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One-stage versus 2-stage bilateral total knee arthroplasty
J J Jankiewicz1, T P Sculco, C S Ranawat
1Hospital for Special Surgery, New York, NY 10021.
Clinical Orthopaedics and Related Research
|December 1, 1994
Summary
Simultaneous bilateral total knee arthroplasty reduces hospital stay and costs but increases blood loss. Complication rates are similar, though fat embolism syndrome warrants further investigation for risk prediction.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
Background:
- Bilateral total knee arthroplasty (TKA) can be performed simultaneously or in stages.
- Choosing between simultaneous and staged TKA involves balancing surgical efficiency with potential risks and outcomes.
Purpose of the Study:
- To compare outcomes, complications, and costs between simultaneous and staged bilateral total knee arthroplasty.
- To evaluate the incidence of fat embolism syndrome in bilateral TKA and assess predictive factors.
Main Methods:
- Retrospective review of 155 bilateral total knee arthroplasties (99 simultaneous, 56 staged).
- Analysis of blood loss, transfusion requirements, hospital stay, physical therapy duration, hospital costs, and complication rates (pulmonary embolism, wound problems, infection, deep venous thrombosis, death, fat embolism syndrome).
Main Results:
- The simultaneous group experienced higher blood loss and homologous blood requirements (60%).
- Simultaneous TKA demonstrated reduced hospital stay, physical therapy, and hospital costs.
- Complication rates were comparable between groups, except for a higher-than-reported incidence of fat embolism syndrome in this study.
- Current preoperative evaluations could not predict fat embolism syndrome.
Conclusions:
- Simultaneous bilateral TKA offers economic and efficiency benefits but necessitates strategies to mitigate increased blood loss.
- Fat embolism syndrome incidence requires further investigation, potentially through more invasive preoperative assessments.
- Preoperative interventions like marrow stimulants and reinfused blood may reduce homologous blood use in simultaneous TKA.