients with concurrent DM and cardiovascular comorbidities.
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Affiliation(s)
- Tünay Kandemir
- Department of Anaesthesia, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Selda Muslu
- Department of Anaesthesia, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Dilek Kalaycı
- Department of Anaesthesia, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Erbin Kandemir
- Department of Anaesthesia, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
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Liu J, Elkassabany N, Poultsides L, Nelson CL, Memtsoudis SG. Staging Bilateral Total Knee Arthroplasty During the Same Hospitalization: The Impact of Timing. J Arthroplasty 2015; 30:1172-6. [PMID: 25724110 DOI: 10.1016/j.arth.2015.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/16/2015] [Accepted: 02/10/2015] [Indexed: 02/01/2023] Open
Abstract
The concept of staging during the same hospitalization for bilateral total knee arthroplasty (BTKA) has emerged as a practice to minimize perioperative risks, although with few data providing an evidence base. A total of 41,664 BTKA patients from Nationwide Inpatient Sample data between 1998 and 2010 were identified, and categorized into three groups, same day, staging 1-3 days, and staging 4-7 days BTKA. Staging BTKA 1-3 days apart was associated with increased rates for complications compared to same day BTKA, while staging 4-7 days BTKA was associated with similar complication profiles compared to same day BTKA. Our study suggests that same day BTKA for selective patient population is preferable, and staging BTKA either 1-3 days or 4-7 days apart should be discouraged.
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Affiliation(s)
- Jiabin Liu
- Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nabil Elkassabany
- Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lazaros Poultsides
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Charles L Nelson
- Department of Orthopaedic Surgery, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Early morbidity after simultaneous and staged bilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:831-7. [PMID: 24503963 DOI: 10.1007/s00167-014-2880-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/24/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this nationwide study was to investigate the early morbidity after bilateral simultaneous and staged total knee arthroplasty (TKA) in order to clarify potential benefits of a well-established fast-track regime. METHODS The Danish National Patient Registry was searched for all bilateral simultaneous and staged TKA procedures from 2010 to 2011. The staged procedures were defined as two separate procedures done within 0-6 months or within 7-18 months. RESULTS A total of 157 patients had bilateral simultaneous TKA, 346 patients had bilateral staged TKA within 0-6 months and 292 patients had bilateral staged TKA within 7-18 months. The median length of stay in hospital (LOS) was 4 days (interquartile range, IQR: 3) after bilateral simultaneous TKA versus cumulated LOS of 6 days (IQR: 3) in both of the bilateral staged groups (p < 0.001). There were no deaths after bilateral simultaneous TKA versus three deaths (0.9 and 1.0 %) in each of the bilateral staged groups within 90 days of surgery (n.s.). The total readmission rate within 30 days of surgery was lower after bilateral simultaneous TKA (7 %, CI 4.0-12.0) and bilateral staged TKA within 0-6 months (9 %, CI 6.4-12.4) compared with 14 % (CI 11.5-20.1) after bilateral staged TKA within 7-18 months. CONCLUSIONS The results from this nationwide study indicate that bilateral simultaneous TKA can safely be performed in a fast-track set-up.
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Inpatient mortality after orthopaedic surgery. INTERNATIONAL ORTHOPAEDICS 2015; 39:1307-14. [DOI: 10.1007/s00264-015-2702-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/30/2015] [Indexed: 10/23/2022]
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Meehan JP, Blumenfeld TJ, White RH, Kim J, Sucher M. Risks and Benefits of Simultaneous Bilateral Total Knee Arthroplasty. JBJS Rev 2015; 3:01874474-201502000-00003. [DOI: 10.2106/jbjs.rvw.n.00019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Banka TR, Ruel A, Fields K, YaDeau J, Westrich G. Preoperative predictors of postoperative opioid usage, pain scores, and referral to a pain management service in total knee arthroplasty. HSS J 2015; 11:71-5. [PMID: 25737672 PMCID: PMC4342398 DOI: 10.1007/s11420-014-9418-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/04/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about preoperative predictors of postoperative pain and referral to a recuperative pain management service after total knee arthroplasty (TKA). QUESTIONS/PURPOSES We sought to identify the preoperative predictors of postoperative pain scores, referral to a pain management service, and narcotic usage in patients undergoing primary total knee arthroplasty. METHODS We performed a prospective cohort study of 97 TKAs from a single surgeon. Pre and 6-week postoperative WOMAC, visual analog pain scale (VAS) scores, narcotic usage, and catastrophizing pain scores were collected. RESULTS After adjusting for all other variables, higher age and catastrophizing pain scores were associated with lower odds of postoperative opioid usage. Increasing age and BMI were associated with lower odds of being referred to pain management. There was no relationship between self-reported preoperative pain tolerance and postoperative change in WOMAC or VAS pain scores. CONCLUSIONS This information may help surgeons advise their patients preoperatively and set expectations during the recovery period.
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Affiliation(s)
- Trevor R. Banka
| | - Allison Ruel
| | - Kara Fields
| | - Jacques YaDeau
| | - Geoffrey Westrich
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Poultsides LA, Memtsoudis SG, Do HT, Sculco TP, Figgie MP. Perioperative morbidity and mortality of same-admission staged bilateral TKA. Clin Orthop Relat Res 2015; 473:190-7. [PMID: 24986775 PMCID: PMC4390927 DOI: 10.1007/s11999-014-3757-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Controversy continues regarding the optimal timing of surgery for patients with symptomatic bilateral degenerative knee arthritis who are not considered eligible for same-day bilateral TKA (BTKA). QUESTIONS/PURPOSES We compared (1) 30-day mortality; (2) rates of in-hospital complications; and (3) blood transfusion rates between patients undergoing same-admission staged BTKA and patients undergoing BTKA staged within 1 year in a highly specialized center where specific guidelines have been implemented for same-day BTKA patient selection. METHODS We analyzed institutional data for 149 patients undergoing same-admission staged and 1557 patients undergoing staged BTKA diagnosed with bilateral knee idiopathic osteoarthritis from 1998 to 2011. Although patients in both groups presented with bilateral knee disease, same-admission staged patients had more medical comorbidities and did not qualify for same-day BTKA. Specifically, patients with coronary artery disease with inducible ischemia, congestive heart failure, advanced chronic obstructive pulmonary disease, uncontrolled diabetes, peripheral vascular disease, renal failure, morbid obesity, history of venous thromboembolism, or those who were older than 75 years were not considered eligible for same-day BTKA. Patient demographics and Deyo comorbidity index were tabulated. The groups were similar in age, but same-admission staged patients were more likely to be male and had a higher overall comorbidity burden. The complications were categorized into systemic (medical) and local (orthopaedic). Furthermore, the systemic complications were subcategorized into major (required complex surgical or medical intervention or were deemed life-threatening) and minor (necessitated additional observation or required medical treatment), depending on their severity. Regression models were conducted to examine the association between surgery type and development of complications. RESULTS There was no difference in 30-day mortality between the groups (0% versus 0.06%; p=0.754). There was no difference in the local complication rates (0.7% versus 0.8%; p=1.000). However, multivariable regression analysis adjusting for age, sex, and Deyo comorbidity index showed that same-admission staged patients were three and two times more likely than staged to develop a minor (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.25-3.25; p=0.004) and major (OR, 2.02; 95% CI, 2.09-4.37; p<0.001) complication, respectively. The same-admission group experienced more acute postoperative anemia (11% versus 3%; p<0.001) and blood transfusions (93% versus 54%; p<0.001). CONCLUSIONS These results suggest that patients who are not appropriate candidates for same-day BTKA as a result of increased overall comorbidity burden may be better served by undergoing staged BTKA within 1 year rather than same-admission staged because of the associated higher perioperative morbidity observed in the same-admission BTKA group. LEVEL OF EVIDENCE Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lazaros A Poultsides
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA,
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Choi YJ, Lee HI, Ra HJ, Hwang DY, Kim TK, Shim SJ. Perioperative Risk Assessment in Patients Aged 75 Years or Older: Comparison between Bilateral and Unilateral Total Knee Arthroplasty. Knee Surg Relat Res 2014; 26:222-9. [PMID: 25505704 PMCID: PMC4258489 DOI: 10.5792/ksrr.2014.26.4.222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 10/11/2014] [Accepted: 10/14/2014] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the risk of sequential bilateral total knee arthroplasty (TKA) under 1 anesthesia in patients 75 years or older. MATERIALS AND METHODS Patients aged 75 years or older who underwent sequential bilateral TKA (bilateral group, n=159) and unilateral TKA (unilateral group, n=159) between 2002 and 2012 were selected. All patients were evaluated for underlying medical diseases, such as cardiac, pulmonary, and renal problems, and high-risk patients were recommended to postpone the surgery. We compared the underlying diseases, major postoperative complications, and the length of hospital stay between bilateral and unilateral groups. RESULTS The prevalence of underlying diseases of the bilateral group was 74.8% and major complications occurred in 6 patients (3.8%). The prevalence of underlying diseases of the unilateral group was 52.4% and complications were observed in 4 patients (2.4%). Although the complication rate of the bilateral group was slightly higher than that of the unilateral group, the difference was not statistically meaningful (p=0.204). The length of hospital stay was 21.9 days for the bilateral group and 24.9 days for the unilateral group. CONCLUSIONS There was no significant difference in postoperative complications between groups. The result shows that bilateral TKA can be relatively safe compared with unilateral TKA in patients 75 years or older. However, careful selection of low-risk patients is advised.
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Affiliation(s)
- Young-Joon Choi
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Hyun-Il Lee
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Ho Jong Ra
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Do-Yon Hwang
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Tae-Kyung Kim
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Sang-Jun Shim
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
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Poultsides LA, Rasouli MR, Maltenfort MG, Parvizi J, Memtsoudis SG, Sculco TP. Trends in same-day bilateral total knee arthroplasty. J Arthroplasty 2014; 29:1713-6. [PMID: 24848780 DOI: 10.1016/j.arth.2014.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/04/2014] [Accepted: 04/16/2014] [Indexed: 02/01/2023] Open
Abstract
Between 2000 and 2009 demographics, comorbidity, complications, and 30-day mortality following same-day BTKA (SBTKA) in two high-volume institutions were obtained. Two 5-year periods were created to facilitate trend analysis. The percentage of SBTKA decreased by 36.2% in the latter period. A decline in mean age reflected mainly by a 50% decrease in patients >75 years was observed. The average LOS decreased (5.7 vs. 4.5 days). Overall, selected patients were healthier in the second period. The prevalence of CAD and obesity decreased, whereas hypercholesteremia increased. The overall complication rate decreased by 55.5%; reduction in cardiac adverse events and acute posthemorrhagic anemia was observed. The rate of PE and 30-day mortality was unchanged with time. A need for more selective preoperative screening for potential candidates of SBTKAs is indicated.
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Affiliation(s)
- Lazaros A Poultsides
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Mohammad R Rasouli
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mitchell G Maltenfort
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Thomas P Sculco
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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Cahill CW, Schwarzkopf R, Sinha S, Scott RD. Simultaneous bilateral knee arthroplasty in octogenarians: can it be safe and effective? J Arthroplasty 2014; 29:998-1000. [PMID: 24321479 DOI: 10.1016/j.arth.2013.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/03/2013] [Accepted: 10/29/2013] [Indexed: 02/01/2023] Open
Abstract
Simultaneous bilateral knee arthroplasty (SBTKA) in octogenarians is controversial. Our purpose was to review the outcomes of octogenarians undergoing SBTKA. All patients greater than 80 years of age who underwent SBTKA by a single surgeon were retrospectively evaluated. Fifty-six patients with an average age of 82.5 years were identified. Twelve postoperative complications occurred. Three were serious; two non-fatal PEs and one wound debridement. Minor complications included UTI, decubitus ulcer, DVT, confusion, transfusion reaction and ileus. Average postoperative survival was 7.4 years. No deaths occurred within 30 days postoperatively. Simultaneous bilateral total knee arthroplasty can be a safe and effective option for octogenarians. Complications and mortality are not higher for SBTKA compared to UTKA in this population.
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Affiliation(s)
- Catherine W Cahill
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Sumi Sinha
- Harvard Medical School, Boston, Massachusetts
| | - Richard D Scott
- Department of Orthopedic Surgery, New England Baptist Hospital, Harvard Medical School, Roxbury Crossing, Massachusetts
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Poultsides L, Memtsoudis S, Gonzalez Della Valle A, De Martino I, Do HT, Alexiades M, Sculco T. Perioperative morbidity and mortality of same-day bilateral TKAs: incidence and risk factors. Clin Orthop Relat Res 2014; 472:111-120. [PMID: 23836245 PMCID: PMC3889452 DOI: 10.1007/s11999-013-3156-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Controversy persists regarding the safety of same-day bilateral TKAs, and indications for same-day versus staged bilateral surgery need to be clarified. QUESTIONS/PURPOSES We compared the (1) 30-day mortality, (2) rates of in-hospital complications, (3) in-hospital charges, and (4) risk factors for complications among patients undergoing same-day and staged bilateral TKAs at two separate admissions within 1 year either less than 3 months apart (staged 0-3) or more than 3 months apart (staged 3-12) at an institution where same-day bilateral TKAs were discouraged in patients with more severe medical comorbidities. METHODS We analyzed institutional data from 3960 same-day, 172 staged 0-3, and 1533 staged 3-12 bilateral TKAs performed between 1998 and 2011. Patient demographics, comorbidities, and 30-day mortality were tabulated. Same-day patients were younger and healthier. Outcomes of interest included complications, blood transfusions, transfer to rehabilitation, and in-hospital charges. Regression models were conducted to identify independent risk factors for major morbidity or mortality. RESULTS There were no differences in 30-day mortality among groups. The same-day group experienced more acute postoperative anemia, blood transfusions, and transfers to rehabilitation, but otherwise had complications comparable to those of the staged groups. In-hospital charges were lower in the same-day group. Congestive heart failure and pulmonary hypertension were the most significant factors associated with morbidity and mortality in the same-day group. CONCLUSIONS In a high-volume subspecialty setting in which patients undergoing same-day bilateral TKAs were generally much healthier and younger, we found that same-day bilateral TKAs appeared to be safe.
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Affiliation(s)
- Lazaros Poultsides
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA,
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Fleischut PM, Mazumdar M, Memtsoudis SG. Perioperative database research: possibilities and pitfalls. Br J Anaesth 2013; 111:532-4. [PMID: 24027144 DOI: 10.1093/bja/aet164] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P M Fleischut
- Department of Anesthesiology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, 525 East 68th Street, M-308, New York, NY 10065, USA
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Poultsides LA, Memtsoudis SG, Vasilakakos T, Wanivenhaus F, Do HT, Finerty E, Alexiades M, Sculco TP. Infection following simultaneous bilateral total knee arthroplasty. J Arthroplasty 2013; 28:92-5. [PMID: 23937920 DOI: 10.1016/j.arth.2013.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 06/29/2013] [Accepted: 07/02/2013] [Indexed: 02/01/2023] Open
Abstract
Between 2000 and 2009, demographics, clinical characteristics, and infection details were compared among patients undergoing simultaneous BTKA (SBTKA), staged or UTKA. 2825 (16%) patients underwent SB, 1151 (6%) staged, and 13,983 (78%) UTKA. The overall infection rate following SBTKA (0.57%) was lower compared to staged (1.39%) or UTKA (1.1%) (P=0.01). The in-hospital infection rate was lower for the SB group (0.28% vs. 0.96% vs. 0.69%, respectively, P=0.01). The rate of late infections was comparable between the groups (0.32% vs. 0.43% vs. 0.43%, respectively, P=0.72). The rate of superficial infection was lower in the simultaneous cohort (0.28% vs. 1.04% vs. 0.87%; P=0.003). The overall rate of deep infection and reoperation for infection was similar among the groups. Among patients with late infection, age, gender, comorbidity score, time to infection, and most common organism isolated were not significantly different between the groups. Among infected patients after SB or staged TKA, 3 SB patients (18.75%), and 3 staged (20%) had bilateral involvement (P=1.0). Staged patients had more 2nd side infections, while simultaneous patients had more 1st side infections (P=0.02). Regression analysis showed that UTKA patients were 2.5 times more likely to develop in-hospital infection compared to SBTKA, while staged patients were almost 3.4 times more likely. Each additional hospital day increased the risk of late infection by 11.3%. SBTKA demonstrates an advantage over staged and maintains the safety profile of unilateral approaches with respect to infectious complications.
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Affiliation(s)
- Lazaros A Poultsides
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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