Comparison of early post-operative complications following unilateral or single-stage bilateral unicompartmental knee arthroplasty

Sakka, Brandan I.; Shiinoki, Aaron; Morikawa, Landon; Mathews, Kristin; Andrews, Samantha; Nakasone, Cass K.

doi:10.1016/j.knee.2020.07.096

Cited by 8 publications

(11 citation statements)

References 20 publications

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“…Greater experience and efficiency, as measured by shorter tourniquet and surgical times, have previously been postulated to decrease the risk of these complications [27][28][29]. Tourniquet times previously reported at the current study site are low, averaging 37 min per knee and SSBTKA total surgical time, to include transition time between knees, averaging about 155 minutes [30,31]. The transfusion rate experienced by this cohort was also relatively low.…”

Section: Discussionmentioning

confidence: 60%

Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty?

Ishii

Wong

Shimoda

et al. 2023

Arch Orthop Trauma Surg

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IntroductionThe 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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Section: Discussionmentioning

confidence: 60%

Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty?

Ishii

Wong

Shimoda

et al. 2023

Arch Orthop Trauma Surg

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“… 15 , 22 - 35 All the retrieved articles were published between March 2009 and July 2020, three were conducted in Italy, 26 , 31 , 33 three in the US, 15 , 25 , 35 two in the UK, 22 , 24 two in France, 29 , 30 one in China, 32 one in India, 27 one in Turkey, 34 one in Korea, 28 and one in Singapore. 23 Among the retrieved studies, six were case-controls comparing one-stage vs. two-stage UKA, 15 , 22 , 23 , 30 - 32 five were case-controls comparing one-stage bilateral UKA vs. unilateral UKA, 26 , 29 , 33 - 35 two were case-controls comparing one-stage bilateral UKA vs. TKA, 25 , 28 one RCT compared one-stage bilateral UKA vs. TKA, 27 and one was a case series about bilateral single-stage UKA ( Table 1 ). 24 …”

Section: Resultsmentioning

confidence: 99%

“…Among the retrieved studies, one was a LOE 2 RCT, 27 13 were LOE 3 case-control studies, 15 , 22 , 23 , 25 , 26 , 28 - 35 and one was a LOE 4 case series. 24 The quality of the studies selected was judged overall to be high, with none of the included papers deemed to have a high risk of bias ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“… 24 The quality of the studies selected was judged overall to be high, with none of the included papers deemed to have a high risk of bias ( Table 2 ). According to the Newcastle-Ottawa Scale, 19 two studies have awarded a total of 7 stars, 31 , 35 three studies 8 stars, 26 , 30 , 34 and the other 10 the maximum possible score of 9 stars. 15 , 22 - 25 , 27 - 29 , 32 , 33 …”

Section: Resultsmentioning

confidence: 99%

“…Moreover, the one-time hospitalization implies numerous advantages; on the one hand, patients solve two problems at once with all the consequent benefits such as one-time sick leave and follow-up visits halved; on the other hand, the hospital has to plan only one operating room, with all the positive logistic and economical consequences such as the need for only one surgical team organization and one instrument set. In this regard, when evaluating the retrieved studies about bilateral single-stage UKA, nine articles stated that bilateral UKAs were performed by the same team, 24 - 26 , 28 , 29 , 32 - 35 while only three articles 22 , 27 , 30 declared that two teams were involved (all the remaining articles did not clarify this detail). In addition, the operatory time in the two procedures, quantified by pooling the literature data, shows an advantage of the one-stage approach, at an average of 112.3 min vs. the 125.4 min taken for the two-stage surgeries.…”

Section: Discussionmentioning

confidence: 99%

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One-stage bilateral unicompartmental knee arthroplasty is a suitable option vs. the two-stage approach: a meta-analysis

Feltri¹,

Lodi²,

Grassi

et al. 2021

EFORT Open Reviews

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To compare one-stage vs. two-stage bilateral unicondylar knee arthroplasty (UKA) in terms of complications, mortality, reinterventions, transfusion rate, days to discharge, and outcomes for the treatment of bilateral mono-compartmental knee osteoarthritis. A systematic review was performed in the PubMed, Web of Science, and Cochrane databases up to February 2021. Randomized controlled trials, case-control studies, and case series describing the use of bilateral UKA were retrieved. A meta-analysis was performed on complications, mortality, reinterventions, transfusion rate, and days to discharge comparing one-stage vs. two-stage replacement, and outcomes were also reported. Assessment of risk of bias and quality of evidence was performed with the Newcastle-Ottawa Scale. Fifteen articles were included on 1451 patients who underwent bilateral UKA (44.9% men, 55.1% women, mean age 66 years). The systematic review documented, for bilateral one-stage UKA: 2.6% major and 5.4% minor complication rates, 0.5% mortality, 1.9% reintervention, 4.1% transfusion rates, and 4.5 mean days to discharge. No studies reported functional differences. The meta-analysis did not find differences for major complications, minor complications, mortality, reintervention, transfusion rates, or days to discharge versus two-stage bilateral procedures. The operative time was 112.3 vs. 125.4 minutes for one-stage and two-stage surgeries, respectively. The overall quality of the retrieved studies was high. Bilateral single-stage UKA is a safe procedure, with a few complications, and overall positive clinical results. No differences were found in terms of complications, mortality, reinterventions, transfusion rate, and days to discharge in comparison with the two-stage approach. Cite this article: EFORT Open Rev 2021;6:1063-1072. DOI: 10.1302/2058-5241.6.210047

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True “outpatient discharge” following single-stage bilateral unicompartmental knee arthroplasty may be unrealistic for most

Sakka

Lawton

Unebasami

et al. 2023

Arch Orthop Trauma Surg

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Comparison of early post-operative complications following unilateral or single-stage bilateral unicompartmental knee arthroplasty

Cited by 8 publications

References 20 publications

Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty?

Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty?

One-stage bilateral unicompartmental knee arthroplasty is a suitable option vs. the two-stage approach: a meta-analysis

True “outpatient discharge” following single-stage bilateral unicompartmental knee arthroplasty may be unrealistic for most

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