Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications.

Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 4.31). 11/2003; 85-A(10):1981-6.
Source: PubMed

ABSTRACT Previous studies have demonstrated an increased rate of perioperative complications and morbidity following simultaneous bilateral total knee arthroplasty compared with the rate following unilateral total knee arthroplasty. The purpose of this study was to compare the rate of perioperative complications and morbidity associated with simultaneous bilateral total knee arthroplasty with that associated with unilateral total knee arthroplasty.
The records on all bilateral total knee arthroplasties performed between January 1994 and June 2000 and unilateral total knee arthroplasties performed between January 1995 and June 2000 were retrospectively reviewed. The records on 514 unilateral total knee arthroplasties and 255 bilateral total knee arthroplasties were analyzed to determine demographic information, preoperative comorbidities, perioperative complications, and thirty-day and one-year mortality rates.
The rates of some perioperative complications, including myocardial infarction, postoperative confusion, and the need for intensive monitoring, were greater after the bilateral arthroplasties. However, the thirty-day and one-year mortality rates and the risks of pulmonary embolism, infection, and deep venous thrombosis were similar for the two groups.
The risk of perioperative complications associated with bilateral simultaneous total knee arthroplasty was slightly increased compared with that associated with unilateral total knee arthroplasty, but the mortality rates were similar. Ultimately, the decision to proceed with simultaneous knee replacement should depend on patient preference through informed choice.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study is to evaluate the risk of sequential bilateral total knee arthroplasty (TKA) under 1 anesthesia in patients 75 years or older. Patients aged 75 years or older who underwent sequential bilateral TKA (bilateral group, n=159) and unilateral TKA (unilateral group, n=159) between 2002 and 2012 were selected. All patients were evaluated for underlying medical diseases, such as cardiac, pulmonary, and renal problems, and high-risk patients were recommended to postpone the surgery. We compared the underlying diseases, major postoperative complications, and the length of hospital stay between bilateral and unilateral groups. The prevalence of underlying diseases of the bilateral group was 74.8% and major complications occurred in 6 patients (3.8%). The prevalence of underlying diseases of the unilateral group was 52.4% and complications were observed in 4 patients (2.4%). Although the complication rate of the bilateral group was slightly higher than that of the unilateral group, the difference was not statistically meaningful (p=0.204). The length of hospital stay was 21.9 days for the bilateral group and 24.9 days for the unilateral group. There was no significant difference in postoperative complications between groups. The result shows that bilateral TKA can be relatively safe compared with unilateral TKA in patients 75 years or older. However, careful selection of low-risk patients is advised.
    12/2014; 26(4):222-9. DOI:10.5792/ksrr.2014.26.4.222
  • [Show abstract] [Hide abstract]
    ABSTRACT: There has been an increase in the prevalence of morbid obesity and the demand for total knee arthroplasty (TKA). Physicians must help patients with bilateral knee arthritis to make informed decisions regarding whether to undergo staged, sequential, or simultaneous TKA. The purpose of this study was to evaluate the perioperative complications of 2-team simultaneous bilateral TKA in the morbidly obese. The authors performed a retrospective review of the records at a single tertiary hospital from 1997 to 2007 and identified 35 morbidly obese (body mass index [BMI] greater than 40 kg/m(2)) patients who had undergone unilateral TKA, as well as 42 morbidly obese and 79 nonobese (BMI less than 30 kg/m(2)) patients who underwent simultaneous bilateral TKA. Clinical, operative, and postoperative variables and complication rates were recorded. Clinical variables were similar between the morbidly obese TKA patients. The bilateral group had significantly increased operative times (132.4 vs 115.5 minutes; P<.01), intravenous fluids (2556.1 vs 2114.7 mL; P=.03), percentage transfused (64.2% vs 11.4%; P<.01), days in the hospital (3.6 vs 3.2 days; P=.03), and discharge rates to rehabilitation facility (72.7% vs 48.6%; P=.01). Major and minor complications were few and comparable, with the need for manipulation under anesthesia in unilateral TKA (11.4%; P=.04) as the only significant difference between groups, including when comparing bilateral nonobese TKAs with bilateral morbidly obese TKAs. The authors feel that morbidly obese patients may undergo 2-team simultaneous bilateral TKA after careful discussion regarding some of the differences in short-term outcomes.
    Orthopedics 03/2014; 37(3):e252-9. DOI:10.3928/01477447-20140225-57 · 0.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Acute pancreatitis is a known post-operative complication, commonly after abdominal surgery rather than total knee arthroplasty. When complications occur, post total knee arthroplasty, they tend to be cardiovascular and neurological events, rarely involving the gastrointestinal system. Therefore, when gastrointestinal complications occur, especially if they present with atypical symptoms, this tends to result in a delay in diagnosis. We present a case of acute pancreatitis post simultaneous bilateral total knee arthroplasty in a patient with risk factors like alcoholism and hypercholesterolaemia. Its atypical presentation of only persistent tachycardia, without abdominal pain, was misleading and the resultant delay in treatment dangerous. Therefore, it is important to consider acute pancreatitis as a differential diagnosis in a patient with persistent tachycardia post total knee arthroplasty, especially if he has risk factors for the condition.
    12/2013; 10(4):200–203. DOI:10.1016/j.jor.2013.09.007