The Safety of Bilateral Simultaneous Hip and Knee Arthroplasty versus Staged Arthroplasty in a High-Volume Center Comparing Blood Loss, Peri- and Postoperative Complications, and Early Functional Outcome

Abstract

Purpose: In recent years, there has been increasing interest in the use of simultaneous hip and knee arthroplasty compared to staged procedures in patients with bilateral pathology. The aim of this study was to compare simultaneous and staged hip and knee arthroplasty in patients with bilateral pathology by assessing the transfusion rate, postoperative hemoglobin drop, length of stay (LOS), in-hospital complications, 30-day readmissions and early functional outcome. Methods: We conducted a retrospective cohort study that included all patients who were undergoing primary TKA, THA and UKA by a single surgeon in a high-volume arthroplasty center between 2015 and 2020 as simultaneous or staged procedures. Staged bilateral arthroplasties were performed within 12 months and were stratified by the time between procedures. Data were acquired through the electronic files at the Orthopädische Chirurgie München (OCM). For functional outcome, the ability of the patients to walk independently on the ward was compared with the ability to walk a set of stairs alone, which was recorded daily by the attending physiotherapist. Results: In total n = 305 patients were assessed for eligibility and included in this study. One hundred and forty-five patients were allocated to the staged arthroplasty group. This group was subdivided into a hip and a knee group, whereas the knee group was split into TKA and UKA. The second staged procedure was performed within 12 months of the first procedure. One hundred and sixty patients were allocated to the simultaneous arthroplasty group. This group was also subdivided into a hip and knee group, whereas the knee group was split again into a TKA and UKA group. No statistical difference was found between the two groups regarding demographic data. Primary outcome measurements: There was no significant difference in the transfusion rate or complication rate. Secondarily, no statistically significant difference was found between the postoperative hemoglobin drop and the functional outcome, or in the length of stay (LOS) between both groups. Walking the stairs showed a significant difference in the knee group. Conclusions: There were no significant differences observed in the transfusion rate in-hospital complications, or readmission rate between both groups. The early functional outcome showed no significant difference in mobility for all groups. Simultaneous arthroplasty for knee or hip is as safe as a staged procedure, with no higher risk for the patient, in a specialized high-volume center. Level of evidence: Level IV.

Implant Preference and Clinical Outcomes of Patients with Staged Bilateral Total Knee Arthroplasty: All-Polyethylene and Contralateral Metal-Backed Tibial Components

“…Another recent study comparing the two tibial components observed similar clinical results using the same evaluation method [20]. In the literature, there are only a few specific clinical comparisons between the components in bilateral staged TKA [21,22]. Our study recorded comparable clinical and functional outcomes using the Knee Society Score.…”

Mortality Following Simultaneous Versus Staged Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

“…Similar variations were observed in StaBTKA studies, from the smaller cohort of Berend [ 15 ], with 141 cases, to the extensive dataset of Tsay [ 38 ], with 45,419 cases. Sex distribution also varied, with male percentages ranging from as low as 4.10% in the study by Koh [ 39 ] to as high as 58.49% in the study by Najfeld [ 40 ].…”

Clinical Outcomes and Complications of Simultaneous or Sequential Bilateral Total Ankle Arthroplasty

“…Bilateral hip and knee arthroplasties have been extensively studied, including case series of bilateral arthroplasty, comparison of bilateral arthroplasty with unilateral arthroplasty, and direct comparisons of bilateral simultaneous and sequential THA 1-6 , TKA [6][7][8][9][10] , and UKA [11][12][13][14] . The systematic reviews and meta-analyses have summarized that bilateral simultaneous TKA results in a lower risk of deep infection and respiratory complications but increased 30-day mortality, pulmonary embolism, and blood transfusion rates compared with bilateral sequential TKA [25][26][27] .…”

“…Those in support of bilateral simultaneous arthroplasty have noted significant cost savings as well as multiple reports of noninferior and even superior perioperative complication rates, patient-reported outcome measures, and early rehabilitation when compared with sequential procedures. This literature includes comparisons involving bilateral total hip arthroplasty (THA) [1][2][3][4][5][6] , total knee arthroplasty (TKA) [6][7][8][9][10] , and unilateral knee arthroplasty (UKA) [11][12][13][14] . The literature is less complete for TAA, with only a few studies demonstrating successful outcomes after bilateral TAA [15][16][17][18] .…”