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Published on: July 5, 2011
Consensus statement from the consensus conference on bilateral total knee arthroplasty group.
Stavros G Memtsoudis1, Mary Hargett, Linda A Russell
1Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA. memtsoudiss@hss.edu
Clinical Orthopaedics and Related Research
|April 9, 2013
Summary
Bilateral total knee arthroplasty (BTKA) increases medical risks compared to unilateral procedures. National experts recommend stricter patient selection and a 3-month minimum interval for staged BTKA to ensure patient safety.
Area of Science:
- Orthopaedic Surgery
- Anesthesiology
- Perioperative Medicine
- Epidemiology
Background:
- Controversy surrounds decision-making for same-day versus staged bilateral total knee arthroplasties (BTKAs).
- Key areas of debate include patient selection, perioperative management, and procedural timing.
- Lack of randomized trials necessitates expert consensus for guiding practice.
Framework:
- Modified Delphi process involving national experts in orthopaedics, anesthesiology, perioperative medicine, and epidemiology.
- Extensive literature review to inform expert discussions.
- Consensus statements formulated after expert deliberation and meetings.
Implementation:
- 81% agreed BTKAs are more invasive than unilateral TKAs (UTKAs), with higher perioperative risks.
- Recommended stricter patient selection, excluding those with a cardiac risk index > 3.
- Perioperative assessment and management must address the increased acuity of BTKAs.
Implications:
- Experts perceive increased medical risk with same-day BTKAs.
- A systematic approach is crucial for minimizing complications in BTKA patients.
- Medical safety should supersede orthopaedic need when contraindications exist.
