Top

International Orthopaedics

Published in:

01-10-2020 | Original Paper

Safety of one-stage bilateral total knee arthroplasty —one surgeon sequential vs. two surgeons simultaneous: a randomized controlled study

Authors: Gökçer Uzer, Orkhan Aliyev, Fatih Yıldız, Nurdan Güngören, Nurzat Elmalı, İbrahim Tuncay

Published in: International Orthopaedics | Issue 10/2020

Abstract

Purpose

This study aimed to examine the complications by comparing two surgeons simultaneous bilateral total knee arthroplasty (two-surgeon bilateral TKA) to one surgeon sequential bilateral total knee arthroplasty (single-surgeon bilateral TKA).

Methods

Two hundred forty-six participants were prospectively randomized into two groups: two-surgeon bilateral TKA and single-surgeon bilateral TKA. While two surgeons performed simultaneous total knee arthroplasty in the two-surgeon bilateral TKA group, one surgeon performed sequentially in the single-surgeon bilateral TKA group. Ninety-day major, and minor complications rate, operative time, estimated blood loss (EBL) and patient-reported outcome measures were analysed.

Results

The two surgeons operated in two-surgeon bilateral TKA group 246 knees in 123 patients, while the single surgeon operated in single-surgeon bilateral TKA group 246 knees of 123 patients. The median operating time was 120 (range 70–151) minutes in the two-surgeon bilateral TKA group and 140 (range 75–190) minutes in the single-surgeon bilateral TKA group (p < 0.001). The median EBL was higher in the two-surgeon bilateral TKA group (p < 0.001). The 90-day complications were two major complications (1.6%) in the two-surgeon bilateral TKA group and 11 (8.9%) in the single-surgeon bilateral TKA group (p = 0.01).

Conclusion

Two-surgeon simultaneous bilateral TKA is a safe method with lower complication rates compared with single-surgeon sequential bilateral TKA and can be preferred for experienced teams. However, peri- and post-operative care is required to decrease the risk of bleeding, particularly in patients undergoing two-surgeon simultaneous bilateral TKA.

Trial registration

This study was retrospectively registered in a public trials registry (https://clinicaltrials.gov/, NCT04299516).

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 9:50–59. https://doi.org/10.1007/s11420-012-9315-7CrossRefPubMedPubMedCentral

Chua HS, Whitehouse SL, Lorimer M, De Steiger R, Guo L, Crawford RW (2018) Mortality and implant survival with simultaneous and staged bilateral total knee arthroplasty experience from the Australian Orthopaedic Association National Joint Replacement Registry. J Arthroplast 33:3167–3173. https://doi.org/10.1016/j.arth.2018.05.019CrossRef

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 131:1291–1298. https://doi.org/10.1007/s00402-011-1287-4CrossRefPubMed

Stefansdottir 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 466:3066–3070. https://doi.org/10.1007/s11999-008-0404-3CrossRefPubMedPubMedCentral

Poultsides LA, Rasouli MR, Maltenfort MG, Parvizi J, Memtsoudis SG, Sculco TP (2014) Trends in same-day bilateral total knee arthroplasty. J Arthroplast 29:1713–1716. https://doi.org/10.1016/j.arth.2014.04.021CrossRef

Dimitris CN, Taylor BC, Mowbray JG, Steensen RN, Gaines ST (2011) Perioperative morbidity and mortality of 2-team simultaneous bilateral total knee arthroplasty. Orthopedics 34:e841–e846. https://doi.org/10.3928/01477447-20111021-02CrossRefPubMed

Hutchinson JR, Parish EN, Cross MJ (2006) A comparison of bilateral uncemented total knee arthroplasty: simultaneous or staged? J Bone Joint Surg Br 88:40–43. https://doi.org/10.1302/0301-620X.88B1.16454CrossRefPubMed

Stubbs G, Pryke SE, Tewari S, Rogers J, Crowe B, Bridgfoot L, Smith N (2005) Safety and cost benefits of bilateral total knee replacement in an acute hospital. ANZ J Surg 75:739–746. https://doi.org/10.1111/j.1445-2197.2005.03516.xCrossRefPubMed

Wyles CC, Robinson WA, Maradit-Kremers H, Houdek MT, Trousdale RT, Mabry TM (2019) Cost and patient outcomes associated with bilateral total knee arthroplasty performed by 2-surgeon teams vs a single surgeon. J Arthroplast 34:671–675. https://doi.org/10.1016/j.arth.2018.12.029CrossRef

10.

Sheth DS, Cafri G, Paxton EW, Namba RS (2016) Bilateral simultaneous vs staged total knee arthroplasty: a comparison of complications and mortality. J Arthroplast 31:212–216. https://doi.org/10.1016/j.arth.2016.03.018CrossRef

11.

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 93:2203–2213. https://doi.org/10.2106/JBJS.J.01350CrossRefPubMed

12.

Bolognesi MP, Watters TS, Attarian DE, Wellman SS, Setoguchi S (2013) Simultaneous vs staged bilateral total knee arthroplasty among Medicare beneficiaries, 2000-2009. J Arthroplast 28:87–91. https://doi.org/10.1016/j.arth.2013.05.039CrossRef

13.

Gill SD, Hatton A, de Steiger RN, Page RS (2020) One-surgeon vs two-surgeon single-anesthetic bilateral total knee Arthroplasty: revision and mortality rates from the Australian Orthopedic Association National Joint Replacement Registry. J Arthroplast. https://doi.org/10.1016/j.arth.2020.02.066

14.

Taylor BC, Dimitris C, Mowbray JG, Gaines ST, Steensen RN (2010) Perioperative safety of two-team simultaneous bilateral total knee arthroplasty in the obese patient. J Orthop Surg Res 5:38. https://doi.org/10.1186/1749-799X-5-38CrossRefPubMedPubMedCentral

15.

Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG (2010) CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 340:c869. https://doi.org/10.1136/bmj.c869CrossRefPubMedPubMedCentral

16.

Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH (2007) Total joint arthroplasty: when do fatal or near-fatal complications occur? J Bone Joint Surg Am 89:27–32. https://doi.org/10.2106/JBJS.E.01443CrossRefPubMed

17.

Gross JB (1983) Estimating allowable blood loss: corrected for dilution. Anesthesiology 58:277–280. https://doi.org/10.1097/00000542-198303000-00016CrossRefPubMed

18.

Memtsoudis SG, Valle AGD, Besculides MC, Gaber L, Sculco TP (2008) In-hospital complications and mortality of unilateral, bilateral, and revision TKA. Clin Orthop Relat Res 466:2617–2627. https://doi.org/10.1007/s11999-008-0402-5CrossRefPubMedPubMedCentral

19.

George J, Mahmood B, Sultan AA, Sodhi N, Mont MA, Higuera CA, Stearns KL (2018) How fast should a total knee arthroplasty be performed? An analysis of 140,199 surgeries. J Arthroplast 33:2616–2622. https://doi.org/10.1016/j.arth.2018.03.012CrossRef

20.

Ross D, Erkocak O, Rasouli MR, Parvizi J (2019) Operative time directly correlates with blood loss and need for blood transfusion in total joint arthroplasty. Arch Bone Jt Surg 7:229–234PubMedPubMedCentral

21.

Teo BJX, Yeo W, Chong HC, Tan AHC (2018) Surgical site infection after primary total knee arthroplasty is associated with a longer duration of surgery. J Orthop Surg 26:2309499018785647. https://doi.org/10.1177/2309499018785647CrossRef

22.

Wang Q, Goswami K, Shohat N, Aalirezaie A, Manrique J, Parvizi J (2019) Longer operative time results in a higher rate of subsequent periprosthetic joint infection in patients undergoing primary joint arthroplasty. J Arthroplast 34:947–953. https://doi.org/10.1016/j.arth.2019.01.027CrossRef

23.

Surace P, Sultan AA, George J, Samuel LT, Khlopas A, Molloy RM, Stearns KL, Mont MA (2019) The association between operative time and short-term complications in total hip arthroplasty: an analysis of 89,802 surgeries. J Arthroplast 34:426–432. https://doi.org/10.1016/j.arth.2018.11.015CrossRef

24.

Kushimoto S, Kudo D, Kawazoe Y (2017) Acute traumatic coagulopathy and traumainduced coagulopathy: an overview J Intensive Care 5. DOI https://doi.org/10.1186/s40560-016-0196-6

25.

McLaughlin TP, Fisher RL (1985) Bilateral total knee arthroplasties. Comparison of simultaneous (two-team), sequential, and staged knee replacements. Clin Orthop Relat Res 199:5

Title: Safety of one-stage bilateral total knee arthroplasty —one surgeon sequential vs. two surgeons simultaneous: a randomized controlled study
Authors: Gökçer Uzer
Orkhan Aliyev
Fatih Yıldız
Nurdan Güngören
Nurzat Elmalı
İbrahim Tuncay
Publication date: 01-10-2020
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 10/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04704-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Safety of one-stage bilateral total knee arthroplasty —one surgeon sequential vs. two surgeons simultaneous: a randomized controlled study

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 10/2020

Why are patients dissatisfied following a total knee replacement? A systematic review

Medial opening wedge high tibial osteotomy: more than ten years of experience with Puddu plate technique supports its indication

Evaluation of myeloperoxidase in synovial fluid as a biomarker for chronic periprosthetic joint infection

Coronavirus disease 2019 pandemic: should we delay cartilage regenerative procedures and accept the consequences, or can we find a new normality?

Reply to Letter to Editor: Safety of one-stage bilateral total knee arthroplasty—one-surgeon sequential vs. two surgeons simultaneous: a randomized controlled study

Letter to the editor regarding “Intramedullary fixation versus anatomically contoured plating of unstable fractures: a randomized control trial” by Badenhorst et al