Complications and cost of single-stage vs. two-stage bilateral unicompartmental knee arthroplasty: A case-control study

Siedlecki, Cédric; Beaufils, Philippe; Lemaire, B.; Pujol, Nicolas

doi:10.1016/j.otsr.2018.01.021

Cited by 33 publications

(37 citation statements)

References 24 publications

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“…These results can be associated with the fact that one-stage bilateral UKA offers the benefits of a single anaesthetic, reduced total operating time, shorter total hospital stay and shorter total recovery time. In the two studies reporting cost analysis for bilateral UKA, there was also a significant difference in favour of the one-stage group 12 16. Moreover, our study revealed the lower OR of revision rate in one-stage bilateral UKA than in the staged surgery.…”

Section: Discussionsupporting

confidence: 52%

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Simultaneous bilateral unicompartmental knee arthroplasty surgery has benefits in low complication rate and cost-effectiveness: a systematic review

2020

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ImportanceBilateral knee osteoarthritis is frequent and the best choice of treatment remains questionable, especially when the surgeon has to consider simultaneous or staged bilateral unicompartmental knee arthroplasty (UKA).ObjectiveThe purpose of this systematic review was to conduct a systematic review assessing the clinical outcomes associated with simultaneous bilateral and staged bilateral UKA.Evidence reviewA literature search was conducted in June 2019 in Medline, PubMed and Embase. A full-text review of eligible studies was conducted by two investigators.FindingsA total of 10 retrospective studies were identified. These studies described the results of simultaneous bilateral UKA compared either to staged bilateral UKA or unilateral UKA. Results showed that the prevalence of mortality at a minimum of 30 days postoperatively, deep vein thrombosis, the rate of blood transfusion and reintervention were not higher in patients undergoing a one-stage bilateral UKA. The cost-effectiveness is in favour of doing a one-stage procedure due to the shortness of total hospital stay.Conclusions and relevanceOne-stage simultaneous bilateral UKA can be performed with preventing the postoperative complication, and result in cost savings for patients with symptomatic medial bilateral unicompartmental knee osteoarthritis. Further comparative studies are necessary to determine the best patient profile for such a surgery, and the technical considerations during surgery (consecutive surgery or simultaneous surgery with two operative teams).Level of evidenceIV.

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Section: Discussionsupporting

confidence: 52%

“…The number of studies excluded at each stage of study selection is depicted according to the PRISMA guideline. Following full-text screening, 10 cohort studies12–21 met the inclusion criteria and were included for final analysis. The baseline characteristics of the included articles are provided in table 1.…”

Section: Resultsmentioning

confidence: 99%

Simultaneous bilateral unicompartmental knee arthroplasty surgery has benefits in low complication rate and cost-effectiveness: a systematic review

2020

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“…UKR has been proven to have less mortality and medical complications compared with TKR. 7 For one stage bilateral UKR, most studies have shown it has all the advantages of one stage bilateral arthroplasty without increased complications compared with staged operation [22][23][24][25][26] and only one study showed the opposite. 27 Our center offered one stage bilateral UKR for patients with bilateral medial OA knee without severe anesthetic risks.…”

Section: Discussionmentioning

confidence: 99%

One stage bilateral unicompartmental knee replacement: Similar early clinical outcome with shorter rehabilitation and better resources utilization compared with two stage

Tang¹,

Wong²,

Wong³

2020

Journal of Orthopaedics, Trauma and Rehabilitation

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Introduction: There are a lot of debates on the advantages and safety profile of one stage bilateral knee arthroplasty. Most of the studies focus on total knee replacement, and it may not be applied directly to unicompartmental knee replacement (UKR). We would like to compare the early results of one and two stage bilateral UKR in our center. Methods: This is a retrospective review of all the bilateral medial UKR done in our center in 2018–2019. Patients’ demographic data, operative time, postoperative blood, length of stay (LOS) and complications were recorded. The number of admissions, pre-operative assessment sessions (PAS), and weeks of post-operative physiotherapy were analyzed. Clinical outcome was measured by Knee society knee score and range of motion (ROM). Results: Our center performed 97 UKR in 2018–2019, with 50 UKR performed in 25 patients, among which 16 received one stage while 9 received two stage bilateral UKR. Both groups had similar mean age, BMI, sex ratio, ASA grading, pre-operative knee score and ROM. Patient in the one stage group required only 1 PAS/admission/operation to treat both knees with a mean LOS of 7.3 days and 7.8 weeks of physiotherapy, while those in the two stage group required 2 PAS/admissions/operations with a mean cumulative LOS of 9.8 days and 14.1 weeks of physiotherapy. The mean cumulative operative time was similar for both groups but the one stage group only required 1 operative session. There was no difference in blood loss and there was no transfusion or complication. The post-operative knee score and ROM at 3 and 6 months were similar for both groups. Conclusion: In suitable patients with bilateral medial OA knee, one stage bilateral UKR offers simliar early clinical outcome with shorter rehabilitation duration but without increasing complications compared with two stage. Resources can therefore be better utilized.

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“…Both UKR and TKR can be used for anteromedial osteoarthritis of the knee. UKR provides shorter hospital stays, better function, fewer deep infections, lower mortality, and fewer perioperative complications such as venous thromboembolic and major cardiac events [5][6][7][8]. The main criticism of UKR is its higher revision rate, with registries showing a higher revision rate for UKR than TKR [9-10].…”

Section: Manuscript Introductionmentioning

confidence: 99%

Candidacy for medial unicompartmental knee replacement declines with age

Kennedy¹,

Mellon²,

Lombardi³

et al. 2020

Orthopaedics & Traumatology: Surgery & Research

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Background: The effect of age on the percentage of primary knee replacements appropriate for unicompartmental replacement (UKR), defined as candidacy, is unknown. The aim was to determine the candidacy and outcome of UKR in different age groups.Hypothesis: Age is associated with candidacy for medial UKR Patients and Methods: This cross-sectional study determined UKR candidacy from preoperative radiographs, including stress views, from 457 consecutive knee replacements (TKR or UKR) in a specialist joint replacement centre. Candidacy, estimated from radiographs and from usage, was determined for all knees and then stratified by age group <50, 50-60, 60-70, 70-80, and 80+. The outcome of UKR implanted in these groups was also assessed. To avoid overestimating, candidacy estimated by usage was used for the primary analysis.Results: Candidacy decreased with age (OR 0.98, p=0.008) and was 61% (CI42-78), 52% (CI43-61), 43% (CI35-51), 41% (CI31-52), and 36% (CI22-52) respectively. Candidacy estimated by radiographs was slightly higher overall (49% compared to 46%) and in all age groups than candidacy estimated from usage. Neither functional outcome (p=0.47) nor implant survival (p=0.54) was affected by age.Overall 80% achieved good/excellent Knee Society objective scores, and the five-year implant survival was 99%.Discussion: There is a strong association of candidacy for UKR with age in that younger patients are more likely to be candidates (61% in those <50 and 36% in those 80+). Good outcomes can be expected in patients of all ages who are appropriate for UKR.

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Complications and cost of single-stage vs. two-stage bilateral unicompartmental knee arthroplasty: A case-control study

Abstract: III, case-control study.

Cited by 33 publications

References 24 publications

Simultaneous bilateral unicompartmental knee arthroplasty surgery has benefits in low complication rate and cost-effectiveness: a systematic review

Simultaneous bilateral unicompartmental knee arthroplasty surgery has benefits in low complication rate and cost-effectiveness: a systematic review

One stage bilateral unicompartmental knee replacement: Similar early clinical outcome with shorter rehabilitation and better resources utilization compared with two stage

Candidacy for medial unicompartmental knee replacement declines with age

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