Clinical Orthopaedics and Related Research®

, Volume 471, Issue 8, pp 2649–2657

Consensus Statement from the Consensus Conference on Bilateral Total Knee Arthroplasty Group

  • Stavros G. Memtsoudis
  • Mary Hargett
  • Linda A. Russell
  • Javad Parvizi
  • William L. Cats-Baril
  • Ottokar Stundner
  • Thomas P. Sculco
  • For the Consensus Conference on Bilateral Total Knee Arthroplasty Group
Survey

DOI: 10.1007/s11999-013-2976-9

Cite this article as:
Memtsoudis, S.G., Hargett, M., Russell, L.A. et al. Clin Orthop Relat Res (2013) 471: 2649. doi:10.1007/s11999-013-2976-9

Abstract

Background

Controversy exists regarding many aspects of decision making pertaining to same-day versus staged bilateral TKA (BTKAs), including patient selection, perioperative management decisions, and other important choices.

Questions/purposes

In the absence of suitable randomized trials, we sought to determine areas of consensus among national experts on the following questions: (1) What are the comparative risks of same-day BTKAs compared with unilateral TKA (UTKA) and staged BTKAs? (2) Who should be considered an appropriate candidate for same-day BTKAs? (3) What constitutes appropriate workup and perioperative management for BTKAs? (4) What is the optimal time between procedures if same-day BTKAs are not deemed appropriate? (5) Are there orthopaedic or rehabilitation considerations for BTKAs that might outweigh medical contraindications?

Methods

In the setting of a consensus conference of national experts in orthopaedic surgery, anesthesiology, perioperative medicine, and epidemiology, the major questions surrounding same-day BTKAs were addressed by using an extensive literature review and the modified Delphi process. The process concluded with a meeting of participants and formulation of consensus statements.

Results

Eighty-one percent of participants agreed that BTKAs are more invasive and complex procedures associated with increased risk for perioperative adverse events compared with UTKA in an unselected group of patients. The consensus group agreed that physicians and hospitals should consider using more restrictive patient selection criteria and exclude those with a modified cardiac risk index greater than 3 to mitigate the potentially increased risk. The majority of the group agreed that perioperative assessment and management should reflect the higher level of acuity of same-day BTKAs. Eighty-one percent of participants agreed that if a patient is not deemed a candidate for same-day BTKAs, a second TKA should be scheduled no sooner than 3 months after the first. The entire group agreed that when there is a conflict between the orthopaedic need and the medical adequacy of same-day BTKAs, the medical concern for the patient’s safety should prevail over the orthopaedic need.

Conclusions

Experts perceived that same-day BTKAs increase medical risk, and thus a systematic approach to the management of patients should be taken to minimize complications.

Supplementary material

11999_2013_2976_MOESM1_ESM.doc (34 kb)
Supplementary material 1 (DOC 34 kb)

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Stavros G. Memtsoudis
    • 1
  • Mary Hargett
    • 1
  • Linda A. Russell
    • 2
  • Javad Parvizi
    • 3
  • William L. Cats-Baril
    • 4
  • Ottokar Stundner
    • 1
  • Thomas P. Sculco
    • 5
  • For the Consensus Conference on Bilateral Total Knee Arthroplasty Group
  1. 1.Department of Anesthesiology, Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkUSA
  2. 2.Department of Perioperative Medicine, Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkUSA
  3. 3.Department of Orthopaedic Surgery, Jefferson UniversityThe Rothman InstitutePhiladelphiaUSA
  4. 4.School of Business AdministrationThe University of VermontBurlingtonUSA
  5. 5.Department of Orthopaedic Surgery, Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkUSA

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