Abstract
Aims
Anesthetic technique affects perioperative outcomes, but less was known in simultaneous bilateral total knee arthroplasty (BTKA). A single center, retrospective analysis was carried out to prove the hypothesis that utilization of regional anesthesia would result in favorable perioperative outcomes.
Methods
Medical records of patients admitted for simultaneous BTKA between 2004 and 2013 were analyzed. Two groups, the general anesthesia (GA) and regional anesthesia (RA) group, were identified. Patient preoperative characteristics were compared. Perioperative outcomes measured included blood loss, transfusion requirement, length of hospitalization, operating time, and 30-day perioperative complications.
Results
A total of 513 patients were identified, 54.6 % were performed under GA, and 45.4 % under RA. Patient characteristics were similar between the two groups, except that patients operated under GA were younger than those under RA. RA was associated with significantly less perioperative blood loss (981 vs. 1075 mL, p = 0.017) and 30-day complications (6.4 vs. 13.2 %, p = 0.016). Systemic and organ specific infections were particularly lower in the RA group (0.4 vs. 3.9 %, p = 0.009). Transfusion requirement, length of hospitalization, and operating time were similar between the two groups. After correcting for covariates, RA offered a 92 mL (p = 0.023) reduction in blood loss and 49 % less overall complications (p = 0.047), compared to GA.
Conclusion
Patients who underwent simultaneous BTKA under RA had lesser blood loss and lower complication rate than GA. The impact of RA can be further exploited to improve perioperative outcomes of simultaneous BTKA in addition to various other interventions.
Similar content being viewed by others
References
Memtsoudis SG, Besculides MC, Reid S, Gaber-Baylis LK, Gonzalez Della Valle A (2009) Trends in bilateral total knee arthroplasties: 153,259 discharges between 1990 and 2004. Clin Orthop Relat Res 467(6):1568–1576
Vulcano E, Memtsoudis S, Della Valle AG (2013) Bilateral total knee arthroplasty guidelines: are we there yet? J Knee Surg 26(4):273–279
Fu D, Li G, Chen K, Zeng H, Zhang X, Cai Z (2013) Comparison of clinical outcome between simultaneous-bilateral and staged-bilateral total knee arthroplasty: a systematic review of retrospective studies. J Arthroplasty 28(7):1141–1147
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
Hu J, Liu Y, Lv Z, Li X, Qin XD, Fan WM (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
Gurunathan U (2013) Perioperative considerations of bilateral total knee replacement: a review. J Clin Anesth 25(3):232–239
Noble J, Goodall JR, Noble DJ (2009) Simultaneous bilateral total knee replacement: a persistent controversy. Knee 16(6):420–426
Rodgers A, Walker N, Schug S et al (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321(7275):1493
Macfarlane AJ, Prasad GA, Chan VW, Brull R (2009) Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review. Br J Anaesth 103(3):335–345
Hu S, Zhang ZY, Hua YQ, Li J, Cai ZD (2009) A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis. J Bone Joint Surg Br 91(7):935–942
Macfarlane AJ, Prasad GA, Chan VW, Brull R (2009) Does regional anesthesia improve outcome after total knee arthroplasty? Clin Orthop Relat Res 467(9):2379–2402
Spicer E, Thomas GR, Rumble EJ (2013) Comparison of the major intraoperative and postoperative complications between unilateral and sequential bilateral total knee arthroplasty in a high-volume community hospital. Can J Surg 56(5):311–317
Parvizi J, Chaudhry S, Rasouli MR et al (2011) Who needs autologous blood donation in joint replacement? J Knee Surg 24(1):25–31
Lee GC, Hawes T, Cushner FD, Scott WN (2005) Current trends in blood conservation in total knee arthroplasty. Clin Orthop Relat Res 440:170–174
Peak EL, Hozack WJ, Sharkey PF, Parvizi J, Rothman RH (2008) One-stage bilateral total joint arthroplasty: a prospective, comparative study of total hip and total knee replacement. Orthopedics 31(2):131
Stundner O, Chiu YL, Sun X et al (2012) Comparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee arthroplasty. Reg Anesth Pain Med 37(6):638–644
Cankaya D, Ozkurt B, Aydin C, Tabak AY (2014) No difference in blood loss between posterior-cruciate-ligament-retaining and posterior-cruciate-ligament-stabilized total knee arthroplasties. Knee Surg Sports Traumatol Arthrosc 22(8):1865–1869
Chen JY, Lo NN, Chong HC, et al (2014) Cruciate retaining versus posterior stabilized total knee arthroplasty after previous high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3259-z
Yi SX, Tan JX, Chen C, Chen H, Huang W (2014) The use of pneumatic tourniquet in total knee arthroplasty: a meta-analysis. Arch Orthopaedic and Trauma Surg 134(10):1469–1476
Charlson ME, Pompei P, Ales KL, Mackenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383
Nadler SB, Hidalgo JU, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(2):224–232
Chen JY, Rikhraj IS, Zhou Z, et al (2014) Can tranexamic acid and hydrogen peroxide reduce blood loss in cemented total knee arthroplasty? Arch Orthop Trauma Surg 134(7):997–1002
Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 7(3):151–155
Moonen AF, Neal TD, Pilot P (2006) Peri-operative blood management in elective orthopaedic surgery. a critical review of the literature. Injury 37(Suppl 5):S11–S16
Salido JA, Marin LA, Gomez LA, Zorrilla P, Martinez C (2002) Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. J Bone Joint Surg Am 84-A(2):216–220
Liu J, Ma C, Elkassabany N, Fleisher LA, Neuman MD (2013) Neuraxial anesthesia decreases postoperative systemic infection risk compared with general anesthesia in knee arthroplasty. Anesth Analg 117(4):1010–1016
Chang CC, Lin HC, Lin HW, Lin HC (2010) Anesthetic management and surgical site infections in total hip or knee replacement: a population-based study. Anesthesiology 113(2):279–284
Mauermann WJ, Shilling AM, Zuo Z (2006) A comparison of neuraxial block versus general anesthesia for elective total hip replacement: a meta-analysis. Anesth Analg 103(4):1018–1025
Liu JL, Yuan WX, Wang XL et al (2014) Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery. Clin Interv Aging 9:341–350
Ong CKS, Lirk P, Seymour RA, Jenkins BJ (2005) The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 100(3):757–773
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhu, M., Chen, J.Y., Tan, Y.R. et al. Effects of anesthetic technique on blood loss and complications after simultaneous bilateral total knee arthroplasty. Arch Orthop Trauma Surg 135, 565–571 (2015). https://doi.org/10.1007/s00402-015-2188-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-015-2188-8