Higher Early Mortality with Simultaneous Rather than Staged Bilateral TKAs: Results From the Swedish Knee Arthroplasty Register
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Patients with knee osteoarthritis (OA) often present with symptoms that warrant bilateral TKAs. There are potential benefits to operating on both knees on the same day, but the safety of simultaneous bilateral TKAs has been questioned. To evaluate whether there were any differences in 30-day mortality between patients having simultaneous bilateral TKAs and those having staged bilateral TKAs, we analyzed data from the Swedish Knee Arthroplasty Register and the Swedish Cause of Death Register. We included 48,931 patients with OA having 60,062 primary TKAs during 1985 to 2004; 1139 had surgery on both knees on the same day (simultaneous bilateral) and 3432 had surgery on both knees on two different occasions with less than 1 year between operations (staged bilateral). The 30-day mortality after simultaneous bilateral TKAs was 7.53 (confidence interval, 2.62–21.69) times higher than after the second of staged TKA and 3.77 (confidence interval, 2.04–6.98) times higher than after a primary unilateral TKA. Assuming the total risk for a staged procedure is twice that of a unilateral procedure, the risk of mortality within 30 days is 1.94 (confidence interval, 1.05–3.59) times higher with simultaneous than staged TKA. It is safer to operate on one knee at a time.
Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
- Berman AT, Parmet JL, Harding SP, Israelite CL, Chandrasekaran K, Horrow JC, Singer R, Rosenberg H. Emboli observed with use of transesophageal echocardiography immediately after tourniquet release during total knee arthroplasty with cement. J Bone Joint Surg Am. 1998;80:389–396.
- Bullock DP, Sporer SM, Shirreffs TG Jr. Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg Am. 2003;85:1981–1986.
- Dorey F, Nasser S, Amstutz H. The need for confidence intervals in the presentation of orthopaedic data. J Bone Joint Surg Am. 1993;75:1844–1852.
- Gill GS, Mills D, Joshi AB. Mortality following primary total knee arthroplasty. J Bone Joint Surg Am. 2003;85:432–435.
- Hutchinson JR, Parish EN, Cross MJ. A comparison of bilateral uncemented total knee arthroplasty: simultaneous or staged? J Bone Joint Surg Br. 2006;88:40–43. CrossRef
- ICD-9: International Statistical Classification of Diseases and Related Health Problems 9th revision. Available at: http://icd9cm.chrisendres.com/index.php.
- ICD-10: International Statistical Classification of Diseases and Related Health Problems 10th revision. Available at http://www.who.int/classifications/apps/icd/icd10online/. Accessed November 20, 2007.
- Khan A, Emberson J, Dowd GS. Standardized mortality ratios and fatal pulmonary embolism rates following total knee replacement: a cohort of 936 consecutive cases. J Knee Surg. 2002;15:219–222; discussion 222.
- Lombardi AV, Mallory TH, Fada RA, Hartman JF, Capps SG, Kefauver CA, Dodds KRN, Adams JB. Simultaneous bilateral total knee arthroplasties: who decides? Clin Orthop Relat Res. 2001;392:319–329. CrossRef
- Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP. Staged bilateral total knee replacement: a safer approach in older patients. Knee. 2001;8:207–211. CrossRef
- Mantilla CB, Horlocker TT, Schroeder DR, Berry JD, Brown DL. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology. 2002;96:1140–1146. CrossRef
- Mont MA, Mitzner DL, Jones LC, Hungerford DS. History of the contralateral knee after primary knee arthroplasty for osteoarthritis. Clin Orthop Relat Res. 1995;321:145–150.
- Morrey BF, Adams RA, Ilstrup DM, Bryan RS. Complications and mortality associated with bilateral or unilateral total knee arthroplasty. J Bone Joint Surg Am. 1987;69:484–488.
- Oakes DA, Hanssen AD. Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks. Clin Orthop Relat Res. 2004;428:87–91. CrossRef
- Parmet JL, Horrow JC, Berman AT, Miller F, Pharo G, Collins L. The incidence of large venous emboli during total knee arthroplasty without pneumatic tourniquet use. Anesth Analg. 1998;87:439–444. CrossRef
- Parvizi J, Sullivan TA, Trousdale RT, Lewallen DG. Thirty-day mortality after total knee arthroplasty. J Bone Joint Surg Am. 2001;83:1157–1161.
- Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am. 2007;89:1220–1226. CrossRef
- Reuben JD, Meyers SJ, Cox DD, Elliott M, Watson M, Shim SD. Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty. J Arthroplasty. 1998;13:172–179. CrossRef
- Ritter M, Mamlin LA, Melfi CA, Katz BP, Freund DA, Arthur DS. Outcome implications for the timing of bilateral total knee arthroplasties. Clin Orthop Relat Res. 1997;345:99–105. CrossRef
- Ritter MA, Harty LD. Debate: simultaneous bilateral knee replacements: the outcomes justify its use. Clin Orthop Relat Res. 2004;428:84–86. CrossRef
- Ritter MA, Harty LD, Davis KE, Meding JB, Berend M. Simultaneous bilateral, staged bilateral, and unilateral total knee arthroplasty: a survival analysis. J Bone Joint Surg Am. 2003;85:1532–1537.
- Walmsley P, Murray A, Brenkel IJ. The practice of bilateral, simultaneous total knee replacement in Scotland over the last decade: data from the Scottish Arthroplasty Project. Knee. 2006;13:102–105. CrossRef
- Higher Early Mortality with Simultaneous Rather than Staged Bilateral TKAs: Results From the Swedish Knee Arthroplasty Register
Clinical Orthopaedics and Related Research
Volume 466, Issue 12 , pp 3066-3070
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