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Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Research article

No difference in the functional improvements between unilateral and bilateral total knee replacements

Authors: Yu-Hao Huang, Chin Lin, Jia-Hwa Yang, Leou-Chyr Lin, Chih-Yuan Mou, Kwo-Tsao Chiang, Man-Gang Lee, Hsien-Feng Chang, Hsueh-Lu Chang, Wen Su, Shih-Jen Yeh, Hung Chang, Chih-Chien Wang, Sui-Lung Su

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

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Abstract

Background

Differences between staged bilateral total knee replacement (TKR) and simultaneous bilateral TKR have been investigated, but few studies have investigated differences in the functional improvements resulting from these methods. Therefore, this study investigates the different functional improvements between staged bilateral total knee TKR and simultaneous bilateral TKR.

Methods

Among 144 potential bilateral TKR patients who were included in this study, 93 (64.6%) patients selected unilateral TKR and 51 (35.4%) selected bilateral TKR. Functional improvements were assessed using the Western Ontario and McMaster University osteoarthritis index (WOMAC) and the Medical Outcomes Trust Short Form-36 (SF-36), and patients were interviewed pre-operatively and after 6 months. A generalized equation was used to test for differences in functional improvements.

Results

After TKR, pain, stiffness, function and total WOMAC scores were significantly reduced in both groups, with mean changes from − 26.6 to − 41.4 and from − 27.5 to − 42.2.The mean health change of SF-36 scores, physical component and mental component scores changed to 45.2 ± 18.2, 74.0 ± 15.4 and 77.0 ± 9.6, respectively, in Group 1 and 47.1 ± 17.1, 74.0 ± 15.2 and 75.5 ± 12.1, respectively, in Group 2.
Unilateral and simultaneous bilateral TKR produce similar functional improvements, although current work status may be a novel impact factor.

Conclusion

No differences in functional improvements were identified between patients who selected unilateral versus bilateral TKR, indicating no recommendation for one procedure over the other.
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Literature
1.
go back to reference 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.PubMed 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.PubMed
2.
go back to reference Waimann CA, Fernandez-Mazarambroz RJ, Cantor SB, Lopez-Olivo MA, Zhang H, Landon GC, Siff SJ, Suarez-Almazor ME. Cost-effectiveness of total knee replacement: a prospective cohort study. Arthritis Care Res. 2014;66(4):592.CrossRef Waimann CA, Fernandez-Mazarambroz RJ, Cantor SB, Lopez-Olivo MA, Zhang H, Landon GC, Siff SJ, Suarez-Almazor ME. Cost-effectiveness of total knee replacement: a prospective cohort study. Arthritis Care Res. 2014;66(4):592.CrossRef
3.
go back to reference White DK, Zhang Y, Felson DT, Niu J, Keysor JJ, Nevitt MC, Lewis CE, Torner JC, Neogi T. The independent effect of pain in one versus two knees on the presence of low physical function in a multicenter knee osteoarthritis study. Arthritis Care Res. 2010;62(7):938.CrossRef White DK, Zhang Y, Felson DT, Niu J, Keysor JJ, Nevitt MC, Lewis CE, Torner JC, Neogi T. The independent effect of pain in one versus two knees on the presence of low physical function in a multicenter knee osteoarthritis study. Arthritis Care Res. 2010;62(7):938.CrossRef
4.
go back to reference Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP. Staged bilateral total knee replacement--a safer approach in older patients. Knee. 2001;8(3):207.CrossRefPubMed Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP. Staged bilateral total knee replacement--a safer approach in older patients. Knee. 2001;8(3):207.CrossRefPubMed
5.
go back to reference 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. 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.
6.
go back to reference Wang YC, Teng WN, Kuo IT, Chang KY, Chang WK, Tsou MY, Chan KH, Ting CK. 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.CrossRefPubMed Wang YC, Teng WN, Kuo IT, Chang KY, Chang WK, Tsou MY, Chan KH, Ting CK. 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.CrossRefPubMed
7.
go back to reference Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2007;89(6):1220.CrossRefPubMed Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2007;89(6):1220.CrossRefPubMed
8.
go back to reference Courtney PM, Melnic CM, Alosh H, Shah RP, Nelson CL, Israelite CL. Is bilateral total knee arthroplasty staged at a one-week interval safe? A matched case control study. J Arthroplast. 1946;29(10):2014. Courtney PM, Melnic CM, Alosh H, Shah RP, Nelson CL, Israelite CL. Is bilateral total knee arthroplasty staged at a one-week interval safe? A matched case control study. J Arthroplast. 1946;29(10):2014.
9.
go back to reference Cahill CW, Schwarzkopf R, Sinha S, Scott RD. Simultaneous bilateral knee arthroplasty in octogenarians: can it be safe and effective? J Arthroplast. 2014;29(5):998.CrossRef Cahill CW, Schwarzkopf R, Sinha S, Scott RD. Simultaneous bilateral knee arthroplasty in octogenarians: can it be safe and effective? J Arthroplast. 2014;29(5):998.CrossRef
10.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
11.
go back to reference Lin A, Chao E, Yang CM, Wen HC, Ma HL, Lu TC. Costs of staged versus simultaneous bilateral total knee arthroplasty: a population-based study of the Taiwanese National Health Insurance Database. J Orthop Surg Res. 2014;9(1):59.CrossRefPubMedPubMedCentral Lin A, Chao E, Yang CM, Wen HC, Ma HL, Lu TC. Costs of staged versus simultaneous bilateral total knee arthroplasty: a population-based study of the Taiwanese National Health Insurance Database. J Orthop Surg Res. 2014;9(1):59.CrossRefPubMedPubMedCentral
12.
go back to reference Jain S, Wasnik S, Mittal A, Sohoni S, Kasture S. Simultaneous bilateral total knee replacement: a prospective study of 150 patients. J Orthop Surg (Hong Kong). 2013;21(1):19.CrossRef Jain S, Wasnik S, Mittal A, Sohoni S, Kasture S. Simultaneous bilateral total knee replacement: a prospective study of 150 patients. J Orthop Surg (Hong Kong). 2013;21(1):19.CrossRef
14.
go back to reference March LM, Cross M, Tribe KL, Lapsley HM, Courtenay BG, Cross MJ, Brooks PM, Cass C, Coolican M, Neil M, Pinczewski L, Quain S, Robertson F, Ruff S, Walter W, Zicat B. Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA. Osteoarthr Cartil. 2004;12(5):400.CrossRefPubMed March LM, Cross M, Tribe KL, Lapsley HM, Courtenay BG, Cross MJ, Brooks PM, Cass C, Coolican M, Neil M, Pinczewski L, Quain S, Robertson F, Ruff S, Walter W, Zicat B. Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA. Osteoarthr Cartil. 2004;12(5):400.CrossRefPubMed
15.
go back to reference Minter JE, Dorr LD. Indications for bilateral total knee replacement. Contemp Orthop. 1995;31(2):108.PubMed Minter JE, Dorr LD. Indications for bilateral total knee replacement. Contemp Orthop. 1995;31(2):108.PubMed
16.
go back to reference Vulcano E, Memtsoudis S, Della Valle AG. Bilateral total knee arthroplasty guidelines: are we there yet? J Knee Surg. 2013;26(4):273.CrossRefPubMed Vulcano E, Memtsoudis S, Della Valle AG. Bilateral total knee arthroplasty guidelines: are we there yet? J Knee Surg. 2013;26(4):273.CrossRefPubMed
17.
go back to reference Oakes DA, Hanssen AD. Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks. Clin Orthop Relat Res. 2004;(428):87–91. Oakes DA, Hanssen AD. Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks. Clin Orthop Relat Res. 2004;(428):87–91.
18.
go back to reference Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1833;15(12):1988. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1833;15(12):1988.
19.
go back to reference Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473.CrossRefPubMed Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473.CrossRefPubMed
20.
go back to reference Faul F, Erdfelder E, Lang AG, Buchner A. G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175.CrossRefPubMed Faul F, Erdfelder E, Lang AG, Buchner A. G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175.CrossRefPubMed
21.
go back to reference Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis and cartilage / OARS. Osteoarthritis Res Soc. 2007;15(3):273.CrossRef Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis and cartilage / OARS. Osteoarthritis Res Soc. 2007;15(3):273.CrossRef
22.
go back to reference Baker P, Muthumayandi K, Gerrand C, Kleim B, Bettinson K, Deehan D. Influence of body mass index (BMI) on functional improvements at 3 years following total knee replacement: a retrospective cohort study. PLoS One. 2013;8(3):e59079.CrossRefPubMedPubMedCentral Baker P, Muthumayandi K, Gerrand C, Kleim B, Bettinson K, Deehan D. Influence of body mass index (BMI) on functional improvements at 3 years following total knee replacement: a retrospective cohort study. PLoS One. 2013;8(3):e59079.CrossRefPubMedPubMedCentral
23.
go back to reference Jenny JY, Trojani C, Prudhon JL, Vielpeau C, Saragaglia D, Houillon C, Ameline T, Steffan F, Bugnas B, Arndt J. Simultaneous bilateral total knee arthroplasty. A multicenter feasibility study. Orthop Traumatol Surg Res. 2013;99(2):191.CrossRefPubMed Jenny JY, Trojani C, Prudhon JL, Vielpeau C, Saragaglia D, Houillon C, Ameline T, Steffan F, Bugnas B, Arndt J. Simultaneous bilateral total knee arthroplasty. A multicenter feasibility study. Orthop Traumatol Surg Res. 2013;99(2):191.CrossRefPubMed
24.
go back to reference 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.CrossRef 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.CrossRef
25.
go back to reference Al-Omran AS. The quality of life (QOL) after Total knee arthroplasties among Saudi Arabians: a pilot study. Int J Biomed Sci. 2014;10(3):196.PubMedPubMedCentral Al-Omran AS. The quality of life (QOL) after Total knee arthroplasties among Saudi Arabians: a pilot study. Int J Biomed Sci. 2014;10(3):196.PubMedPubMedCentral
Metadata
Title
No difference in the functional improvements between unilateral and bilateral total knee replacements
Authors
Yu-Hao Huang
Chin Lin
Jia-Hwa Yang
Leou-Chyr Lin
Chih-Yuan Mou
Kwo-Tsao Chiang
Man-Gang Lee
Hsien-Feng Chang
Hsueh-Lu Chang
Wen Su
Shih-Jen Yeh
Hung Chang
Chih-Chien Wang
Sui-Lung Su
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-2006-x

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