Risks and Benefits of Simultaneous Bilateral Total Knee Arthroplasty

Meehan, John P.; Blumenfeld, Thomas J.; White, Richard; Kim, Jason; Sucher, Mark

doi:10.2106/jbjs.rvw.n.00019

Cited by 20 publications

(20 citation statements)

References 40 publications

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“…bilateral TKA) [4]. Bilateral TKA may also be performed in a staged manner where one knee is replaced on a different day, during the same admission or delayed for several weeks to months after the initial procedure to allow for recovery between surgeries.…”

mentioning

confidence: 99%

Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

Yong

Young

Molloy

et al. 2020

The Journal of Arthroplasty

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a b s t r a c tBackground: There is limited evidence describing long-term implant survivorship and modes of failure in simultaneous concurrent bilateral total knee arthroplasty (TKA). Methods: We performed a retrospective review of 266 consecutive patients (532 knees) who underwent simultaneous concurrent bilateral TKA. We reviewed medical records for preoperative characteristics, perioperative complications, and revision surgeries. The primary outcome was TKA survivorship. Secondary outcomes included indication and type of revision surgery. We used the Kaplan-Meier method to estimate survivorship and characterize risk of revision up to 20 years post-TKA. Results: Our cohort had median follow-up of 9.8 years (interquartile range, 3.9-15.9). Forty-four patients (17%) underwent revision. Revision was more common among younger and male patients. The cumulative incidence of first-time revision per knee (n ¼ 532) was 1.27 per 100 component-years. Implant survival was 99% (confidence interval, 97%-99%) at 5 years, 92% (89%-95%) at 10 years, 83% (77%-87%) at 15 years, and 62% (50%-73%) at 20 years. Five and 10-year survivorship compared favorably to estimates of TKA survivorship in the literature. The cumulative incidence of revision surgery per patient was 1.91 per 100 component-years. Implant survival at 5-, 10-, 15-, and 20-year time points was 96% (CI, 92%-98%), 84% (77%-89%), 71% (62%-79%), and 59% (46%-70%), respectively. Aseptic loosening (40%), polyethylene wear (34%), and infection (11%) were the most common indications for revision. Conclusion: Simultaneous concurrent bilateral TKA is associated with a higher risk of reoperation for the patient when both knees are evaluated but similar implant survivorship to the literature when each knee was evaluated in isolation.

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mentioning

confidence: 99%

Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

Yong

Young

Molloy

et al. 2020

The Journal of Arthroplasty

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“…Total knee arthroplasty (TKA) continues to be one of the most common surgeries performed in the United States of America (USA) with a projected demand of 3.48 million procedures by 2030 [1]. This projection includes a concomitant increase for bilateral total knee arthroplasty (BTKA), with bilateral procedures accounting for approximately 6% of TKA cases performed annually in the USA [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty

Enns¹,

Garceau²,

Teo

et al. 2021

Arthroplasty Today

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Background: There is little evidence on outcomes of tourniquet use during bilateral total knee arthroplasty (BTKA). Tourniquet use in BTKA effects postoperative outcomes and efficiency inside the operating room. This study evaluates the safety and efficacy of simultaneous tourniquet inflation in BTKA. Materials and Methods: A retrospective review was performed on BTKA patients between March 2013 and May 2018. A total of 285 patients were divided into 2 cohorts. Patients in the simultaneous cohort had concomitant elevation of both tourniquets, but the sequential cohort did not. Perioperative variables were collected, and postoperative complications were tracked for a minimum of 90 days. Patients followed a uniform postoperative protocol. Complications were grouped by category to increase statistical power and compared using a noninferiority test. "Clinically noninferior" was defined as a margin 5%. Results: The simultaneous cohort had significantly (P < .05) higher American Society of Anesthesiologists class and smokers. Tourniquet time, delta hemoglobin, and surgical time were significantly lower. For the complication categories of "Any Thrombotic Event", "Respiratory", and "Soft Tissue/Wound", the difference in occurrence rates was no more than 2.8%, 2.8%, and 5.2% between cohorts, respectively. The "Cardiovascular (non-MI)" group was no more than 9.3% different, that is, authors are 95% confident that 3 of 4 complication categories meet the clinically noninferior threshold. Conclusion: The study demonstrates the noninferiority of simultaneous as compared to sequential tourniquet inflation in BTKA. Patients with cardiac history may need sequential inflation or staged TKA. The information presented in the study assists surgeons in safely and efficiently performing BTKA.

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“…The sequencing of BTKA occurs in three main ways: (i) separate admission staged BTKA, (ii) single‐anaesthetic sequential BTKA in which knees are replaced one after the other, usually by the same surgeon and (iii) single‐anaesthetic simultaneous BTKA (sim‐BTKA), where arthroplasties are performed by two surgeons, each replacing a separate knee at the same time …”

Section: Introductionmentioning

confidence: 99%

“…Single‐anaesthetic BTKA has been associated with lower total anaesthetic time, healthcare costs and revision rates compared to staged BTKA . However, the use of single‐anaesthetic BTKA is debated due to the risk of complications . Three systematic reviews reported higher 30‐day mortality and blood transfusion rates in single‐anaesthetic BTKA compared to staged BTKA, but found no differences for cardiac complications, deep venous thrombosis and superficial infections, and mixed results for pulmonary embolization, deep infection and neurological complications .…”

Section: Introductionmentioning

confidence: 99%

Simultaneous (two‐surgeon) versus staged bilateral knee arthroplasty: an observational study of intraoperative and post‐operative outcomes

Gill

Hill‐Buxton

Gwini

et al. 2020

ANZ Journal of Surgery

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Background: The advantages of simultaneous bilateral total knee arthroplasty (sim-BTKA) remain controversial. This study investigated the effects of two-surgeon sim-BTKA compared to separate admission staged BTKA regarding intraoperative and post-operative outcomes and health service costs. Methods: Patients underwent sim-BTKA or staged BTKA between 1 November 2008 and 30 June 2016. Data were extracted from a joint replacement registry and medical records. Median regression and chi-squared tests were used for between-group comparisons. Results: Median hospital total length of stay was 5 days less for sim-BTKA (n = 122) than staged BTKA group (n = 46) (7 versus 12; 95% confidence interval (CI) 3.9, 6.1), and 9 days less for inpatient rehabilitation (17 versus 26; 95% CI 3.7, 14.3). However, 80% of sim-BTKA patients went to inpatient rehabilitation (versus 27% following staged BTKA), so median total length of stay was 9 days less for staged BTKA (13 versus 22; 95% CI −12.8, −5.2). Total anaesthesia time was 135 min less for sim-BTKA (P < 0.001), while staged BTKA required less blood transfusions (P = 0.001). Complication rates were similar, except for superficial infections which were observed twice as often after staged BTKA (30% versus 15%, P = 0.048). Twelve months following sim-BTKA and the first staged total knee arthroplasty, sim-BTKA had better WOMAC pain, stiffness and function scores (P ≤ 0.05). Average inpatient costs (hospital and rehabilitation) were $6388 less for sim-BTKA. Conclusion: Sim-BTKA appears to be a comparatively safe alternative to staged BTKA. Sim-BTKA may be superior to staged BTKA due to faster improvements in pain and function and lower healthcare costs. How these results generalize to other health services requires further investigation.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 826-832ANZJSurg.com

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Risks and Benefits of Simultaneous Bilateral Total Knee Arthroplasty

Cited by 20 publications

References 40 publications

Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty

Simultaneous (two‐surgeon) versus staged bilateral knee arthroplasty: an observational study of intraoperative and post‐operative outcomes

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