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Trends in Bilateral Total Knee Arthroplasties: 153,259 Discharges between 1990 and 2004

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Clinical Orthopaedics and Related Research®

Abstract

Information regarding national trends in bilateral TKAs is needed for a rational allocation of resources, policy making, and research. Therefore, we analyzed data from the National Hospital Discharge Survey to elucidate temporal changes in the demographics, comorbidity profiles, hospital stay, and in-hospital complications of patients undergoing bilateral TKAs in the United States. We created three 5-year periods: 1990–1994, 1995–1999, 2000–2004. Procedure, healthcare system, and patient-related variables were analyzed for an estimated 153,259 discharges. Use of bilateral TKAs more than doubled for the entire civilian population and almost tripled among the female population, with the steepest increase seen during the last two study periods. A decline of nearly 50% in the use of bilateral TKAs in patients 85 years and older was seen between the second and third study periods. The prevalence of coronary artery disease and pulmonary disease increased from the first to the second study periods but decreased from the second to the third. The changes in the variables studied may reflect a recently acquired reluctance to perform bilateral TKAs in elderly patients with cardiopulmonary comorbidities. Additional studies are necessary to identify other causal relationships and define the impact of these changes on various aspects of the healthcare system.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, USA

    Stavros G. Memtsoudis MD, PhD & Shane Reid BA

  2. Mathematica Policy Research, Inc, Princeton, NJ, USA

    Melanie C. Besculides DrPH, MPH

  3. LKG Consulting, Plainsboro, NJ, USA

    Licia K. Gaber-Baylis BA

  4. Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, 10021, USA

    Alejandro González Della Valle MD

Authors
  1. Stavros G. Memtsoudis MD, PhD
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  2. Melanie C. Besculides DrPH, MPH
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  3. Shane Reid BA
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  4. Licia K. Gaber-Baylis BA
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  5. Alejandro González Della Valle MD
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Corresponding author

Correspondence to Stavros G. Memtsoudis MD, PhD.

Additional information

One or more of the authors (SGM) have received funding from the Hospital for Special Surgery Anesthesiology Young Investigator Award provided by the Department of Anesthesiology and the Hospital for Special Surgery, New York, NY.

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Memtsoudis, S.G., Besculides, M.C., Reid, S. et al. Trends in Bilateral Total Knee Arthroplasties: 153,259 Discharges between 1990 and 2004. Clin Orthop Relat Res 467, 1568–1576 (2009). https://doi.org/10.1007/s11999-008-0610-z

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  • DOI: https://doi.org/10.1007/s11999-008-0610-z

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