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Simultaneous, same-anaesthetic bilateral total knee arthroplasty has low mortality and complication rates

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The benefits of simultaneous bilateral total knee arthroplasty (SBTKR) include reduced hospital costs, single anaesthetic exposure and in many cases is also the patient’s preference. Despite these potential benefits, risk-adversity with respect to assumed complications and mortality make it difficult for the orthopaedic surgeon and patient to make an informed decision. This study aimed to address the inconsistencies and lack of consensus in previous literature regarding the short-term complications and clinical safety of SBTKR in patients with end-stage knee osteoarthritis (OA).

Methods

A cohort of 950 knees (475 patients) undergoing surgery between 2008 and 2013 was extracted from a prospectively collected clinical database and retrospectively linked to the Australian Joint Replacement Registry and hospital records. Patients underwent sequential SBTKR by their treating surgeon under one anaesthetic. Basic demographic data and outcome data including complications and mortality were collected. All data were analyzed using descriptive statistics only.

Results

A total of 413 patients and 826 knees were included. The average age of the cohort was 70 years with range between 46 and 88 years. 50% of patients were female. The overall mortality rate during the study follow-up period was 1.9%, with an average time to death postoperatively of 23.8 months. There were no cases of acute postoperative mortality (< 6 weeks). Medical complication rates were low.

Conclusions

In contrast to the higher mortality and complication rates suggested in previous literature, this study has demonstrated that SBTKR is safe, with low mortality and complication rates under the current surgical protocol.

Level of Evidence

IV.

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Abbreviations

OA:

Osteoarthritis

TKR:

Total knee replacement

SBTKR:

Simultaneous bilateral total knee replacement

NSLHD:

Northern Sydney Local Health District

HREC:

Human research ethics committee

HDU:

High-dependency unit

AIHW:

Australian institute of Health and Welfare

DVT:

Deep vein thrombosis

PE:

Pulmonary embolism

MI:

Myocardial infarction

CVA:

Cerebrovascular accident

CI:

Confidence intervals

OR:

Odds ratio

UTKR:

Unilateral total knee replacement

StBTKR:

Staged bilateral total knee replacement.

References

  1. Adili A, Bhandari M, Petruccelli D, De Beer J (2001) Sequential bilateral total knee arthroplasty under 1 anesthetic in patients> or = 75 years old: complications and functional outcomes. J Arthroplasty 16(3):271–278

    Article  CAS  Google Scholar 

  2. Alemparte J, Johnson GV, Worland RL, Jessup DE, Keenan J (2002) Results of simultaneous bilateral total knee replacement: a study of 1208 knees in 604 patients. J South Orthop Assoc 11(3):153–156

    PubMed  Google Scholar 

  3. Australian Institute of Health and Welfare (2013) General Record of Incidence of Mortality (GRIM) books. http://www.aihw.gov.au/deaths/grim-books/

  4. Barrett J, Baron JA, Losina E, Wright J, Mahomed NN, Katz JN (2006) Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg Am 88(10):2146–2151

    PubMed  Google Scholar 

  5. Benjamin J, Tucker T, Ballesteros P (2001) Is obesity a contraindication to bilateral total knee arthroplasties under one anesthetic? Clin Orthop Relat Res 392:190–195

    Article  Google Scholar 

  6. Besser MI (1983) Bilateral Attenborough total knee replacement as a single procedure. Arch Orthop Trauma Surg 101(4):271–272

    Article  CAS  Google Scholar 

  7. Bini SA, Khatod M, Inacio MC, Paxton EW (2014) Same-day versus staged bilateral total knee arthroplasty poses no increase in complications in 6,672 primary procedures. J Arthroplasty 29(4):694–697

    Article  Google Scholar 

  8. Bolognesi MP, Watters TS, Attarian DE, Wellman SS, Setoguchi S (2013) Simultaneous vs staged bilateral total knee arthroplasty among medicare beneficiaries, 2000–2009. J Arthroplasty 28:87–91

    Article  Google Scholar 

  9. Bould M, Freeman BJ, Pullyblank A, Newman JH (1998) Blood loss in sequential bilateral total knee arthroplasty. J Arthroplasty 13:77–79

    Article  CAS  Google Scholar 

  10. Brotherton SL, Roberson JR, de Andrade JR, Fleming LL (1986) Staged versus simultaneous bilateral total knee replacement. J Arthroplasty 1(4):221–228

    Article  CAS  Google Scholar 

  11. Bullock DP, Sporer SM, Shirreffs TG Jr (2003) Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg Am 85(10):1981–1986

    Article  Google Scholar 

  12. Cohen RG, Forrest CJ, Benjamin JB (1997) Safety and efficacy of bilateral total knee arthroplasty. J Arthroplasty 12:497–502

    Article  CAS  Google Scholar 

  13. Dorr LD, Merkel C, Mellman MF, Klein I (1989) Fat emboli in bilateral total knee arthroplasty: predictive factors for neurologic manifestations. Clin Orthop Relat Res. (248):112–119

  14. Forster MC, Bauze AJ, Bailie AG, Falworth MS, Oakeshott RD (2006) A retrospective comparative study of bilateral total knee replacement staged at a one-week interval. J Bone Joint Surg Br 88(8):1006–1010

    Article  CAS  Google Scholar 

  15. Gill GS, Mills D, Joshi AB (2003) Mortality following primary total knee arthroplasty. J Bone Joint Surg Am 85:432–435

    Article  Google Scholar 

  16. Gradillas EL, Volz RG (1979) Bilateral total knee replacement under one anesthetic. Clin Orthop Relat Res 140:153–158

    Google Scholar 

  17. Hardaker WT Jr, Ogden WS, Musgrave RE, Goldner JL (1978) Simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg Am 60:247–250

    Article  Google Scholar 

  18. Hooper GJ, Hooper NM, Rothwell AG, Hobbs T (2009) Bilateral total joint arthroplasty: the early results from the New Zealand National Joint Registry. J Arthroplasty 24:1174–1177

    Article  Google Scholar 

  19. Hu J, Liu Y, Lv Z, Li X, Qin X, Fan W (2011) Mortality and morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 131(9):1291–1298

    Article  Google Scholar 

  20. Hussain N, Chien T, Hussain F, Bookwala A, Simunovic N, Shetty V, Bhandari M (2013) Simultaneous versus staged bilateral total knee arthroplasty a meta-analysis evaluating mortality, peri-operative complications and infection rates. HSSJ 9:50–59

    Article  Google Scholar 

  21. Husted H, Troelsen A, Otte KS, Kristensen BB, Holm G, Kehlet H (2011) Fast-track surgery for bilateral total knee replacement. J Bone Joint Surg Br 93(3):351–356

    Article  CAS  Google Scholar 

  22. Hutchinson JR, Parish EN, Cross MJ (2006) A comparison of bilateral uncemented total knee arthroplasty: simultaneous or staged? J Bone Joint Surg Br 88(1):40–43

    Article  CAS  Google Scholar 

  23. Ivory JP, Simpson AH, Toogood GJ, McLardy-Smith PD, Goodfellow JW (1993) Bilateral knee replacements: simultaneous or staged? J R Coll Surg Edinb 38(2):105–107

    CAS  PubMed  Google Scholar 

  24. Jankiewicz JJ, Sculco TP, Ranawat CS, Behr C, Tarrentino S (2004) One-stage versus 2-stage bilateral total knee arthroplasty. Clin Orthop Relat Res. (309):94–101

  25. Kim YH, Choi YW, Kim JS (2009) Simultaneous bilateral sequential total knee replacement is as safe as unilateral total knee replacement. J Bone Joint Surg Br 91:64–68

    Article  Google Scholar 

  26. Kim YH (2001) Incidence of fat embolism syndrome after cemented or cementless bilateral simultaneous and unilateral total knee arthroplasty. J Arthroplasty 16:730–739

    Article  CAS  Google Scholar 

  27. Kolettis GT, Wixson RL, Peruzzi WT, Blake MJ, Wardell S, Stulberg SD (1994) Safety of 1-stage bilateral total knee arthroplasty. Clin Orthop Relat Res. (309):102–109

  28. Kovacik MW, Singri P, Khanna S, Gradisar IA (1997) Medical and financial aspects of same-day bilateral total knee arthroplasties. Biomed Sci Instrum 33:429–434

    CAS  PubMed  Google Scholar 

  29. Lane GJ, Hozack WJ, Shah S et al (1997) Simultaneous bilateral versus unilateral total knee arthroplasty: outcomes analysis. Clin Orthop Relat Res 345:106–112

    Article  Google Scholar 

  30. Leonard L, Williamson DM, Ivory JP, Jennison C (2003) An evaluation of the safety and efficacy of simultaneous bilateral total knee arthroplasty. J Arthroplasty 18(8):972–978

    Article  CAS  Google Scholar 

  31. Liu TK, Chen SH (1998) Simultaneous bilateral total knee arthroplasty in a single procedure. Int Orthop 22(6):390–393

    Article  CAS  Google Scholar 

  32. Lombardi AV, Mallory TH, Fada RA et al (2001) Simultaneous bilateral total knee arthroplasties: who decides? Clin Orthop Relat Res 392:319–329

    Article  Google Scholar 

  33. Lynch NM, Trousdale RT, Ilstrup DM (1997) Complications after concomitant bilateral total knee arthroplasty in elderly patients. Mayo Clin Proc. 72:799–805

    Article  CAS  Google Scholar 

  34. Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP (2001) Staged bilateral total knee replacement: a safer approach in older patients. Knee 8(3):207–211

    Article  CAS  Google Scholar 

  35. McLaughlin TP, Fisher RL (1985) Bilateral total knee arthroplasties: comparison of simultaneous (two-team), sequential, and staged knee replacements. Clin Orthop Relat Res. (199):220–225

  36. Meehan JP, Danielsen B, Tancredi DJ, Kim S, Jamali AA, White RH (2011) A population-based comparison of the incidence of adverse outcomes after simultaneous-bilateral and staged-bilateral total knee arthroplasty. J Bone Joint Surg Am 93:2203–2213

    Article  Google Scholar 

  37. Memtsoudis SG, Ma Y, Della Valle AG, Mazumdar M, GAber-Baylis LK, MacKenzie CR, Sculco TP (2009) Perioperative outcomes after unilateral and bilateral total knee arthroplasty. Anesthesiology 111(6):1206–1216

    Article  Google Scholar 

  38. Morrey BF, Adams RA, Ilstrup DM, Bryan RS (1987) Complications and mortality associated with bilateral or unilateral total knee arthroplasty. J Bone Joint Surg Am 69(4):484–488

    Article  CAS  Google Scholar 

  39. Noble J, Goodall JR, Noble DJ (2009) Simultaneous Bilateral Total Knee Replacement: A persistent controversy. The Knee 16:420–426

    Article  CAS  Google Scholar 

  40. Oakes DA, Hanssen AD (2004) Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks. Clin Orthop Relat Res 428:87–91

    Article  Google Scholar 

  41. Odum SM, Troyer JL, Kelly MP, Dedini RD, Bozic KJ (2013) A cost-utility Analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg Am 95(16):1441

    Article  Google Scholar 

  42. Parvizi J, Sullivan TA, Trousdale RT, Lewallen DG (2001) Thirty-day mortality after total knee arthroplasty. J Bone Joint Surg Am 83(8):1157–1161

    Article  Google Scholar 

  43. Pavone V, Johnson T, Saulog PS, Sculco TP, Bottner F (2004) Perioperative morbidity in bilateral one-stage total knee replacements. Clin Orthop Relat Res 421:155–161

    Article  Google Scholar 

  44. Peskun C, Mayne I, Malempati H, Kosashvili Y, Gross A, Backstein D (2012) Cardiovascular disease predicts complications following bilateral total knee arthroplasty under a single anaesthetic. Knee 19:580–584

    Article  Google Scholar 

  45. Restrepo C, Parvizi J, Dietrich T, Einhorn TA (2007) Safety of simultaneous bilateral total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 89(6):1220–1226

    Article  Google Scholar 

  46. Reuben JD, Meyers SJ, Cox DD, Elliott M, Watson M, Shim SD (1998) Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty. J Arthroplasty 13(2):172–179

    Article  CAS  Google Scholar 

  47. Ritter M, Mamlin LA, Melfi CA, Katz BP, Freund DA, Arthur DS (1997) Outcome implications for the timing of bilateral total knee arthroplasties. Clin Orthop Relat Res 345:99–105

    Article  Google Scholar 

  48. Ritter MA, Harty LD, Davis KE, Meding JB, Berend M (2003) Simultaneous bilateral, staged bilateral, and unilateral total knee arthroplasty: a survival analysis. J Bone Joint Surg Am 85(8):1532–1537

    Article  Google Scholar 

  49. Ritter MA, Harty LD (2004) Debate: simultaneous bilateral knee replacements: the outcomes justify its use. Clin Orthop Relat Res 428:84–86

    Article  Google Scholar 

  50. Ritter MA, Meding JB (1987) Bilateral simultaneous total knee arthroplasty. J Arthroplasty 2(3):185–189

    Article  CAS  Google Scholar 

  51. Shin YH, Kim MH, Ko JS, Park JA (2010) The safety of simultaneous bilateral versus unilateral total knee arthroplasty: the experience in a Korean hospital. Singap Med J 51:44–49

    CAS  Google Scholar 

  52. Sliva CD, Callaghan JJ, Goetz DD, Taylor SG (2005) Staggered bilateral total knee arthroplasty performed four to seven days apart during a single hospitalization. J Bone Joint Surg Am 87(3):508–513

    Article  Google Scholar 

  53. Soudry M, Binazzi R, Insall JN, Nordstrom TJ, Pellicci PM, Goulet JA (1985) Successive bilateral total knee replacement. J Bone Joint Surg Am 67(4):573–576

    Article  CAS  Google Scholar 

  54. Stanley D, Stockley I, Getty CJ (1990) Simultaneous or staged bilateral total knee replacements in rheumatoid arthritis: a prospective study. J Bone Joint Surg Br 72(5):772–774

    Article  CAS  Google Scholar 

  55. Stefansdottir A, Lidgren L, Robertsson O (2008) Higher early mortality with simultaneous rather than staged bilateral TKAs: results from the Swedish Knee Arthroplasty Register. Clin Orthop Relat Res 466:3066–3070

    Article  Google Scholar 

  56. Yoon HS, Han CD, Yang IH (2010) Comparison of simultaneous bilateral and staged bilateral total knee arthroplasty in terms of perioperative complications. J Arthroplasty 25:179–184

    Article  Google Scholar 

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Funding

The study was financed by acquired independent research funds, and was not financed by a specific grant.

Author information

Authors and Affiliations

  1. Sydney Orthopaedic Research Institute, Level 1 The Gallery, 445 Victoria Avenue, Chatswood, NSW, 2067, Australia

    Eugene Wong, Chu Luan Nguyen, Sean Park & David Parker

  2. Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia

    Eugene Wong, Sean Park & David Parker

Authors
  1. Eugene Wong
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  2. Chu Luan Nguyen
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  4. David Parker
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Contributions

All authors (EW, CN, SP, DP) were involved in study design, collection of data, data analysis and manuscript preparation. All authors have read and approved the final manuscript for submission.

Corresponding author

Correspondence to Eugene Wong.

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Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

Ethics approval for this retrospective study was granted following review by the Northern Sydney Local Health District Human Research Ethics Committee (NSLHD HREC Reference Number NSPHEC 2014-LNR-006).

Informed consent

For this type of study formal consent is not required.

Additional information

Investigation performed at the Sydney Orthopaedic Research Institute, Sydney, Australia.

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Wong, E., Nguyen, C.L., Park, S. et al. Simultaneous, same-anaesthetic bilateral total knee arthroplasty has low mortality and complication rates. Knee Surg Sports Traumatol Arthrosc 26, 3395–3402 (2018). https://doi.org/10.1007/s00167-018-4908-4

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  • DOI: https://doi.org/10.1007/s00167-018-4908-4

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