Perioperative Complications of Simultaneous versus Staged Unicompartmental Knee Arthroplasty

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Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 01/2011; 469(1):168-73. DOI: 10.1007/s11999-010-1492-4
Source: PubMed


The complication risk of staged versus simultaneous total knee arthroplasty continues to be debated in the literature. Previous reports suggest unicompartmental knee arthroplasty provides a more rapid functional recovery than total knee arthroplasty. However, little data exist on whether simultaneous unicompartmental knee arthroplasty can be performed without increasing the perioperative risk compared with staged unicompartmental knee arthroplasty.
We therefore asked if there is an increased risk of perioperative complications with bilateral simultaneous unicompartmental knee arthroplasty.
We retrospectively compared 141 patients (282 knees) treated with staged unicompartmental knee arthroplasty with 35 patients (70 knees) treated with simultaneous unicompartmental knee arthroplasty to evaluate perioperative complications and short-term results assessed by Knee Society function scores and the Lower Extremity Activity Scale.
Patients who underwent simultaneous unicompartmental knee arthroplasty had a shorter cumulative operative time (109 versus 122 minutes), a shorter cumulative length of hospital stay (1.7 versus 2.5 days), higher Knee Society function scores at most recent followup (88 versus 73), and higher Lower Extremity Activity Scale (12.0 versus 10.2) without a difference in perioperative complications. The simultaneous cohort was younger (59 versus 63 years of age) and less obese (body mass index 31 versus 33 kg/m(2)) than the staged group.
Although we found a substantial bias for performing simultaneous unicompartmental knee arthroplasty in younger and less obese patients, these data suggest it can be performed without increasing perioperative morbidity or mortality in this patient population.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Available from: Joanne B Adams, Apr 27, 2015
    • "Analyses of the Swedish and Finnish registries1529 have confirmed that good long term outcomes following UKA at a center are related to the number of UKAs performed at that center. Complications4152730 can occur with UKA, including spin out of mobile meniscus, dislocation, tibial plateau fractures, femoral condyle necrosis, implant loosening, and osteolysis. These are usually the result of poor surgical technique, and quite often than not, preventable.1127 "
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    ABSTRACT: Unicompartmental knee arthroplasty (UKA) has specific indications, producing excellent results. It, however, has a limited lifespan and needs eventual conversion to total knee arthroplasty (TKA). It is, therefore, a temporizing procedure in select active young patients with advanced unicompartmental osteoarthritis (UCOA). Being a less morbid procedure it is suggested as an alternative in the very elderly patients with tricompartmental osteoarthritis (TCOA). We performed UKA in a series of 45 octogenarians with TCOA predominant medial compartment osteoarthritis (MCOA) and analyzed the results. Forty five octogenarian patients with TCOA predominant MCOA underwent UKA (19 bilateral) from January 2002 to January 2012. All had similar preoperative work-up, surgical approach, procedure, implants and postoperative protocol. Clinicoradiological assessment was done at 3-monthly intervals for the first year, then yearly till the last followup (average 72 months, range 8-128 months). Results were evaluated using the knee society scores (KSS), satisfaction index [using the visual analogue scale (VAS)] and orthogonal radiographs (for loosening, subsidence, lysis or implant wear). Resurgery for any cause was considered failure. Four patients (six knees) died due to medical conditions, two patients (three knees) were lost to followup, and these were excluded from the final analysis. Barring two failures, all the remaining patients were pain-free and performing well at the final followup. Indications for resurgery were: medial femoral condyle fracture needing fixation subsequent conversion to TKA at 2 years (n=1) and progression of arthritis and pain leading to revision TKA at 6 years (n=1). UKA has shown successful outcomes with regards to pain relief and function with 96.4% implant survival and 94.9% good or excellent outcomes. Due to lower demands, early rehabilitation, less morbidity, and relative short life expectancy, UKA can successfully manage TCOA in the octogenarians.
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    ABSTRACT: Aim of study: Unicompartmental knee arthroplasty (UKA) has been increasingly utilized over the past decade secondary to favorable reports of better range of motion, higher activity levels, and increased patient satisfaction compared with total knee arthroplasty (TKA). The aim of this study was to determine the 90-day incidence of perioperative complications and mortality of patients undergoing UKA. Methods: One thousand consecutive UKA in 828 patients were retrospectively reviewed. A retrospective review was performed to evaluate 90-day perioperative complication and mortality rates. Results: There were zero deaths during the study period. Twelve percent of surgeries were complicated by variances within the 90-day postoperative period. There was one deep venous thrombosis (0.1%) and no pulmonary emboli. Cardiovascular complications were infrequent. Three patients had a myocardial infarction (0.31%), one developed congestive heart failure (0.1%), one angina (0.1%), and three had arrhythmias (0.31%). Secondary procedures were performed in 15 patients during the follow-up period: seven were manipulations under anesthesia for arthrofibrosis, one was an arthroscopic removal of retained cement, one arthroscopic removal of a drain, one repeat wound closure after a dehiscence secondary to a fall, one open reduction internal fixation for a supracondylar femur fracture, three irrigation and debridement procedures for an aseptic hematoma, and one radical debridement with later successful conversion to a total knee arthroplasty for a periprosthetic infection. Conclusion: This study supports the notion that UKA is a safe procedure that is associated with a low rate of mortality and serious post-operative complications.
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    ABSTRACT: BACKGROUND: Controversy exists regarding many aspects of decision making pertaining to same-day versus staged bilateral TKA (BTKAs), including patient selection, perioperative management decisions, and other important choices. QUESTIONS/PURPOSES : In the absence of suitable randomized trials, we sought to determine areas of consensus among national experts on the following questions: (1) What are the comparative risks of same-day BTKAs compared with unilateral TKA (UTKA) and staged BTKAs? (2) Who should be considered an appropriate candidate for same-day BTKAs? (3) What constitutes appropriate workup and perioperative management for BTKAs? (4) What is the optimal time between procedures if same-day BTKAs are not deemed appropriate? (5) Are there orthopaedic or rehabilitation considerations for BTKAs that might outweigh medical contraindications? METHODS : In the setting of a consensus conference of national experts in orthopaedic surgery, anesthesiology, perioperative medicine, and epidemiology, the major questions surrounding same-day BTKAs were addressed by using an extensive literature review and the modified Delphi process. The process concluded with a meeting of participants and formulation of consensus statements. RESULTS: Eighty-one percent of participants agreed that BTKAs are more invasive and complex procedures associated with increased risk for perioperative adverse events compared with UTKA in an unselected group of patients. The consensus group agreed that physicians and hospitals should consider using more restrictive patient selection criteria and exclude those with a modified cardiac risk index greater than 3 to mitigate the potentially increased risk. The majority of the group agreed that perioperative assessment and management should reflect the higher level of acuity of same-day BTKAs. Eighty-one percent of participants agreed that if a patient is not deemed a candidate for same-day BTKAs, a second TKA should be scheduled no sooner than 3 months after the first. The entire group agreed that when there is a conflict between the orthopaedic need and the medical adequacy of same-day BTKAs, the medical concern for the patient's safety should prevail over the orthopaedic need. CONCLUSIONS : Experts perceived that same-day BTKAs increase medical risk, and thus a systematic approach to the management of patients should be taken to minimize complications.
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