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Simultaneous bilateral total knee arthroplasties: who decides?
A V Lombardi1, T H Mallory, R A Fada
1Joint Implant Surgeons, Inc, Columbus, OH 43215, USA.
Clinical Orthopaedics and Related Research
|November 22, 2001
Summary
Simultaneous bilateral total knee arthroplasty (TKA) increases blood loss and gastrointestinal complications. However, patient age, not the procedure type, is the primary driver of perioperative complications in TKA.
Area of Science:
- Orthopedic Surgery
- Perioperative Medicine
- Arthroplasty Research
Background:
- Simultaneous bilateral total knee arthroplasty (TKA) is an option for patients requiring knee replacement in both limbs.
- Previous studies suggest comparable outcomes and patient satisfaction with bilateral TKA versus unilateral TKA.
Purpose of the Study:
- To compare perioperative complications, hospital stay, and discharge disposition between simultaneous bilateral TKA and unilateral TKA.
- To investigate the influence of patient age on perioperative morbidity in TKA procedures.
Main Methods:
- Retrospective review of 1498 patients undergoing 1090 simultaneous bilateral TKAs and 958 unilateral TKAs over a 3-year period.
- Analysis of intraoperative blood loss, transfusion requirements, complication rates (gastrointestinal, pulmonary, neurologic, cardiac, genitourinary), length of stay, and discharge disposition.
- Comparison of complication rates between bilateral and unilateral TKA groups, and within age subgroups (≥80 years vs. <80 years).
Main Results:
- Simultaneous bilateral TKA patients experienced significantly higher intraoperative blood loss, increased transfusion rates, and a greater incidence of gastrointestinal complications compared to unilateral TKA patients.
- In both unilateral and bilateral TKA groups, patients aged 80 years or older exhibited significantly higher rates of pulmonary, neurologic, and cardiac complications compared to younger patients.
- Age emerged as a more significant factor than the surgical procedure (bilateral vs. unilateral) in determining perioperative morbidity.
Conclusions:
- While simultaneous bilateral TKA is associated with increased blood loss and gastrointestinal issues, patient age is the predominant determinant of perioperative complications.
- The findings support the continued offering of simultaneous bilateral TKA as a viable option, considering patient preference and comparable outcomes.
- Further research may focus on optimizing patient selection and perioperative management for elderly patients undergoing bilateral TKA.
