Clinical Orthopaedics and Related Research®

, Volume 469, Issue 1, pp 168–173 | Cite as

Perioperative Complications of Simultaneous versus Staged Unicompartmental Knee Arthroplasty

  • Keith R. Berend
  • Michael J. Morris
  • Michael D. Skeels
  • Adolph V. LombardiJr
  • Joanne B. Adams
Symposium: Papers Presented at the Annual Meetings of the Knee Society

Abstract

Background

The complication risk of staged versus simultaneous total knee arthroplasty continues to be debated in the literature. Previous reports suggest unicompartmental knee arthroplasty provides a more rapid functional recovery than total knee arthroplasty. However, little data exist on whether simultaneous unicompartmental knee arthroplasty can be performed without increasing the perioperative risk compared with staged unicompartmental knee arthroplasty.

Questions/purposes

We therefore asked if there is an increased risk of perioperative complications with bilateral simultaneous unicompartmental knee arthroplasty.

Methods

We retrospectively compared 141 patients (282 knees) treated with staged unicompartmental knee arthroplasty with 35 patients (70 knees) treated with simultaneous unicompartmental knee arthroplasty to evaluate perioperative complications and short-term results assessed by Knee Society function scores and the Lower Extremity Activity Scale.

Results

Patients who underwent simultaneous unicompartmental knee arthroplasty had a shorter cumulative operative time (109 versus 122 minutes), a shorter cumulative length of hospital stay (1.7 versus 2.5 days), higher Knee Society function scores at most recent followup (88 versus 73), and higher Lower Extremity Activity Scale (12.0 versus 10.2) without a difference in perioperative complications. The simultaneous cohort was younger (59 versus 63 years of age) and less obese (body mass index 31 versus 33 kg/m2) than the staged group.

Conclusions

Although we found a substantial bias for performing simultaneous unicompartmental knee arthroplasty in younger and less obese patients, these data suggest it can be performed without increasing perioperative morbidity or mortality in this patient population.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Barrett J, Baron JA, Losina E, Wright J, Mahomed NN, Katz JN. Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg Am. 2006;88:2146–2151.CrossRefPubMedGoogle Scholar
  2. 2.
    Berend KR, Lombardi AV Jr, Adams JB. Simultaneous vs staged cementless bilateral total hip arthroplasty: perioperative risk comparison. J Arthroplasty. 2007;22(Suppl 2):111–115.CrossRefPubMedGoogle Scholar
  3. 3.
    Berend KR, Salin JW, Lombardi AV Jr. Unicondylar knee arthroplasty. In: Wiesel SW, ed. Operative Techniques in Orthopaedic Surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2009.Google Scholar
  4. 4.
    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.PubMedGoogle Scholar
  5. 5.
    Chan WCW, Musonda P, Cooper AS, Glasgow MMS, Donell ST, Walton NP. One-stage versus two-stage bilateral unicompartmental knee replacement: a comparison of immediate post-operative complications. J Bone Joint Surg Br. 2009;91:1305–1309.PubMedGoogle Scholar
  6. 6.
    Della Valle CJ, Idjadi J, Hiebert RN, Jaffe WL. The impact of Medicare reimbursement policies on simultaneous bilateral total hip and knee arthroplasty. J Arthroplasty. 2003;18:29–34.CrossRefPubMedGoogle Scholar
  7. 7.
    Han I, Seong SC, Lee S, Yoo JH, Lee MC. Simultaneous bilateral MIS-TKA results in faster functional recovery. Clin Orthop Relat Res. 2008;466:1449–1453.CrossRefPubMedGoogle Scholar
  8. 8.
    Hersekli MA, Akpinar S, Özala M, Özkoc, Uysal M, Cesur N, Tandoğan RN. A comparison between single- and two-staged bilateral total knee arthroplasty operations in terms of the amount of blood loss and transfusion, perioperative complications, hospital stay, and cost-effectiveness. Acta Orthop Traumatol Turc. 2004;38:241–246.PubMedGoogle Scholar
  9. 9.
    Hutchinson JRM, Parish EN, Cross MJ. A comparison of bilateral uncemented total knee arthroplasty: simultaneous or staged? J Bone Joint Surg Br. 2006;88:40–43.CrossRefPubMedGoogle Scholar
  10. 10.
    Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14. PubMedGoogle Scholar
  11. 11.
    Kim YH, Yoo JH, Kim JS. Factors leading to decreased rates of deep vein thrombosis and pulmonary embolism after total knee arthroplasty. J Arthroplasty. 2007;22:974–980.CrossRefPubMedGoogle Scholar
  12. 12.
    Leonard L, Williamson DM, Ivory JP, Jennison C. An evaluation of the safety and efficacy of simultaneous bilateral total knee arthroplasty. J Arthroplasty. 2003;18:972–978.CrossRefPubMedGoogle Scholar
  13. 13.
    Lombardi AV Jr, Berend KR, Tucker TL. The incidence and prevention of symptomatic thromboembolic disease following unicompartmental knee arthroplasty. Orthopedics. 2007;30(Suppl):41–43.Google Scholar
  14. 14.
    Lombardi AV Jr, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA. Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty? Clin Orthop Relat Res. 2009;467:1450–1457.CrossRefPubMedGoogle Scholar
  15. 15.
    Lombardi AV Jr, Mallory TH, Fada RA. Simultaneous bilateral total knee arthroplasties: who decides? Clin Orthop Relat Res. 2001;392:319–329.CrossRefPubMedGoogle Scholar
  16. 16.
    Lombardi AV Jr, Viacava AJ, Berend KR. Rapid recovery protocols and minimally invasive surgery help achieve high knee flexion. Clin Orthop Relat Res. 2006;452:117–122.CrossRefPubMedGoogle Scholar
  17. 17.
    Lonner JH, Jasko JG, Bezwada HP, Booth RE Jr. Morbidity of sequential bilateral revision TKA performed under a single anesthetic. Clin Orthop Relat Res. 2007;464:151–156.PubMedGoogle Scholar
  18. 18.
    Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty. 2009;24(Suppl 1):84–88.CrossRefPubMedGoogle Scholar
  19. 19.
    Meding JB, Klay M, Healy A, Ritter MA, Keating EM, Berend ME. The prescreening history and physical in elective total joint arthroplasty. J Arthroplasty. 2007;22(Suppl):21–23.CrossRefPubMedGoogle Scholar
  20. 20.
    Memtsoudis SG, González Della Valle A, Besculides MC, Esposito M, Koulouvaris P, Salvati EA. Risk factors for perioperative mortality after lower extremity arthroplasty: a population-based study of 6,901,324 patient discharges. J Arthroplasty. 2008 Dec 22 [Epub ahead of print].Google Scholar
  21. 21.
    Memtsoudis SG, González Della Valle A, Besculides MC, Gaber L, Sculco TP. In-hospital complications and mortality of unilateral, bilateral, and revision TKA: based on an estimate of 4,159,661 discharges. Clin Orthop Relat Res. 2008;466:2617–2627.CrossRefPubMedGoogle Scholar
  22. 22.
    Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomized controlled trial. J Bone Joint Surg Br. 2009;91:52–57.PubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    Powell RS, Pulido P, Tuason MS, Colwell CW Jr, Ezzet KA. Bilateral vs unilateral total knee arthroplasty: a patient-based comparison of pain levels and recovery of ambulatory skills. J Arthroplasty. 2006;21:642–649.CrossRefPubMedGoogle Scholar
  25. 25.
    Price AJ, Waite JC, Svard UC. Long-term clinical results of the Oxford medial unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2005;435:171–180.CrossRefPubMedGoogle Scholar
  26. 26.
    Rauh MA, Krackow KA. In-hospital deaths following elective total joint arthroplasty. Orthopedics. 2004;27:407–411.PubMedGoogle Scholar
  27. 27.
    Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. J Bone Joint Surg Am. 2007;89:1220–1226.CrossRefPubMedGoogle Scholar
  28. 28.
    Reuben JD, Meyers SJ, Cox DD, Elliot M, Watson M, Shim SD. Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty. J Arthroplasty. 1998;13:172–179.CrossRefPubMedGoogle Scholar
  29. 29.
    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.PubMedGoogle Scholar
  30. 30.
    Ritter MA, Meding JB. Bilateral simultaneous total knee arthroplasty. J Arthroplasty. 1987;2:185–189.CrossRefPubMedGoogle Scholar
  31. 31.
    Saleh KJ, Mulhall KJ, Bershadsky B, Ghomrawi HM, White LE, Buyea CM, Krackow KA. Development and validation of a Lower-Extremity Activity Scale. J Bone Joint Surg Am. 2005;87:1985–1994.CrossRefPubMedGoogle Scholar
  32. 32.
    Shetty GM, Mullaji A, Bhayde S, Chandra Vadapalli R, Desai D. Simultaneous bilateral versus unilateral computer-assisted total knee arthroplasty: a prospective comparison of early postoperative pain and functional recovery. Knee. 2009 Sep 26 [Epub ahead of print].Google Scholar
  33. 33.
    Stefánsdóttir A, Lidgren L, Robertsson O. Higher early mortality with simultaneous rather than staged bilateral TKAs: results from the Swedish Knee Arthroplasty Register. Clin Orthop Relat Res. 2008;466:3066–3070.CrossRefPubMedGoogle Scholar
  34. 34.
    Wu CC, Lin CP, Yeh YC, Cheng YJ, Sun WZ, Hou SM. Does different time interval between staggered bilateral total knee arthroplasty affect perioperative outcome? A retrospective study. J Arthroplasty. 2008;23:539–542.CrossRefPubMedGoogle Scholar
  35. 35.
    Yoon HS, Han CD, Yang IH. Comparison of simultaneous bilateral and staged total knee arthroplasty in terms of perioperative complications. J Arthroplasty. 2009 Feb 3 [Epub ahead of print].Google Scholar
  36. 36.
    Zeni JA Jr, Snyder-Mackler L. Clinical outcomes after simultaneous bilateral total knee arthroplasty: comparison to unilateral total knee arthroplasty and healthy controls. J Arthroplasty. 2009 Apr 7. [Epub ahead of print].Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Keith R. Berend
    • 1
    • 2
    • 3
  • Michael J. Morris
    • 1
  • Michael D. Skeels
    • 1
  • Adolph V. LombardiJr
    • 1
    • 2
    • 3
    • 4
  • Joanne B. Adams
    • 1
  1. 1.Joint Implant Surgeons, IncNew AlbanyUSA
  2. 2.Department of OrthopaedicsThe Ohio State UniversityColumbusUSA
  3. 3.Mount Carmel Health SystemNew AlbanyUSA
  4. 4.Department of Biomedical EngineeringThe Ohio State UniversityColumbusUSA

Personalised recommendations