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Archives of Orthopaedic and Trauma Surgery

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01-05-2019 | Knee Arthroplasty

Simultaneous vs staged bilateral total knee arthroplasty: a propensity-matched case–control study from nine fast-track centres

Authors: M. Lindberg-Larsen, F. T. Pitter, H. Husted, H. Kehlet, C. C. Jørgensen, The Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 5/2019

Abstract

Introduction

Limited data exist on patient safety after simultaneous vs staged bilateral total knee arthroplasty (TKA) in matched groups. Hence, the aim of this study was to compare length of stay (LOS), in-hospital complications, 30-day readmissions and mortality after simultaneous and staged bilateral TKA in matched patients.

Patients and methods

A retrospective case–control study of prospectively collected data in nine centres from February 2010 to November 2015. Propensity scores (PS) were used to match simultaneous and staged (1–6 months between stages) bilateral TKA patients with prospectively collected patient characteristics from the Lundbeck Foundation Centre for Fast-track THA and TKA Database. 30-day follow-up was acquired from the Danish Patient Registry and patient records.

Results

A total of 344 (47.1%) simultaneous and 386 (52.9%) staged bilateral TKA procedures were performed. PS matching was possible in 232 simultaneous and 232 staged bilateral TKA patients. LOS was median 4 days (IQR 3–5) after simultaneous and cumulated 4 days (IQR 4–6) after staged procedures. The in-hospital complication rate was 15.5% after simultaneous vs 7.3% (p = 0.004) after staged procedures. Two cases (0.9%) of venous thromboembolic events were found in each group. Eight patients (3.4%) were re-operated after simultaneous vs one patient (0.4%) after staged bilateral TKA (p = 0.037). The 30-day readmission rate was 8.6% after simultaneous vs 5.6% after staged procedures (p = 0.281). No patients died in either group.

Conclusions

We found no significant differences in 30-day readmission rates and mortality between simultaneous and staged bilateral TKA, but the in-hospital complication rate and re-operation rate was higher after the simultaneous procedure calling for further matched investigations in larger cohorts.

Metcalfe AJ, Andersson ML, Goodfellow R, Thorstensson CA (2012) Is knee osteoarthritis a symmetrical disease? Analysis of a 12 year prospective cohort study. BMC Musculoskelet Disord 13:153CrossRefPubMedPubMedCentral

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 28:87–91CrossRef

Hooper GJ, Hooper NM, Rothwell AG, Hobbs T (2009) Bilateral total joint arthroplasty: the early results from the New Zealand National Joint Registry. J Arthroplast 24:1174–1177CrossRef

Lindberg-Larsen M, Jorgensen CC, Husted H, Kehlet H (2015) Early morbidity after simultaneous and staged bilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:831–837CrossRefPubMed

Poultsides LA, Rasouli MR, Maltenfort MG, Parvizi J, Memtsoudis SG, Sculco TP (2014) Trends in same-day bilateral total knee arthroplasty. JArthroplasty 29:1713–1716CrossRef

Husted H (2012) Fast-track hip and knee arthroplasty. Clinical and organizational aspects. Acta OrthopSuppl 83:1–39CrossRef

Kehlet H (2013) Fast-track hip and knee arthroplasty. Lancet 381:1600–1602CrossRef

Fransen BL, Hoozemans MJM, Argelo KDS, Keijser LCM, Burger BJ.(2018) Fast-track total knee arthroplasty improved clinical and functional outcome in the first 7 days after surgery: a randomized controlled pilot study with 5-year follow-up. Arch Orthop Trauma Surg 138(9):1305–1316CrossRefPubMedPubMedCentral

Gromov K, Troelsen A, Stahl OK, Orsnes T, Husted H (2016) Morbidity and mortality after bilateral simultaneous total knee arthroplasty in a fast-track setting. Acta Orthop 87:286–290CrossRefPubMedPubMedCentral

10.

Hart A, Antoniou J, Brin YS, Huk OL, Zukor DJ, Bergeron SG (2016) Simultaneous bilateral versus unilateral total knee arthroplasty: a comparison of 30-day readmission rates and major complications. J Arthroplast 31:31–35CrossRef

11.

Husted H, Troelsen A, Otte KS, Kristensen BB, Holm G, Kehlet H (2011) Fast-track surgery for bilateral total knee replacement. J Bone Joint Surg Br 93:351–356CrossRefPubMed

12.

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

13.

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 93:2203–2213CrossRefPubMed

14.

Peskun C, Mayne I, Malempati H, Kosashvili Y, Gross A, Backstein D (2012) Cardiovascular disease predicts complications following bilateral total knee arthroplasty under a single anesthetic. Knee 19:580–584CrossRefPubMed

15.

Restrepo C, Parvizi J, Dietrich T, Einhorn TA (2007) Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 89:1220–1226CrossRef

16.

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 466:3066–3070CrossRefPubMedPubMedCentral

17.

Sobh AH, Siljander MP, Mells AJ, Koueiter DM, Moore DD, Karadsheh MS (2018) Cost analysis, complications, and discharge disposition associated with simultaneous vs staged bilateral total knee arthroplasty. J Arthroplast 33:320–323CrossRef

18.

Bini SA, Khatod M, Inacio MC, Paxton EW (2014) Same-day versus staged bilateral total knee arthroplasty poses no increase in complications in 6672 primary procedures. J Arthroplast 29:694–697CrossRef

19.

Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement (2018) http://www.fthk.dk/. Accessed 30 Oct 2018

20.

Jorgensen CC, Jacobsen MK, Soeballe K, Hansen TB, Husted H, Kjaersgaard-Andersen P, Hansen LT, Laursen MB, Kehlet H (2013) Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study. BMJ Open 3(12):e003965CrossRefPubMedPubMedCentral

21.

Jorgensen CC, Kehlet H (2013) Role of patient characteristics for fast-track hip and knee arthroplasty. Br J Anaesth 110:972–980CrossRefPubMed

22.

Jorgensen CC, Pitter FT, Kehlet H (2017) Safety aspects of preoperative high-dose glucocorticoid in primary total knee replacement. Br J Anaesth 119(2):267CrossRefPubMed

23.

Lynge E, Sandegaard JL, Rebolj M (2011) The Danish national patient register. Scand J Public Health 39:30–33CrossRef

24.

Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH (1999) The Danish National Hospital Register. A valuable source of data for modern health sciences. DanMedBull 46:263–268

25.

Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424CrossRef

Title: Simultaneous vs staged bilateral total knee arthroplasty: a propensity-matched case–control study from nine fast-track centres
Authors: M. Lindberg-Larsen
F. T. Pitter
H. Husted
H. Kehlet
C. C. Jørgensen
The Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 5/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03157-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Simultaneous vs staged bilateral total knee arthroplasty: a propensity-matched case–control study from nine fast-track centres

Abstract

Introduction

Patients and methods

Results

Conclusions

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Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusions

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