A Population-Based Comparison of the Incidence of Adverse Outcomes After Simultaneous-Bilateral and Staged-Bilateral Total Knee Arthroplasty

Meehan, John P.; Danielsen, Beate; Tancredi, Daniel J.; Kim, Sunny; Jamali, Amir A.; White, Richard H.
December 2011
Journal of Bone & Joint Surgery, American Volume;12/7/2011, Vol. 93-A Issue 23, p2203
Academic Journal
Background: It is unclear whether simultaneous-bilateral total knee arthroplasty is as safe as staged-bilateral arthroplasty is. We are aware of no randomized trials comparing the safety of these surgical strategies. The purpose of this study was to retrospectively compare these two strategies, with use of an intention-to-treat approach for the staged-bilateral arthroplasty cohort. Methods: We used linked hospital discharge data to compare the safety of simultaneous-bilateral and staged-bilateral knee arthroplasty procedures performed in California between 1997 and 2007. Estimates were generated to take into account patients who had planned to undergo staged-bilateral arthroplasty but never underwent the second procedure because of death, a major complication, or elective withdrawal. Hierarchical logistic regression modeling was used to adjust the comparisons for patient and hospital characteristics. The principal outcomes of interest were death, a major complication involving the cardiovascular system, and a periprosthetic knee infection or mechanical malfunction requiring revision surgery. Results: Records were available for 11,445 simultaneous-bilateral arthroplasty procedures and 23,715 staged-bilateral procedures. On the basis of an intermediate estimate of the number of complications that occurred after the first procedure in a staged-bilateral arthroplasty, patients who underwent simultaneous-bilateral arthroplasty had a significantly higher adjusted odds ratio (OR) of myocardial infarction (OR = 1.6, 95% confidence interval [CI] = 1.2 to 2.2) and of pulmonary embolism (OR = 1.4, 95% CI = 1.1 to 1.8), similar odds of death (OR = 1.3, 95% CI = 0.9 to 1.9) and of ischemic stroke (OR = 1.0, 95% CI = 0.6 to 1.6), and significantly lower odds of major joint infection (OR = 0.6, 95% CI = 0.5 to 0.7) and of major mechanical malfunction (OR = 0.7, 95% CI = 0.6 to 0.9) compared with patients who planned to undergo staged-bilateral arthroplasty. The unadjusted thirty-day incidence of death or a coronary event was 3.2 events per thousand patients higher after simultaneous-bilateral arthroplasty than after staged-bilateral arthroplasty, but the one-year incidence of major joint infection or major mechanical malfunction was 10.5 events per thousand lower after simultaneous-bilateral arthroplasty. Conclusions: Simultaneous-bilateral total knee arthroplasty was associated with a clinically important reduction in the incidence of periprosthetic joint infection and malfunction within one year after arthroplasty, but it was associated with a moderately higher risk of an adverse cardiovascular outcome within thirty days. If patients who are at higher risk for cardiovascular complications can be identified, simultaneous-bilateral knee arthroplasty may be the preferred surgical strategy for the remaining lower-risk patients.


Related Articles

  • Factors affecting range of motion after total knee arthroplasty in patients with more than 120 degrees of preoperative flexion angle. Sugitani, Kazuya; Arai, Yuji; Takamiya, Hisatake; Terauchi, Ryu; Nakagawa, Shuji; Ueshima, Keiichiro; Kubo, Toshikazu // International Orthopaedics;Aug2015, Vol. 39 Issue 8, p1535 

    Purpose: The postoperative flexion angle reportedly shows a positive correlation with the preoperative flexion angle, but in some cases, the postoperative flexion angle decreases in patients with a large preoperative flexion angle. The purpose of this study was to investigate factors affecting...

  • Study suggests medial mobile bearing UKA not a temporary procedure.  // Orthopaedics Today Europe;Jan/Feb2012, Vol. 15 Issue 1, p6 

    The article discusses a study which concluded that medial mobile bearing unicompartmental knee arthroplasty is better than total knee arthroplasty in terms of activity level and complications.

  • A Prospective Randomized Study of Minimally Invasive Total Knee Arthroplasty Compared with Conventional Surgery. Wülker, N.; Lambermont, J. P.; Sacchetti, L.; Lazaró, J. G.; Nardi, J. // Journal of Bone & Joint Surgery, American Volume;7/7/2010, Vol. 92-A Issue 7, p1584 

    Background: Despite intense debate regarding whether minimally invasive techniques for total knee arthroplasty improve clinical outcomes over standard techniques, few prospective randomized trials addressing this debate are available in the literature. We therefore designed this multi center...

  • 'Spin-out' - eine vermeidbare Komplikation in der Knieendoprothetik. Magin, M.N. // Der Orthopäde;Feb2014, Vol. 43 Issue 2, p175 

    Spin out of a rotating polyethylene (PE) platform after total knee replacement leads to rotation of the bearing compared to the fixed metal components of the prosthesis at the femur and tibia of approximately 90°. This complication occurs only in prosthesis designs which do not have a...

  • 1 in 3 knee surgeries in the U.S. may be 'inappropriate'. Kim, Stephanie H. // McKnight's Long-Term Care News;Aug2014, Vol. 35 Issue 8, p6 

    The article discusses research by Daniel L. Riddle and colleagues from the Virginia Commonwealth University, published in the June 30, 2014 issue of the journal "Arthritis and Rheumatology," which found that about one-third of knee replacement surgeries in the U.S. may be regarded as inappropriate.

  • Prospective trial reveals no clinical advantage for mobile-bearing TKA implant.  // Orthopedics Today;Jun2010, Vol. 30 Issue 6, p30 

    The article presents information about a study which compared the impact of using mobile- and fixed bearing design of the identical total knee prosthesis, held by Dr. Shuichi Matsuda and colleagues at Kyushu University and published in an issue of "Knee Surgery, Sports Traumatology, Arthroscopy."

  • Development of a New Knee Society Scoring System. Noble, Philip; Scuderi, Giles; Brekke, Adam; Sikorskii, Alla; Benjamin, James; Lonner, Jess; Chadha, Priya; Daylamani, Daniel; Scott, W.; Bourne, Robert // Clinical Orthopaedics & Related Research;Jan2012, Vol. 470 Issue 1, p20 

    Background: The Knee Society Clinical Rating System was developed in 1989 and has been widely adopted. However, with the increased demand for TKA, there is a need for a new, validated scoring system to better characterize the expectations, satisfaction, and physical activities of the younger,...

  • Effects of anesthetic technique on blood loss and complications after simultaneous bilateral total knee arthroplasty. Zhu, Meng; Chen, Jerry; Tan, Yan; Yew, Andy; Chong, Hwei; Chia, Shi-Lu; Lo, Ngai; Yeo, Seng // Archives of Orthopaedic & Trauma Surgery;Apr2015, Vol. 135 Issue 4, p565 

    Aims: Anesthetic technique affects perioperative outcomes, but less was known in simultaneous bilateral total knee arthroplasty (BTKA). A single center, retrospective analysis was carried out to prove the hypothesis that utilization of regional anesthesia would result in favorable perioperative...

  • Anterolateral approach using tibial tubercle osteotomy for total knee arthroplasty: can we predict failure? Wishart, Marc; Arnold, Markus; Huegli, Rolf; Amsler, Felix; Friederich, Niklaus; Hirschmann, Michael // International Orthopaedics;Dec2012, Vol. 36 Issue 12, p2485 

    Purpose: The purpose of this study was to identify predictive factors for the occurrence of complications in a consecutive series of patients who underwent step-cut tibial tubercle osteotomy (TTO) and subsequent screw refixation in primary total knee arthroplasty (TKA). Methods: Using...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics