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Pulling the Trigger Sooner: Patients Pursue Subsequent Contralateral Total Joint Arthroplasty With Lower Preoperative
Manjot Singh1, Joseph E Nassar, Jonathan Liu
1From the Mount Sinai Hospital, New York, NY (Singh), the Department of Orthopedics, Brown University, Providence, RI (Nassar, Toavs, Liu), the UMass Chan Medical School, University of Massachusetts, Worcester, MA (McAnena), the Force Therapeutics, New York, NY (Harary), and the Dartmouth Hitchcock Medical Center, Department of Orthopaedics, Lebanon, NH (Schilling, and Moschetti).
Background:
Severe osteoarthritis is commonly managed with total hip/knee arthroplasty (THA/TKA). A subset of patients present with bilateral osteoarthritis and undergo staged total joint arthroplasty (TJA). Among those who ultimately proceed with both stages, we hypothesize that the decision to proceed with the second surgery is likely influenced by their initial TJA.
Methods:
Adults who underwent staged bilateral THA or TKA between 2018 and 2023 were included. Daily Visual Analog Scale (VAS) pain scores (0 to 10) were tracked from 30 days preoperatively to 90 days postoperatively for all patients. Mean preoperative and postoperative pain score plateaus were described and compared after the first and second operations. Hospital-related and patient-reported outcomes were also collected and compared. Finally, optimal intervals between surgeries that maximized pain improvement were also identified.
Results:
A total of 193 staged bilateral THA (64 years, 54% female) and 280 staged bilateral TKA (70 years, 55% female) patients were included. Patients had higher preoperative pain scores (THA: first = 6.7 vs. second = 5.4, TKA: 5.7 vs. 4.7) and larger absolute reductions in pain scores (THA: -5.3 vs. -4.0, TKA: -3.8 vs. -2.2) after their first TJA (P < 0.05). In addition, they had higher procedural satisfaction scores (THA: 4.8/5.0 vs. 4.7/5.0, TKA: 4.7/5.0 vs. 4.6/5.0) and higher rates of emergency department (THA: 11% vs. 6%, TKA: difference not significant) or urgent care (THA: difference not significant, TKA: 5% vs. 1%) visits after their first procedure (P < 0.05). Furthermore, they had worse preoperative patient-reported outcome measures and larger preoperative to postoperative improvements after their initial operation (P < 0.05). VAS pain improvement was greatest in those waiting 6 to 12 months between THAs and TKAs (P < 0.05).
Conclusion:
Patients undergoing their second contralateral TJA had lower preoperative pain scores and similar postoperative pain levels compared with their first procedure, resulting in smaller absolute pain reductions. Greater pain improvement was observed when the second operation was done >6 months after first TJA.
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