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Age-adjusted Charlson comorbidity index as a novel guideline for patient selection between unilateral versus
Priyadarshi Amit1,2, S K S Marya3
1Department of Orthopaedics and Joint Replacement, Max Smart Super Speciality Hospital, Saket, New Delhi, 110017, India. drpamit@gmail.com.
Purpose:
The aim of this study was to validate the age-adjusted Charlson comorbidity index as a clinical practice guideline for patient selection between unilateral total knee arthroplasty (UTKA) and bilateral simultaneous total knee arthroplasty (BSTKA).
Methods:
A consecutive series of 1016 patients undergoing UTKA (402 patients) or BSTKA (614 patients) was analysed. The age-adjusted Charlson comorbidity index (ACCI) was measured for all the patients and graded as low (0-2 score), moderate (3-4 score) and high risk (≥ 5 score). The complications occurring within 3 months of surgery were compared between UTKA and BSTKA recipients.
Results:
Following surgery, the complication rate was comparable between both the groups. However, among high-risk patients, there was significant difference in the complication rates between UTKA and BSTKA groups (12% versus 30.76%, minor; 8% versus 23.07%, major complication). The high-risk patients who had bilateral surgery were at more than three times greater risk of developing major and minor complications than those who had unilateral surgery.
Conclusion:
The BSTKA procedure is associated with significantly higher risk of post-operative complications than UTKA procedure in patients with ≥ 5 ACCI scores.
