Retrospective immediate post-operative comparative study of sequential bilateral total knee replacement versus unilateral total knee replacement for knee primary osteoarthritis
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20210612Keywords:
Total knee replacement, Primary osteoarthritis, SequentialAbstract
Background: The study is to compare the immediate post operative outcomes of sequential bilateral versus unilateral total knee replacement (TKR) for the treatment of primary knee osteoarthritis. Study comprised of 96 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral and sequential bilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and duration of hospital stay, post operative mobilisation, fall in haemoglobin level immediate post operative, need for blood transfusion, post operative complications, post operative pain and duration of surgery was recorded. The results were statistically compared. The mean duration of hospital stay, post operative blood loss in terms of fall in HB, post operative pain control, need of transfusions and duration of surgery revealed statistically significant differences.
Methods: Total 96 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 operated with sequential bilateral TKR under single anaesthetic procedure and group 2 with unilateral TKR both operated by same surgeon and anaesthetist.
Results: It was observed that longer duration of surgery and hospital stay, higher fall in HB levels, increased need of analgesics and higher requirement of blood transfusions were associated with group 1 as compared to 2. Complication rates and post op mobilisation was similar in both groups.
Conclusions: Sequential bilateral TKR is a viable option for patient with symptomatic bilateral knees but patient selection and pre op counselling takes the priority.
References
McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis. 1993;52(4):258-62.
Boutron I, )Rannoud M,)Jardinaudlopez M.†Meric G)Revel M)Poiraudeau S). Disability and quality of life of patients with knee or hip osteoarthritis in the primary care setting and factors associated with general practitioners' indication for prosthetic replacement within 1 year. Osteoarthritis and Cartilage. 2008;16(9):1024-031.
Rönn K, Reischl N, Gautier E, Jacobi M. Current Surgical Treatment of Knee Osteoarthritis. Arthritis. 2011;2011:454873.
Metcalfe AJ, Andersson MLE, Goodfellow R, Thorstensson CA .Is knee osteoarthritis a symmetrical disease? Analysis of a 12 year prospective cohort study. BMC Musculoskelet Disord. 2012;13:153.
Zeni J, Flowers P, Bade M, Cheuy V. Stiff knee gait may increase risk of second total knee arthroplasty. Journal Of Orthopaedic Research. 2018.
Mirghasemi SA, RasouliM MR, Maltenfort S, Rashidinia J, Parvizi. Staged bilateral total knee arthroplasty: when is the second knee safe to be replaced?. Orthopaedic Proceedings. 2018.
Stern SH, Sharrock N. Hematologic and circulatory changes associated with total knee arthroplasty surgical instrumentation. Clin Orthop. 1994;299:179.
Botherton SL, Roberson JR. Staged versus simultaneous bilateral total knee replacement. J Arthroplasty. 1986;1:221.
McLaughlin TP, Fisher RL. Bilateral Total knee arthroplasties. Comparison of simultaneous (two team), sequential and staged knee replacements. Clin Orthop. 1985;199:220.
Jankiewicz JJ, Sculco TP. One stage versus 2 stage bilateral total arthroplasty. Clin Orthop. 1994;309:94.
Arden GP. Total knee replacement. Clin Orthop. 1993;294:92.
Freeman PA. Walldius arthroplasty. A review of 80 cases Clin Orthop. 1973;94:85.
Bohm E, Molodianovitsh K, Dragan K, Zhu N, Webster G, Masri B, Schemitsch E, Dunbar M. Outcomes of unilateral and bilateral total knee arthroplasty in 238,373 patients. Acta Orthop. 2016;87(Suppl 1):24-30.
Yoon H S, Han C D, Yang I H. Comparison of simultaneous bilateral and staged bilateral total knee arthroplasty in terms of perioperative complications. J Arthroplasty. 2010;25(2):179-85.
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;446(12):3066-70.
Restrepo C, Parvizi J, Dietrich T, Einhorn T A. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg (Am). 2007;89(6):1220-6.
Odum S M, Troyer J L, Kelly M P, Dedini R D, Bozic K J. A cost-utility analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg (Am). 2013;95(16):1441-9.
Meehan J P, Danielsen B, Tancredi D J, Kim S, Jamali A A, White R H. A population-based comparison of the incidence of adverse outcomes after simultaneous-bilateral and staged-bilateral total knee arthroplasty. J Bone Joint Surg (Am). 2011;93(23):2203-13.
Lombardi A V, Mallory T H, Fada R A, Hartman J F, Capps S G, Kefauver C A, Dodds K, Adams J B.Simultaneous bilateral total knee arthroplasties: who decides? Clin Orthop Relat Res. 2001;(392):319-29.
Forster M C, Bauze AJ, Bailie A G, Falworth M S, Oakeshott R D. A retrospective comparative study of bilateral total knee replacement staged at a one-week interval. J Bone Joint Surg (Br). 2006;88(8):1006-10.
Fu D, Li G, Chen K, Zeng H, Zhang X, Cai Z. Comparison of clinical outcome between simultaneous-bilateral and staged-bilateral total knee arthroplasty: a systematic review of retrospective studies. J Arthroplasty. 2013;28(7):1141-7.
Hu J, Liu Y, Lv Z, Li X, Qin X, Fan W. Mortality and morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg. 2011;131(9):1291-8.
Hussain N, Chien T, Hussain F, Bookwala A, Simunovic N, Shetty V et al. Simultaneous versus staged bilateral total knee arthroplasty: a meta-analysis evaluating mortality, peri-operative complications and infection rates. HSS J. 2013;9(1):50-9.
Bullock D P, Sporer S M, Shirreffs T G Jr.Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg (Am). 2003;85(10):1981-6.
Yu-Hao Huang, Chin-lin, Jia-Hwa Yang, Chin-Yuan Mou. No difference in the functional improvements between unilateral and bilateral total knee replacements. BMC Musculoskeletal Disorders. 2018.
Wang YC, Teng WN, Kuo IT, Chang KY, Chang WK, Tsou MY et al. Patient-machine interactions of intravenous patient-controlled analgesia in bilateral versus unilateral total knee arthroplasty: a retrospective study. J Chin Med Assoc. 2013;76(6):330.
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-a(8):1532.
Jenny JY, Trojani C, Prudhon JL, Vielpeau C, Saragaglia D, Houillon C et al. Simultaneous bilateral total knee arthroplasty. A multicenter feasibility study. Orthop Traumatol Surg Res. 2013;99(2):191.
Hooper GJ, Hooper NM, Rothwell AG, Hobbs T. Bilateral total joint arthroplasty: the early results from the New Zealand National Joint Registry. J Arthroplast. 2009;24(8):1174.