Skip to main content

Advertisement

SpringerLink
Log in

Medium-term outcomes in single anaesthetic bilateral total knee replacement surgery: a single surgeon series

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The lifetime risk of developing symptomatic knee osteoarthritis (OA) is estimated to be 45%, with up to two thirds of patients presenting with bilateral knee symptoms. Patients presenting with end stage bilateral knee OA may benefit from single anaesthetic bilateral total knee replacement (SABTKR). Our study aim was to compare the outcomes of SABTKR with unilateral total knee arthroplasty (TKA) in a single surgeon series over a 20 year period.

Methods

We performed a retrospective review of a single surgeon’s data from the New Zealand Joint Registry (NZJR) over a 20-year period from January 1999 to December 2018. This review reports on patient demographics, functional outcomes, revision rates and mortality rates.

Results

1225 total knee replacements were performed by the senior author (995 TKAs and 115 patients underwent SABTKRs) over the 20 year period reviewed. The mean ages of the TKA and SABTKR groups were 67.7 and 66.7 years, respectively. There was 16.9% mortality rate for the TKA group versus 7.8% in SABTKR group. There were no revisions in the SABTKR group versus 17 revisions in the TKA group representing a revision rate of 0.23/100 component years which can be viewed against a 20 year revision rate of 0.48/100 component years (p < 0.05) for all comers in the NZJR.

Conclusion

This NZJR study demonstrates excellent medium term survival outcomes for selected patients having simultaneous bilateral total knee replacements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, Dragomir A, Kalsbeek WD, Luta G, Jordan JM (2008) Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum 59:1207–1213. https://doi.org/10.1002/art.24021

    Article  PubMed  PubMed Central  Google Scholar 

  2. Jacobs J, Andersson G, Bell J, Weinstein S, Dormans JP, Gnatz SM, Furman M, Lane N, Puzas J, Clair E(2008). United States Bone and Joint Decade: the burden of musculoskeletal diseases in the United States. American Academy of Orthopaedic Surgery, Rosemont

  3. Mont MA, Serna FK, Krackow KA, Hungerford DS (1996) (1996) Exploration of radiographically normal total knee replacements for unexplained pain. Clin Orthop Relat Res 331:216–220. https://doi.org/10.1097/00003086-199610000-00030 (PMID: 8895641)

    Article  Google Scholar 

  4. Harris WH, Sledge CB (1990) Review total hip and total knee replacement (1). N Engl J Med 323(11):725–731

    Article  CAS  Google Scholar 

  5. Culliford DJ, Maskell J, Beard DJ et al (2010) Temporal trends in hip and knee replacement in the United Kingdom: 1991 to 2006. J Bone Joint Surg 92-B:130–135

    Article  Google Scholar 

  6. Barrett J, Baron JA, Losina E, Wright J, Mahomed NN, Katz JN (2006) Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg Am 88(10):2146–2151

    PubMed  Google Scholar 

  7. New Zealand Orthopaedic Association (2018) The New Zealand Joint Registry Twenty Year report January 1999 to December 2018

  8. National Joint Registry of England, Wales, Northern Ireland and the Isle of Man (2019) 16th Annual Report 2019.

  9. Gill SD, Hill-Buxton L-M, Gwini SM, Morrison S, Moreira B, Beattie S, Thomson A, Page RS (2020) Simultaneous (two-surgeon) versus staged bilateral knee arthroplasty: an observational study of intraoperative and post-operative outcomes. ANZ J Surg 90:826–832. https://doi.org/10.1111/ans.15766

    Article  PubMed  Google Scholar 

  10. Abram SGF, Nicol F, Spencer SJ (2016) Patient reported outcomes in three hundred and twenty eight bilateral total knee replacement cases (simultaneous versus staged arthroplasty) using the Oxford Knee Score. Int Orthop 40(10):2055–2059. https://doi.org/10.1007/s00264-016-3122-6

    Article  PubMed  Google Scholar 

  11. Grace TR, Tsay EL, Roberts HJ, Vail TP, Ward DT (2020) Staged bilateral total knee arthroplasty: increased risk of recurring complications. J Bone Joint Surg Am 102(4):292–297. https://doi.org/10.2106/JBJS.19.00243

    Article  PubMed  Google Scholar 

  12. Odum SM, Troyer JL, Kelly MP, Dedini RD, Bozic KJ (2013) A cost-utility analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg Am 95(16):1441–1449

    Article  Google Scholar 

  13. Lin AC, Chao E, Yang CM, Wen HC, Ma HL, Lu TC (2014) Costs of staged versus simultaneous bilateral total knee arthroplasty: a population-based study of the Taiwanese National Health Insurance Database. J Orthop Surg Res. https://doi.org/10.1186/s13018-014-0059-6

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ritter MA, Harty LD, Davis KE, Meding JB, Berend M (2003) Simultaneous bilateral, staged bilateral, and unilateral total knee arthroplasty. A survival analysis. J Bone Joint Surg Am 85:1532–1537

    Article  Google Scholar 

  15. Ritter MA, Harty LD (2004) Debate: simultaneous bilateral knee replacements: the outcomes justify its use. Clin Orthop Relat Res 428:84–86

    Article  Google Scholar 

  16. Kolettis GT, Wixson RL, Peruzzi WT, Blake MJ, Wardell S, Stulberg SD (1994) Safety of 1-stage bilateral total knee arthroplasty. Clin Orthop Relat Res 309:102–109

    Google Scholar 

  17. Gradillas EL, Volz RG (1979) Bilateral total knee replacement under one anesthetic. Clin Orthop Relat Res 140:153–158

    Google Scholar 

  18. Ritter M, Mamlin LA, Melfi CA, Katz BP, Freund DA, Arthur DS (1997) Outcome implications for the timing of bilateral total knee arthroplasties. Clin Orthop Relat Res 345:99–105

    Article  Google Scholar 

  19. Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE (2009) Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty 24(6 Suppl):84–88

    Article  Google Scholar 

  20. Kim Y-H, Choi Y-W, Kim J-S (2009) Simultaneous bilateral sequential total knee replacement is as safe as unilateral total knee replacement. J Bone Joint Surg 91-B(1):64–68

    Article  Google Scholar 

  21. Meehan JP, Danielsen B, Tancredi DJ, Kim S, Jamali AA, White RH (2011) A population-based comparison of the incidence of adverse outcomes after simultaneous-bilateral and staged-bilateral total knee arthroplasty. J Bone Joint Surg Am 93(23):2203–2213

    Article  Google Scholar 

  22. Wyatt MC, Hozack JW, Frampton C, Rothwell A, Hooper GJ (2018) Is single-anaesthetic bilateral primary total hip replacement still safe? A 16-year cohort study from the New Zealand Joint Registry. ANZ J Surg 88(12):1289–1293. https://doi.org/10.1111/ans.14864

    Article  PubMed  Google Scholar 

  23. Dunbar MJ (2001) Subjective outcomes after knee arthroplasty. Acta Orthop Scand 72:1–63

    Article  CAS  Google Scholar 

  24. Hooper G, Lee AJ, Rothwell A, Frampton C (2014) Current trends and projections in the utilisation rates of hip and knee replacement in New Zealand from 2001 to 2026. N Z Med J 127:82–93

    PubMed  Google Scholar 

  25. Kurtz SM, Ong KL, Lau E, Bozic KJ (2014) Impact of the economic downturn on total joint replacement demand in the United States. J Bone Joint Surg Am 96(8):624–630

    Article  Google Scholar 

  26. Stefánsdóttir A, Lidgren L, Robertsson O (2008) Higher early mortality with simultaneous rather than staged bilateral TKAs: results from the Swedish Knee Arthroplasty Register. Clin Orthop Relat Res 466(12):3066–3070

    Article  Google Scholar 

  27. Lindberg-Larsen M, Jørgensen CC, HustedKehlet HH (2015) Early morbidity after simultaneous and staged bilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23(3):831–837

    Article  Google Scholar 

  28. Hussain N, Chien T, Hussain F, Bookwala A, Simunovic N, Shetty V, Bhandari M (2013) Simultaneous versus staged bilateral total knee arthroplasty: a meta-analysis evaluating mortality, peri-operative complications and infection rates. HSS J 9(1):50–59

    Article  Google Scholar 

  29. Hu J, Liu Y, Lv Z, Li X, Qin X, Fan W (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

    Article  Google Scholar 

  30. Memtsoudis SG, Valle AGD, Besculides MC, Gaber L, Sculco TP (2008) In-hospital complications and mortality of unilateral, bilateral, and revision TKA: based on an estimate of 4,159,661 discharges. Clin Orthop Relat Res 466(11):2617–2627

    Article  Google Scholar 

  31. Warren JA, Siddiqi A, Krebs VE, Molloy R, Higuera CA, Piuzzi NS (2020) Bilateral simultaneous total knee arthroplasty may not be safe even in the healthiest patients. J Bone Joint Surg Am. https://doi.org/10.2106/JBJS.20.01046 (Epub ahead of print. PMID: 33369981)

    Article  PubMed  Google Scholar 

  32. Forster MC, Bauze AJ, Bailie AG, Falworth MS, Oakeshott RD (2006) A retrospective comparative study of bilateral total knee replacement staged at a one-week interval. J Bone Joint Surg Br 88(8):1006–1010

    Article  CAS  Google Scholar 

  33. Jankiewicz JJ, Sculco TP, Ranawat CS, Behr C, Tarrentino S (1994) One-stage versus 2-stage bilateral total knee arthroplasty. Clin Orthop Relat Res 309:94–101

    Google Scholar 

  34. Bullock DP, Sporer SM, Shirreffs TG Jr (2003) (2003) Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg Am 85(10):1981–1986

    Article  Google Scholar 

  35. Malahias M-A, Gu A, Adriani M, Addona JL, Alexiades MM, Sculco PK (2019) Comparing the safety and outcome of simultaneous and staged bilateral total knee arthroplasty in contemporary practice: a systematic review of the literature. J Arthroplasty 34(7):1531–1537. https://doi.org/10.1016/j.arth.2019.03.046

    Article  PubMed  Google Scholar 

  36. Klasan A, Putnis SE, Yeo WW et al (2020) Should sequential bilateral total knee arthroplasty be limited to patients younger than 80? A two-arm propensity matched study. J Knee Surg. https://doi.org/10.1055/s-0040-1712100

    Article  PubMed  Google Scholar 

  37. Putnis SE, Klasan A, Redgment JD, Daniel MS, Parker DA, Coolican MRJ (2020) One-stage sequential bilateral total knee arthroplasty: an effective treatment for advanced bilateral knee osteoarthritis providing high patient satisfaction. J Arthroplasty 35(2):401–406. https://doi.org/10.1016/j.arth.2019.09.032

    Article  PubMed  Google Scholar 

  38. Memtsoudis SG, Hargett M, Russell LA et al (2013) Consensus statement from the consensus conference on bilateral total knee arthroplasty group. Clin Orthop Relat Res 471(8):2649–2657. https://doi.org/10.1007/s11999-013-2976-9

    Article  PubMed  PubMed Central  Google Scholar 

  39. Urban MK, Chisholm M, Wukovits B (2006) Are postoperative complications more common with single-stage bilateral (SBTKR) than with unilateral knee arthroplasty: guidelines for patients scheduled for SBTKR. HSS J 2:78–82. https://doi.org/10.1007/s11420-005-0125-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Song SJ, Park CH, Bae DK (2019) What to know for selecting cruciate-retaining or posterior-stabilized total knee arthroplasty. Clin Orthop Surg 11(2):142–150. https://doi.org/10.4055/cios.2019.11.2.142

    Article  PubMed  PubMed Central  Google Scholar 

  41. Zeni JA Jr, Snyder-Mackler L (2010) (2010) Clinical outcomes after simultaneous bilateral total knee arthroplasty: comparison to unilateral total knee arthroplasty and healthy controls. J Arthroplasty 25(4):541–546

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Tallaght University Hospital, Tallaght, Dublin 24, Ireland

    M. J. Kelly & J. F. Quinlan

  2. Dunedin Public and Mercy Hospitals, Suite 3, Marinoto Clinic, Otago, Dunedin, New Zealand

    J. F. Quinlan & J. A. Matheson

  3. New Zealand National Joint Registry, Christchurch Public Hospital, Christchurch, New Zealand

    C. Frampton

Authors
  1. M. J. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. F. Quinlan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Frampton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. A. Matheson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. J. Kelly.

Ethics declarations

Conflict of interest

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

Ethical permission for use of patient data has been obtained through the informed consent process of NZJR participation.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kelly, M.J., Quinlan, J.F., Frampton, C. et al. Medium-term outcomes in single anaesthetic bilateral total knee replacement surgery: a single surgeon series. Arch Orthop Trauma Surg 142, 2857–2863 (2022). https://doi.org/10.1007/s00402-021-04151-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-021-04151-0

Keywords

Search

Navigation