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Related Experiment Video

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In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty
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Ninety-Day Morbidity and Mortality in Risk-Screened and Optimized Patients Undergoing Two-Team Fast-Track

Vikas Kulshrestha1, Santhosh Kumar1, Barun Datta1

  • 1Joint Replacement Centre, Army Hospital Research & Referral, New Delhi, India.

The Journal of Arthroplasty
|November 6, 2017
PubMed
Summary

Simultaneous bilateral total knee arthroplasty (SBTKA) shows higher complication rates, particularly cardiovascular and neurological, despite risk screening. A cautious approach is advised for SBTKA due to these increased risks compared to unilateral procedures.

Keywords:
bilateralcardiaccomplicationssafetysimultaneoustotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Patient Safety
  • Clinical Outcomes

Background:

  • Simultaneous bilateral total knee arthroplasty (SBTKA) presents socioeconomic benefits but carries higher reported mortality and morbidity risks than unilateral TKA (UTKA).
  • Evidence supporting SBTKA is limited, despite its continued performance at high-volume centers with careful patient selection.
  • Previous studies and public health data suggest caution regarding SBTKA due to adverse event rates.

Purpose of the Study:

  • To prospectively evaluate 90-day morbidity and mortality for SBTKA versus UTKA.
  • To assess the impact of risk screening and optimization on outcomes in SBTKA patients.
  • To compare complication rates, including cardiovascular and neurological events, between SBTKA and UTKA.

Main Methods:

  • Prospective study comparing 1200 patients undergoing SBTKA with 1200 patients undergoing UTKA.
  • Inclusion of risk-screened and optimized patients in a high-volume joint replacement facility.
  • Analysis of 90-day mortality and morbidity, focusing on procedure-related complications.

Main Results:

  • Ninety-day mortality was slightly higher in SBTKA (0.58%) vs. UTKA (0.42%), though not statistically significant (P=.5646).
  • Overall procedure-related complications were significantly higher in SBTKA (7.25%) vs. UTKA (4.42%) (P=.0034).
  • Cardiovascular complications were 6.5 times higher (1.08% vs. 0.17%) and neurological complications 9.5 times higher (1.58% vs. 0.17%) in SBTKA patients.

Conclusions:

  • Risk screening and optimization mitigate some risks of SBTKA but do not eliminate them.
  • Significant increases in cardiovascular and neurological complications persist in SBTKA patients.
  • A guarded approach is recommended for simultaneous bilateral total knee arthroplasty due to elevated complication risks.