Unilateral vs Bilateral Total Knee Arthroplasty

Fabi, David; Mohan, Vivek; Goldstein, Wayne M.; Dunn, Jonathan H.; Murphy, Brian P.

doi:10.1016/j.arth.2010.07.011

Cited by 55 publications

(45 citation statements)

References 25 publications

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“…However, there are no randomized trials comparing the safety of these surgical strategies. Because of the diversity of study settings and designs, it is difficult to draw definitive conclusions [1,6,7,9,14,15,18,22,[26][27][28].…”

Section: Introductionmentioning

confidence: 99%

“…However, despite potential advantages of the same-day approach, including exposure to the risks of anesthetic only once, one postoperative course of pain, reduced rehabilitation, and an earlier return to baseline function [10,11,23], the safety of same-day procedures has been questioned because of higher morbidity and mortality when compared with unilateral TKAs [15,22]. Several studies have attempted to compare the incidence of complications after same-day bilateral TKAs, staged bilateral TKAs, and unilateral TKAs using single institution databases, large administrative datasets, or meta-analyses [1,6,7,9,14,15,18,22,[26][27][28]. However, there are no randomized trials comparing the safety of these surgical strategies.…”

Section: Introductionmentioning

confidence: 99%

“…We therefore 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 bilateral TKAs, staged bilateral TKAs during two separate admissions fewer than 3 months apart (staged 0-3), and staged bilateral TKAs where the two admissions were from 3 to 12 months apart (staged [3][4][5][6][7][8][9][10][11][12] at an institution where same-day bilateral TKAs were discouraged for patients with more severe medical comorbidities.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

Poultsides

Memtsoudis

Valle

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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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 sameday, 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. Sameday 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 sameday bilateral TKAs appeared to be safe.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

Poultsides

Memtsoudis

Valle

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Patients should be informed of the increased risk of VTE after bilateral TKA, although this additional risk may be outweighed by a reduction in the cumulative recovery time and a lower cumulative risk of developing a prosthetic joint infection. 42,43 Finally, AHRQ's PSI-12 appears to be a useful tool for ascertaining VTE cases and identifying potential opportunities for improvement, when the ''present-on-admission'' status is also available.…”

Section: Discussionmentioning

confidence: 99%

Mechanical and suboptimal pharmacologic prophylaxis and delayed mobilization but not morbid obesity are associated with venous thromboembolism after total knee arthroplasty: A case‐control study

Sadeghi¹,

Romano²,

Maynard³

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:The FDA‐approved dose of low‐molecular‐weight heparin (LMWH) may not provide adequate thromboprophylaxis in morbidly obese patients after total knee arthroplasty (TKA). Suboptimal dosing, delayed initiation, and overreliance on mechanical methods may also limit the effectiveness of thromboprophylaxis.OBJECTIVE:We explored the associations between the type of thromboprophylaxis, obesity, time of mobilization, and undergoing bilateral TKA on development of symptomatic venous thromboembolism (VTE) after TKA.DESIGN/SETTING/PATIENTS:This was a case‐control study of patients undergoing TKA in 15 teaching hospitals between October 2008 and March 2010. Cases were screened using the Agency for Healthcare Research and Quality's Patient Safety Indicator 12 and had objectively documented acute VTE within 9 days of surgery; controls were randomly selected from the same hospital. Multivariable logistic regression was used to analyze risk factors for postoperative VTE, adjusted for age and gender.RESULTS:Among 130 cases with and 463 controls without acute VTE, body mass index (BMI) ranged from 17 to 61 (median = 34). Thromboprophylaxis was LMWH in 284 (48%), warfarin in 189 (32%), both in 55 (10%), and mechanical prophylaxis alone in 120 (20%). Overall, 77% ambulated on day 1 or 2 after surgery. Factors significantly associated with VTE were bilateral simultaneous TKA (odds ratio [OR] = 4.2; 95% confidence interval [CI]: 1.9–9.1), receipt of FDA‐approved pharmacological prophylaxis (OR = 0.5; 95% CI: 0.3–0.8), and ambulation by postoperative day 2 (OR = 0.3; 95% CI: 0.1–0.9). Obesity was neither a significant confounder nor a modifier of these effects.CONCLUSIONS:Severe obesity was not a significant independent predictor for VTE and did not modify the beneficial effect of FDA‐approved pharmacological thromboprophylaxis. Bilateral TKA and failure to ambulate by the second day after surgery were significant risk factors. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

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“…There have been controversies in the post-surgical complications following simultaneous and staged bilateral total Volume [1][2][3]; whereas, Other studies are showing evidence that suggest that there is no difference in the complication between simultaneous and staged bilateral total knee replacement [3]. On the other hand, levy et al [4] found out that in-hospital and late infection with simultaneous bilateral total knee replacement in lower when compared with staged, which increases the morbidity, mortality rates and total hospital stay [5].…”

Section: Introductionmentioning

confidence: 99%

Compare Between the Complication of Simultaneous and Staged Bilateral Knee Replacement at King Abdulaziz Medical City (KAMC) - Riyadh

Abu-Abah¹

2016

MOJOR

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Unilateral vs Bilateral Total Knee Arthroplasty

Cited by 55 publications

References 25 publications

Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

Mechanical and suboptimal pharmacologic prophylaxis and delayed mobilization but not morbid obesity are associated with venous thromboembolism after total knee arthroplasty: A case‐control study

Compare Between the Complication of Simultaneous and Staged Bilateral Knee Replacement at King Abdulaziz Medical City (KAMC) - Riyadh

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