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HSS Journal ®
Published in: HSS Journal ® 1/2013

01-02-2013 | Review Article

Simultaneous Versus Staged Bilateral Total Knee Arthroplasty

A Meta-Analysis Evaluating Mortality, Peri-Operative Complications and Infection Rates

Authors: Nasir Hussain, BSc, Teresa Chien, BSc, Farrah Hussain, BSc, Ammar Bookwala, Nicole Simunovic, MSc, Vijay Shetty, MS (Orth), Mohit Bhandari, MD, PhD, FRCS(C)

Published in: HSS Journal ® | Issue 1/2013

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Abstract

Background

An important source of debate in many orthopaedic practices is the choice of performing simultaneous or staged bilateral total knee arthroplasty.

Questions/Purpose

The objective of this meta-analysis is to compare simultaneous bilateral with staged bilateral total knee arthroplasty for peri-operative complication rates, infection rates and mortality outcomes.

Methods

All relevant citations were retrieved from MEDLINE, EMBASE, COCHRANE databases and the unpublished literature. Included studies were assessed for methodological quality and abstracted data was conducted independently by two reviewers. Data was categorized into subgroups and pooled using the DerSimonian and Laird’s random effects model.

Results

A total of 18 articles were identified from 873 potentially relevant titles and selected for inclusion in the primary meta-analyses. The incidence of mortality was significantly higher in the simultaneous group at 30 days (RR [relative risk] 3.67, 95% confidence interval [CI] 1.68–8.02, p = 0.001, I 2 = 59%, n = 67,691 patients), 3 months (RR 2.45, 95% CI 2.15–2.79, p < 0.00001, I 2 = 0%, n = 66,142 patients) and 1 year (RR 1.85, 95% CI 1.66–2.06, p < 0.001, I 2 = 0%, n = 65,322 patients) after surgery. However, there were no significant differences between the two groups in regards to in-hospital mortality rates (R 1.18, 95% CI 0.74–1.88, p = 0.48, I 2 = 0%, n = 33,814 patients). In addition, there was no increased risk of deep vein thrombosis, cardiac complication, and pulmonary embolism or infection rates in either comparison group.

Conclusions

The results of the analysis suggest that simultaneous bilateral total knee arthroplasty has a significantly higher rate of mortality at 30 days, 3 months and 1 year after surgery, but similar infection and complication rates in comparison to staged bilateral total knee arthroplasty.
Literature
1.
Altman DG, Bland JM. Interaction revisited: the difference between two estimates. BMJ. 2003;326:219.PubMedCrossRef
2.
Barrett J, Baron JA, Losina E, Wright J, Mahomed NN, Katz JN. Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg Am. 2006;88(10):2146–51.PubMedCrossRef
3.
Brotherton, SL, Roberson JR, de Andrade JR, Fleming LL. Staged versus simultaneous bilateral total knee replacement. J Arthroplasty. 1986;1(4):221–8.PubMedCrossRef
4.
Burnett RSJ, MacDonald SJ. Complications in bilateral total knee arthroplasty. Semin Arthroplasty. 2003;14(4):245–62.CrossRef
5.
6.
Forster MC, Bauze AJ, Bailie AG, Falworth MS, Oakeshott RD. 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.PubMedCrossRef
7.
Gill GS, Mills D, Joshi AB. Mortality following primary total knee arthroplasty. J Bone Joint Surg Am. 2003;85(3):432–5.PubMed
8.
Gradillas EL, Volz RG. Bilateral total knee replacement under one anesthetic. Clin Orthop Relat Res. 1979;140:153–8.PubMed
9.
Hardaker WT, Ogden WS, Musgrave RE, Goldner JL. Simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg Am. 1978;60(2):247–50.PubMed
10.
11.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.PubMedCrossRef
12.
Hooper GJ, Hooper NM, Rothwell AG, Hobbs T. Bilateral total joint arthroplasty: the early results from the New Zealand national joint registry. J Arthroplasty. 2009;24(8):1174–77.PubMedCrossRef
13.
Hu J, Yuan L, Zheng L, Xiang L, Xiaodong Q, 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.PubMedCrossRef
14.
Hutchinson JR, Parish EN, Cross MJ. A comparison of bilateral uncemented total knee arthroplasty: simultaneous or staged? J Bone Joint Surg Br. 2006;88(1):40–3.PubMedCrossRef
15.
Ivory JP, Simpson AH, Toogood GJ, McLardy-Smith PD, Goodfellow JW. Bilateral knee replacements: simultaneous or staged? J R Coll Surg Edinb. 1993;38(2):105–7.PubMed
16.
Jankiewicz JJ, Sculco TP, Ranawat CS, Behr C, Tarrentino S. One-stage versus 2-stage bilateral total knee arthroplasty. Clin Orthop Relat Res. 1994;(309):94–101.PubMed
17.
Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the united states from 1990 through 2002. J Bone Joint Surg Am. 2005;87(7):1487–97.PubMedCrossRef
18.
Liang MH, Cullen KE, Larson MG. Cost-effectiveness of total joint arthroplasty in osteoarthritis. Arthritis Rheum. 1986;29(8):937–43.PubMedCrossRef
19.
Liu TK, Chen SH. Simultaneous bilateral total knee arthroplasty in a single procedure. Int Orthop. 1998;22(6):390–93.PubMedCrossRef
20.
Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP. Staged bilateral total knee replacement — a safer approach in older patients. Knee. 2001;8(3):207–11.PubMedCrossRef
21.
McLaughlin TP, Fisher RL. Bilateral total knee arthroplasties. Comparison of simultaneous (two-team), sequential, and staged knee replacements. Clin Orthop Relat Res. 1985; 199: 220–5.PubMed
22.
Memtsoudis SG, Ma Y, González Della Valle A, Mazumdar M, Gaber-Baylis LK, MacKenzie CR, Sculco TP. Perioperative outcomes after unilateral and bilateral total knee arthroplasty. Anesthesiology. 2009;111(6):1206–16.PubMedCrossRef
23.
Minter JE, Dorr LD. Indications for bilateral total knee replacement. Contemp Orthop. 1995;31(2):108–11.PubMed
24.
Morrey BF, Adams RA, Ilstrup DM, Bryan RS. Complications and mortality associated with bilateral or unilateral total knee arthroplasty. J Bone Joint Surg Am. 1987;69(4):484–8.PubMed
25.
Murray A, Brenkel I. Bilateral total knee replacement. Current Orthop. 2003;17(4):308–12.CrossRef
26.
Patil N, Wakankar H. Morbidity and mortality of simultaneous bilateral total knee arthroplasty. Orthopedics. 2008;31(8):780–9.PubMedCrossRef
27.
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.PubMedCrossRef
28.
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;85:1532–7.PubMed
29.
Ritter M, Mamlin LA, Melfi CA, Katz BP, Freund DA, Arthur DS. Outcome implications for the timing of bilateral total knee arthroplasties. Clin Orthop Relat Res. 1997:(345);99–105.PubMedCrossRef
30.
Sliva, C. D., Callaghan, J. J., Goetz, D. D., & Taylor, S. G. (2005). Staggered bilateral total knee arthroplasty performed four to seven days apart during a single hospitalization. J Bone Joint Surg Am. 2005;87(3):508–13.PubMedCrossRef
31.
Soudry M, Binazzi R, Insall JN, Nordstrom TJ, Pellicci PM, Goulet JA. Successive bilateral total knee replacement. J Bone Joint Surg Am. 1985;67(4):573–6.PubMed
32.
Stanley, D., Stockley, I., & Getty, C. J. Simultaneous or staged bilateral total knee replacements in rheumatoid arthritis. A prospective study. J Bone Joint Surg Br. 1990;72(5):772–4.PubMed
33.
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;466(12):3066–70.PubMedCrossRef
34.
Walmsley P, Murray A, Brenkel IJ. The practice of bilateral, simultaneous total knee replacement in Scotland over the last decade, data from the Scottish arthroplasty project. Knee. 2003;13(2):102–5.CrossRef
35.
36.
Yoon HS, Han CD, Yang IH. Comparison of simultaneous bilateral and staged bilateral total knee arthroplasty in terms of perioperative complications. J Arthroplasty. 2010;25(2):179–85.PubMedCrossRef
Metadata
Title
Simultaneous Versus Staged Bilateral Total Knee Arthroplasty
A Meta-Analysis Evaluating Mortality, Peri-Operative Complications and Infection Rates
Authors
Nasir Hussain, BSc
Teresa Chien, BSc
Farrah Hussain, BSc
Ammar Bookwala
Nicole Simunovic, MSc
Vijay Shetty, MS (Orth)
Mohit Bhandari, MD, PhD, FRCS(C)
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
HSS Journal ® / Issue 1/2013
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-012-9315-7

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